Advocacy

SB 114 by Senator Whatley
Optometric Scope Expansion

Click HERE for a copy of the Senate Bill 114  

Doctors of Optometry, who practice throughout this state, enable Alabamians to have local access to safe, quality primary eye health care. Alabama's optometry law has not been significantly updated since 1995, but medicine has dramatically changed in the past 24 years. In order to continue to bring the highest quality eye and vision care to our citizens, our optometry law needs to be updated to reflect the changes in education and technology.

What Does This Bill Do?

  • This bill will expand access to care for all Alabamians by allowing Doctors of Optometry to perform limited laser procedures in their offices, lessening travel time and expenses for many patients.
  • These in-office procedures do not require general anesthesia.
  • Doctors of Optometry will be able to treat the same conditions that they have always diagnosed without patients having to schedule an appointment with another medical professional, saving them time and money.
  • This will not broaden the scope of what conditions optometrists currently manage and/or treat. Instead it will enable optometrists to utilize the latest technologies to bring their patients the best possible care.  

Procedures Included In This Bill

  • YAG Capsulotomy (YAG) - Common in-office procedure to open cloudy film on lens implant after cataract surgery.
  • Laser Peripheral Iridotomy (PI) - Emergency sight-saving procedure to treat elevated intraocular pressure from glaucoma.
  • Selective Laser Trabeculoplasty (SLT) - Common in-office procedure to treat elevated intraocular pressure from glaucoma.
  • Removal and Identification of Skin Lesions Around Eye - Common in-office procedure to remove benign lesions around the eye.
  • Laser-Assisted In Situ Keratomileusis (LASIK) and other future corneal refractive technology -  is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism
  • Intraocular injections     

Other States Are Leading The Way On This Issue

  • Doctors of Optometry in other states have been performing these procedures for 20 years.
  • The states that have already passed legislation to allow these procedures have seen no increase in malpractice premiums: Oklahoma (1998), Kentucky (2011) - no change in malpractice premiums, Louisiana (2014) 
  • Since 1998, Doctors of Optometry in Oklahoma have done over 25,000 laser surgery procedures with only two reported complaints.  

The Majority of these Procedures Are Being Taught in Optometry School

  • Optometry schools have already incorporated the majority of these procedures into their curriculums. 
  • Doctors of optometry receive extensive training in a 4-year program dedicated to learning about the eye and vision care. This is after receiving an undergraduate degree. Many optometrists in Alabama have additionally completed residency training.
  • New graduates from optometry school are now choosing to practice in other states because Alabama doesn't allow them to use the latest technology and practice to the fullest extent of their training.
  • For Alabama to continue to attract some of the best graduates from optometry schools, we must update our laws to allow them to practice at the forefront of optometry.
  • Many practicing doctors have taken additional extensive coursework for further training in lasers and other advanced procedures.
  • Most practicing MDs utilize technologies that they did not learn in medical school or residency. Why? Because the latest technologies and procedures were not invented until after they entered practice. These fine medical doctors learn to do these things by going to continuing education courses, not going back for years of medical school.  Optometrists do the same thing.    

Why Is This Good For Alabama?

  • This bill will expand access for all Alabamians by allowing patients to undergo certain procedures at their optometrist's office when more convenient than the nearest ophthalmology office.
  • According to a study conducted by The Eyesight Foundation in 2010, Doctors of Optometry have locations in 57 counties in Alabama.  Ophthalmologists have locations in only 24 counties, making it more difficult for some of our citizens to receive the care they need.   

Other Points

  • President Trump's administration released a report in 2018 supporting scope expansion in the states.   In the Reforming America's Healthcare System Through Choice and Competition, the administration advocated for scope expansion as a part of reform of the healthcare system and specifically named optometrists as one of the providers that can safely and "effectively provide some of the same healthcare services as physicians, in addition to providing complementary service."  
  • Nurses in the UK have been giving intraocular injections since 2012. They found that patients had the same rates of eye infection regardless of whether the treatment was delivered by a doctor or nurse.  The study looked at rates of postoperative endophthalmitis following injections of intravitreal anti-VEGF - anti-vascular endothelial growth factor - in 31,561 cases from 2006-14  
  • This bill maintains the prohibition on optometrists prescribing hydrocodone.  This should further highlight that the new procedures included in this bill are minor, in-office procedures that do not rise to the level of needing an opiod for pain relief.