Expanding Optometrists’ Role in Eye Care: Addressing Shortages and Improving Access

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Patients across the U.S. are facing challenges in accessing health care services, particularly in rural regions. In these areas, traveling significant distances to consult specialists has become increasingly commonplace. One field experiencing acute shortages is eye care. Demand for ophthalmological services is rapidly outstripping the available supply of ophthalmologists.

While there is a large pool of trained optometrists, many are restricted by laws from performing routine and essential procedures. Over a dozen states allow optometrists to conduct YAG laser capsulotomies. This procedure is straightforward, performed in-office, and treats ‘secondary cataracts,’ a condition that causes cloudy vision after cataract surgery.

Annually, over half a million elderly Americans undergo this procedure, which has an excellent safety record. However, most states limit its performance to ophthalmologists alone. This restriction on optometrists’ scope of practice incurs real costs for patients. In 2020, there were about three times more optometrists than ophthalmologists in the U.S. While ophthalmologists are often based in urban areas, almost all Americans live in a county with a practicing optometrist. Consequently, patients requiring a YAG procedure endure extended wait times and high travel expenses to see an ophthalmologist.

Concerns about patient safety are understandable. Ensuring qualified providers is crucial. However, evidence suggests little cause for worry. Optometrists in the U.S. undergo four years of doctoral training in eye care, frequently including YAG surgery instructions. If not included, optometrists must pursue additional training or certification for performing YAG procedures. Analysis of around 150,000 laser procedures by optometrists reveals a 0.001 percent negative outcome rate, demonstrating high safety standards.

Optometrists in the U.K. and New Zealand have safely performed these procedures for years. A recent policy brief from the Pacific Legal Foundation indicates that expanding optometrists’ scope of practice to include YAG procedures significantly increases utilization. Adjusted population data shows Medicare patients in states with expanded optometrist scopes between 2013 and 2023 received 19 percent more YAG procedures than those in states with restrictive laws.

States that expanded optometrist scope-of-practice before 2013 show even higher rates—almost 42 percent more patients receive YAG surgery compared to states with restrictive practices. These trends indicate that broadening optometrists’ duties enhances access to essential eye care. Often, patients who faced barriers like travel burdens and scheduling delays can finally receive necessary treatments.

Policymakers can derive two insights: Scope-of-practice expansions grow in effectiveness over time. The eye care market gradually adapts to new regulations, suggesting states should act promptly for long-term benefits. Additionally, greater YAG utilization linked to expanded scope occurs more in non-metropolitan areas. This implies geographically isolated patients with severe access barriers benefit most when optometrists perform duties aligned with their training.

Such reforms are not unprecedented. Over two decades, many states have revised scope-of-practice laws for non-physician providers like nurse practitioners, physician assistants, and certified nurse midwives. Data from these changes reveals overwhelmingly positive outcomes: improved access, reduced costs, and a more adaptable health system. Optometry should follow suit.

Despite potential opposition from ophthalmology organizations, these reforms should prioritize patient welfare. As the U.S. population ages and demand for eye care rises, shortages among ophthalmologists will continue. To reduce care delays, especially in underserved communities, every available tool should be utilized. Allowing optometrists expanded roles is a straightforward, effective step to ensure necessary services reach patients.

Kihwan Bae, Ph.D., Assistant Professor, General Business, Knee Regulatory Research Center, John Chambers College of Business and Economics, West Virginia University. Liam Sigaud, Research Analyst, Knee Regulatory Research Center, West Virginia University.