Recent legislation supporting the use of laser procedures by optometric professionals was vetoed by the state’s governor last week—despite passing in both the House and Senate.
First, a look at New Mexico’s scope of practice.
Noted as having “one of the most extensive” optometric scopes of practice with the United States, New Mexico last passed legislation in 2015 aimed at benefiting both optometrists (ODs) and patients.
That legislative update: prescription of controlled substances.
- What it did: This enabled ODs to prescribe certain Schedule II pharmaceuticals—controlled substances like hydrocodone and hydrocodone-combination drugs—and removed restrictions on oral steroids and immunosuppressive therapeutics.
- The purpose: To expand ODs’ prescription capabilities to include a larger range of medications targeting treatment of eye and adnexal tissue conditions.
Notably: This Schedule II prescription update added to ODs’ arsenal of prescription capabilities that also includes Schedule III, IV, and V drugs.
And on the surgical side, what are ODs permitted to do in the state?
New Mexico law allows for ODs to perform minor surgical procedures such as correcting ocular abnormalities like removing “lumps and bumps” around the eye.
- Examples of this: Usage of a scalpel, injecting local anesthetic, and suturing.
Other permitted (non-surgical) procedures include:
- Removing foreign bodies (from the cornea, conjunctiva, and eyelid)
- Non-laser corneal debridement, culture, scrape, or anterior puncture
- Dilation and irrigation
- Eyelash epilation
See here for a full rundown on the law (and check out page 38 for info on surgical procedures).
So what’s on the current ‘forbidden’ list for these optometric professionals?
Optometrists practicing in New Mexico are currently not permitted to:
- Administer general anesthesia or intravitreal (IV) medications
- Perform surgical procedures such as:
- Cataract extractions
- Retinal or refractive surgery (including laser-assisted in situ keratomileusis [LASIK])
- Laser or non-laser injections into the eye’s posterior chamber to treat macular or retinal disease
- Anterior segment laser procedures (yttrium aluminum garnet [YAG] capsulotomy; selective
- Laser trabeculectomy or laser peripheral iridotomy (LPI)
Take note: New Mexico is one of 38 states that currently do not allow ODs to perform such laser surgeries.
Gotcha. Now talk about this legislation.
House Bill (H.B.) 36 sought to amend sections of New Mexico’s Optometry Act to permit certified ODs authorization to perform two specific laser procedures often used in post-cataract and glaucoma treatment.
Those procedures:
- SLT
- YAG capsulotomy
And its significance?
To start, the bill would have made New Mexico the 13th state to permit ODs to perform such office-based laser procedures (with Oklahoma being the first and South Dakota being the most recent).
The New Mexico Optometric Association (NMOA) also weighed in. In response to Glance’s request for comment, the organization shared a recent press release in which NMOA noted that the increased scope of practice also “aimed to enhance healthcare accessibility” across the state.
- “These [laser procedure] services are especially vital in rural and underserved areas of New Mexico, where ophthalmologists are often not readily available,” the organization stated.
And why, exactly, did the governor veto it?
In an executive message to the state’s Speaker of the House, Gov. Michelle Lujan Grisham stated H.B. 36 would have “set a dangerous precedent” for allowing ODs (referred to as “non-surgeons”) to perform surgical procedures.
She referenced two major factors that should generally be taken into consideration when seeking to expand any medical profession's scope of practice—and explained why they were not addressed in the bill.
Those factors:
- Does the change in scope increase access to care for patients?
- Does the change ensure good medical care for patients?
And her explanation?
To start, she wrote, “There is no persuasive evidence that this bill would increase access to care [for patients].”
Her reasoning: She referenced data that reportedly found that giving ODs access to “laser authority” had not resulted in a statistically significant increase in access to those procedures for patients.
- Why: Because ODs “that are currently performing more limited laser procedures cover an area similar to ophthalmologists, typically within a 30-minute drive for the vast majority of patients,” Gov. Grisham stated.
To note: No specific sources were provided for this referenced data.
No supporting data at all?
Nope. However, there is data based on a workforce study published in Ophthalmology in February that projected the number of practicing ophthalmologists in the U.S. from 2020 through 2035.
That projection: A “sizable shortage of [ophthalmologists]” is expected by the year 2035—with "substantial geographic disparities.”
Yikes. Now explain the governor’s second reason for the veto.
Gov. Grisham further stated that she did not believe “this change in scope would increase or even maintain the current standard of care” for patients.
Importantly: She added that the bill would enable “non-surgeons” (ODs) to perform procedures already performed by physicians with “significantly more educational and hands-on training requirements to receive their degrees.”
- To back this up: A specific case was referenced involving an OD in a nearby state who performed an "unauthorized surgical procedure” (as per current New Mexico law) that resulted in a patient suffering from complications and needing intervention by an ophthalmologist.
- Take note, however: The governor provided no supporting reference to validate this claim and sequence of events.
Have any contradictions been made to this?
NOMA responded to the governor’s reasoning by stating that the training and certification standards the bill called for to enable ODs’ surgical authorization was based on “successful programs” from other states across the U.S.—and followed nationally recognized clinical guidelines.
And on that national level: Though not in direct response to New Mexico's bill veto, the American Optometric Association reported last August that—out of over 146K optometric laser procedures performed by U.S. ODs in 12 states—“only two (0.001%) had ‘negative outcomes’ or complications.”
Go on …
In fact, research published in the July 2024 issue of Clinical and Experimental Optometry investigated the establishment and review of education programs aimed at training ODs on laser procedures and injections. Among the findings, the study found that:
- ODs are performing laser procedures safely—with “all U.S.-based optometry colleges and schools [offering] courses on lasers and injectables for their students.”
And looking specifically at YAG laser capsulotomy?
A 2023 study published in Optometry & Vision Science reported that “ 99% of patients [reported] subjective improvement in visual acuity post-procedure and 95% of patients [showed] objective visual improvement that allowed for a better quality of life.”
- The investigators’ conclusion: “YAG laser capsulotomies are effective treatments to improve patient vision that can be safely and effectively performed by optometrists.”
Sounds like the research speaks for itself. So what’s next?
The legislative fight—and advocacy efforts—for New Mexico’s expanded scope of practice isn’t over. Gov. Grisham noted that she may consider future legislation supporting ODs performing laser procedures—providing it addresses “additional supervision and training requirements” for ODs.
As such, NMOA President Dwight Thibodeux, OD, shared that “we remain hopeful and look forward to collaborating with [Gov. Grisham] and other stakeholders to address any concerns and continue working toward modernizing eye care in our state.”
In the meantime, see here for more legislative updates in ophthalmology and optometry.
*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.