Several states face battles over optometry scope of practice

Optometrists are lobbying for surgery and prescribing rights, but physicians in at least two states have been successful in stopping the trend.

By — Posted April 13, 2009

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Physicians are opposing bills in at least five states that seek to expand optometrists' scope of practice, while doctors in Florida and West Virginia recently claimed victories in similar legislative battles.

Bills are pending in Maine, Massachusetts, Nebraska, South Carolina and Texas, according to the American Academy of Ophthalmology, American Medical Association and Federation of State Medical Boards. Optometrists want to perform surgical procedures, administer injections around the eyes and prescribe more medications -- including some controlled substances.

"This was the worst year that we've faced," said Dan Briceland, MD, AAO secretary of state affairs and a Phoenix ophthalmologist. "It turned out to be seven or eight aggressive bills."

Dr. Briceland said the higher number of states locked in scope battles likely stems from last year's annual meeting of the American Optometric Assn. He said the group is pushing its state chapters to lobby for more authority.

In a statement, the AOA said: "Although a decision on whether to seek expansion of scope of practice is left up to each state, the AOA encourages all states to take the necessary measures to ensure they are able to treat patients to the full extent of their education and training, and expand as they feel necessary to ensure access to quality care."

Physicians win tough fights

Companion bills in West Virginia were among the most aggressive proposals. But a House bill was tabled March 23 for study by a committee.

The bills sought expanded authority for optometrists to perform surgical procedures, inject drugs and Botox, and prescribe medications -- including some controlled substances and new contact lenses that dispense medicine. The FDA has classified the lenses as a drug, and many optometrists cannot prescribe them. Since the state House version was tabled, the Senate version isn't likely to be heard.

"This was very controversial," said Nancy S. Tonkin, executive director of the West Virginia Academy of Ophthalmology, which, along with 12 other groups, had opposed both bills. "I'm sure that optometrists believe they will get everything worked out. We are certainly willing to talk about it, but [we] will be very diligent about any agreements that might be forged."

But optometrists in West Virginia think physicians sounded the alarm unnecessarily.

"The scare tactics and the opposition's stance is just way overboard," said Chad D. Robinson, executive director of the West Virginia Optometric Assn. "To even incite the crowd that we want to do cataract surgery is absurd. Right now, the law is so restrictive in what optometrists in West Virginia can or cannot do."

Meanwhile, a Florida Senate bill was downed in a committee hearing after testimony from both sides, including that of AMA Board of Trustees member Cecil B. Wilson, MD, a Florida internist.

Florida is one of only three states that doesn't allow optometrists to prescribe oral medications, according to Tim Stapleton, executive vice president of the Florida Medical Assn. He said the state's demographic breakdown is a big reason physicians continue to keep it that way.

"We have a large elderly population, many of whom take multiple prescriptions," he said. "We felt that optometrists were not qualified to deal with the drug interactions. To allow them to prescribe one medication on top of dozens of other medications that the patients' doctor had prescribed would create a potential problem."

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