Published in Legal

Optometry excluded in new DC scope of practice legislation

This is editorially independent content
9 min read

A new bill recently passed in Washington D.C. targeting an update and modernization of practice scope for several allied health professionals—including optometrists (ODs)—failed to expand ODs’ therapeutic privileges.

Let’s start from the beginning.

Last fall, Bill 25-0545 was introduced in D.C. with the proposed purpose of amending the District of Columbia (D.C) Health Occupations Revision Act of 1985.

About the 1985 legislation: Defined the scope of practice for licensed healthcare professionals (HCPs) practicing within D.C., including their training, education, and clinical services.

The purpose of DC B25-0545: To amend (modernize) portions of the existing laws in relation to licensure, copes of work, and licensing boards of several HCPs to align with current professional standards, environment, and processes.

Let’s get into specifics.

DC B25-0545 sought to address the following  goals:

  1. Create the first-ever general guidelines for telehealth services provided by D.C.-practicing HCPs.
  2. Increase transparency, patient safety, and administrative efficiency with key updates to:
    1. Scopes of practice (our focus)
    2. Licensure
    3. Registration
  3. Reorganize Health Professional Licensing Boards to expand representation, increase professional collaboration/efficiency, and address high levels of Board vacancies

Now to this scope of practice issue.

The proposed bill sought to align the scope of practices of several HCPs with more current standards of practice. These include (but are not limited to) the practice of:

  • Advanced practice registered nurses
  • Certified nurse-midwifeAudiology 
  • Chiropractic
  • Dietetics and nutrition
  • Medical assistants
  • Occupational therapy
  • Optometry
  • Social work
  • Pharmacy
  • Physical therapy
  • Podiatry
  • Psychology
  • Social work

The bill also sought to “allow the professional to provide more health services,” the bill stated.

That last part is key—it’s where ODs come into play.

So what kind of expansion was proposed for optometry?

The bill sought to expand the scope of practice to enable D.C.-practicing ODs to prescribe and administer controlled substances “as regulated to the profession, with certain limitations and safeguards.”

In line with this: The legislation also sought to authorize the Board of Optometry “to issue rules for (ODs) to administer and prescribe pharmaceutical agents.”

And lastly: It proposed removing the requirement that ODs needed to consult with a patient’s physician before treating glaucoma.

That sounds promising…

Indeed it did (emphasis on “did”).

In fact, the bill appeared close to being approved by the legislature—potentially joining the 20% of total U.S. states with expanded scope of practice (we’ll discuss those later).

Now talk about the other shoe that dropped.

Here’s the deal: After undergoing several months of litigation, the bill D.C. Mayor Muriel Bowser signed into law at the beginning of June addressed several key scope of practice expansions for HCPs included in original proposed legislation.

One major area missing, however: A new section that would have enabled ODs to prescribe controlled substances.

And the reasoning?

A report from the D.C Committee on Health noted that, “This decision was influenced by a range of factors, including expert testimonies, research findings, and concerns regarding patient safety and public health.”

Specifically: The Committee reported it had received live or written testimony from 20+ public witnesses—primarily ophthalmologists, they stipulated—who strongly opposed the expansion.

Even more specifically: A significant point raised included the “disparity in training and education between optometrists and ophthalmologists.”

For example?

Ophthalmologists’ 4 years of education are followed by a 4-year residency and typically supplemented with extra fellowship training—while ODs typically complete 4 years of education “without comparable residency and fellowship requirements.”

However: The Committee noted that, “an increasing number (of ODs) are pursuing residencies and various specialities, including ocular disease.”

Any other concerns?

According to ophthalmologists—yes.

Among them: Concerns over including controlled substance pain medication in non-surgical cases—including a questioning over the “adequacy of over-the-counter medication.”

  • The reasoning: This OTC medication may mask underlying conditions and, as a result, potentially lead to delayed diagnosis and vision loss, the ophthalmologists argued.

Other issues raised: Required expertise for the medical management of potent drugs, such as when to prescribe, to when to refrain, and how to address complications.

  • Their argument: These skills are usually acquired via collective years of medical school, surgical residence, and clinical training
    • Even further: Pediatric patient diagnoses were also a topic of raised interest, as emphasized by Aziz Khanifar, MD, chief of Pediatric Retina Service at Children’s National Hospital

Were there any issues with removing primary physicians’ approval for ODs to treat glaucoma?

Keeping with the theme of protest—yes, there was.

Among these issues were the potential risk for patients’ eye safety, with witnesses highlighting the need for ophthalmologists (not ODs) to lead any treatment plans. Further, they noted that “surgical interventions are among the most effective treatments, which (ODs) cannot perform.”

Go on…

The Washington D.C. Metropolitan Ophthalmological Society was also identified as a strong opponent to this part of scope expansion.

The organization’s reasoning: ​​ While glaucoma is treatable when diagnosed and treated early and properly, more serious diseases—including some cancers—can mimic its symptoms, leading to missed diagnoses and permanent vision loss.

Did any ODs provide live support for the bill?

Alas, they did not. However, the Committee stated it received written testimony from “numerous optometrists” plus a letter from the Association of Regulatory Boards of Optometry (ARBO).”

These testimonies noted “the necessity for (ODs) to prescribe pain medication and advocating for the removal of consultation requirements before treating chronic open-angle glaucoma.”

But in the end…

Despite these testimonies—and after careful consideration, the Committee noted—the potential risks were deemed to outweigh the benefits of the proposed scope of practice expansion.

The determination?

The Committee concluded that ODs will continue to provide patients with comprehensive service by  “retaining the ability to prescribe antibiotics, appropriate analgesics, antihistamines, and nonsteroidal anti-inflammatories.”In regards to those other proposed changes, the Committee stated that ODs will still need to require consultation from a patients’ physician or other HCP before initiating glaucoma treatment, “as well as administer medication for the emergency treatment of angle-closure glaucoma.”

Definitely not a victory for ODs. What about scope expansion across the rest of the country?

As of March 2024, 11 U.S. states have passed legislation to permit ODs to perform a range of surgical procedures. These include:

  • Alaska
  • Arkansas
  • Colorado
  • Indiana
  • Kentucky
  • Louisiana
  • Mississippi
  • Oklahoma
  • South Dakota
  • Wyoming
  • Virginia

See here for a look at which procedures are allowed in which states, plus ODs’ specific scopes of practice in each.

Also: Wisconsin deserves an honorable mention as #11 on this list, as practicing ODs in the state are currently allowed to perform such procedures—including laser—within their scope.

  • To note: Wisconsin’s scope of practice has not been amended since its establishment in 1990.

Any other legislation to be aware of?

Click here for all of our recent coverage.

*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.

How would you rate the quality of this content?