New Hampshire-practicing optometrists faced a scope of expansion setback late last month after the state’s governor vetoed legislation that would have added ophthalmic laser capabilities.
This would have made New Hampshire the 16th state to allow ODs to perform such procedures (following just behind Kansas’s recent legislation passing a few weeks ago).
First: Tell me about this legislation.
In a nut shell: House Bill (H.B.) 349 aimed to authorize ODs who mey criteria established by the Board of Registration in optometry to perform certain ophthalmic laser procedures.
This established criteria entailed education, training, and supervised practical experience—with a minimum number (4 to 5) of proctored procedures required for each type of laser treatment.
Which procedures specifically?
Three specific surgeries:
- Laser capsulotomy
- Laser trabeculoplasty
- Laser peripheral iridotomy
Any other inclusions?
The bill also permitted ODs’ certification to perform laser procedures through other states’ (outside of New Hampshire) endorsement, providing similar requirements have been met.
As for patients: It mandated that they provide informed consent prior to undergoing any laser procedure.
Got it. So … what happened?
We’ll walk you through H.B. 349’s journey (and ultimate demise) in the state’s legislature:
The bill was actually first introduced as bipartisan legislation in 2025 and later received a favorable vote by both the state’s House and Senate.
- The breakdown: 193 to 143 (during a roll call vote)
Clearly this favorable vote wasn’t shared by all …
Indeed. In fact, the American Medical Association (AMA) voiced strong opposition to the bill.
In a letter sent to the state’s Governor Kelly Ayotte in early March, AMA CEO and Executive Vice President John Whyte, MD, MPH, noted that the proposed expansion of ODs’ surgical scope would:
- Pose significant risks to patient safety
- Set a dangerous precedent for allowing non-surgeons to perform surgical procedures
- Not be in the best interest of the state’s patients
See here for a more detailed look at these arguments in their entirety, including a focus on ODs’ lack of “rigorous education, training, and experience” compared to ophthalmologists.
Go on …
Dr. Whyte added that H.B. 390 provided no “demonstrable evidence” that it would increase patient access to care in rural areas, and that “ophthalmologists have already provided a market-based innovative solution to concerns around access to eye surgery in rural parts of the state.”
This solution: Refers to a recent partnership that kicked off in January 2026 to provide specialty surgical eye care for patients in Northern New Hampshire, a notably rural region.
- The approach, Dr. Whyte said, “ensures that patients in underserved areas have access to what all patients deserve: high quality surgical eye care”—wihout “unnecessarily expanding surgical privileges to (ODs).”
So what was the governor’s reasoning for her veto?
Gov. Ayotte issued a statement, in which she emphasized the need to ensure patients “receive care delivered by medical professionals trained to perform the full range of procedures that may be required for serious surgeries.”
- Authorizing non-physician providers to perform eye surgeries has the potential to create unnecessary risks for patients, particularly if additional surgical intervention is necessary,” she said.
This was despite the bill requiring ODs’ additional training to perform such procedures?
Yes. While Gov. Ayotte noted the veto as “no criticism to our [eye care] professionals” …. “the reality is that ophthalmologists … receive far greater supervised clinical and surgical training than optometrists.”
“Laser eye surgeries are not minor procedures. Complications or failure of such procedures can lead to permanent vision loss,” she added. “ Even if most of these procedures go as planned, complications can require the full spectrum of surgical skills and training that only ophthalmologists as physicians possess.”