RICHMOND, Va.—In another successful effort to expand optometric scope of practice, legislation signed into law in Virginia will allow doctors of optometry to provide certain office-based laser procedures for glaucoma and post-cataract care after the state moved last week to expand the state’s scope of practice, according to the American Optometric Association (AOA). Gov. Glenn Youngkin signed into law on March 9 the House Bill 213. The legislation amends the state’s optometric scope of practice act to authorize doctors, certified by the state board, to perform optometric laser procedures, including YAG laser capsulotomy, selective laser trabeculoplasty and laser peripheral iridotomy, according to a post on the AOA website.

“Virginia becomes the eighth state—and third since 2021—to expand its scope for these contemporary procedures, affording Virginians’ greater opportunity to access primary eye health care services from their local doctors of optometry,” AOA said.
 
“Virginia doctors of optometry now have a progressive scope of practice law that allows our doctors to practice more fully to the extent of their training,” Lisa Gontarek, OD, president of the Virginia Optometric Association (VOA), said in the AOA post. “This gives Virginians’ access to outstanding clinicians who can provide the majority of the eyecare they need, and it’s especially beneficial for citizens in the more rural areas of our state.”
 
Virginia has more than twice as many doctors of optometry as ophthalmologists, and an ophthalmology study found nearly half of Virginians needing these procedures live more than 30 minutes away from an ophthalmologist. Given optometry’s demonstrated record of safely, efficiently performing these procedures across eight states since the 1990s, optometry’s advocates emphasized the contemporary nature of these procedures as taught by schools and colleges of optometry, AOA noted.
 
Virginia’s scope expansion builds upon the nearly 10,000 hours of clinical education and training provided to doctors at these institutions. 
 
Virginia will require doctors of optometry to obtain certification from an accredited college of optometry with didactic and hands-on training before performing the three laser procedures. Additionally, certified doctors must abide by regulations and requirements yet promulgated by the state board, according to AOA.
 
Jerry Neidigh, OD, VOA’s legislative chair, acknowledged that Virginia’s scope expansion was a measured, deliberate process. As early as 2015, the VOA began working to reestablish direct connections with lawmakers through patient-centered legislation and scope enhancements, such as the state’s injections and prescribing privileges, as well as more recent vision plan and disruptive technologies bills that protected the doctor-patient relationship. 
 
These efforts required a reinvigoration of the state’s grassroots advocates and key person relationships, while doctors worked to educate lawmakers and counter tired opposition arguments of the profession’s proficiencies.
 
“It certainly helped having other states already performing these procedures,” Dr. Neidigh noted. “Our opposition had no argument to counter the fact that out of well over 100,000 of these laser procedures performed by optometrists in other states, there’s not one single complaint. Having that track record to lean on made a big difference for us.”
 
VOA doctors coordinated with local legislators to attend laser demonstration days where doctors, such as Dr. Neidigh, could show lawmakers the procedure, the microscope itself and answer questions about the forthcoming legislation. Dr. Neidigh said once legislators saw the procedure demonstrated in-person, much of the opposition fell flat.
 
“Showing legislators these demonstrations and reiterating the fact that we’ve been educated and trained to provide these procedures since the late 1990s, paired with proof of our proficiency from other states, really drove this argument home for us,” Dr. Neidigh said. “It certainly takes time, effort and sacrifice, but there’s no reason other states can’t do this.”
 
Bo Keeney, VOA’s executive director, attributed the successful effort to bring about scope expansion to “the hard work and strong leadership from volunteers, lobbyists, grassroots advocates, and strategic PAC fundraising and giving,” according to the AOA post.
 
“This now positions Virginia as one of the states with the most expansive practice acts in the country,” Keeney said.