Expanding Eye Care Access: A Path Forward for Rural Communities
Envisioning expanding access to eye care – Healthcare access challenges are increasingly pronounced across the United States, with rural populations bearing a disproportionate burden. For many, traveling long distances to reach a specialist has become a routine part of medical care, particularly in eye treatment. This issue is especially critical as the demand for eye care services continues to surge, outpacing the availability of ophthalmologists in many regions.
Optometrists, a vast and well-trained group, are often underutilized due to restrictive state laws that limit their ability to perform specific procedures. One notable example is the YAG laser capsulotomy, a straightforward procedure used to address “secondary cataracts” — a condition that develops after cataract surgery and can lead to blurred vision. Over half a million elderly Americans undergo this treatment annually, yet it is predominantly available through ophthalmologists in most states.
Barriers to Access and the Cost of Restriction
Although optometrists are equipped to handle a wide range of eye-related issues, legal barriers often prevent them from providing critical care. This limitation forces patients to seek out specialists, resulting in extended wait times and significant travel expenses. In 2020, the U.S. had approximately three times as many optometrists as ophthalmologists, yet 99 percent of Americans reside in counties with access to optometrists. Despite this, rural patients frequently face delays in receiving necessary treatments, highlighting the inefficiency of current regulations.
The question of patient safety often fuels resistance to expanding optometrists’ roles. However, evidence suggests this concern is overstated. Optometrists in the U.S. complete four years of doctoral-level training, frequently incorporating laser procedures into their coursework. In practice, they may undergo additional certification to perform YAG capsulotomies. A comprehensive analysis of nearly 150,000 procedures conducted by optometrists revealed that only 0.001 percent led to adverse outcomes, underscoring their reliability and skill.
Policy Insights from Scope-of-Practice Expansions
A recent policy brief from the Pacific Legal Foundation highlights the benefits of allowing optometrists to perform YAG laser capsulotomies. The study found that states which expanded optometrists’ scope of practice between 2013 and 2023 saw a 19 percent increase in the utilization of these procedures among Medicare beneficiaries compared to states with stricter laws. Furthermore, states that implemented such changes earlier — before 2013 — exhibited nearly 42 percent higher rates of YAG surgery, demonstrating a growing trend in effectiveness over time.
These findings suggest that broadening optometrists’ capabilities can significantly enhance access to essential eye care. In areas with limited medical infrastructure, patients who previously faced obstacles to treatment — such as logistical challenges or scheduling conflicts — are now more likely to receive timely care. This shift not only reduces delays but also ensures that a larger portion of the population can benefit from procedures that are both safe and cost-effective.
A Broader Perspective on Healthcare Reform
Similar reforms have been successfully implemented for other non-physician providers, such as nurse practitioners and physician assistants, over the past two decades. These expansions have consistently improved access, reduced costs, and strengthened the healthcare system’s adaptability. The same principles apply to optometry, where allowing practitioners to perform YAG capsulotomies aligns with broader efforts to make care more efficient and patient-centered.
Despite the clear advantages, policymakers may encounter pushback from established ophthalmology associations. This resistance is not uncommon in professional fields, where traditional roles are often protected by regulatory frameworks. Yet, the debate should center on patient outcomes rather than professional control. As the U.S. population ages, the need for eye care is expected to grow, exacerbating existing shortages. Without reforms, the gap between demand and supply will only widen, leaving vulnerable communities without adequate support.
Expanding optometrists’ scope of practice offers a practical solution to this crisis. By leveraging the existing workforce, states can address the uneven distribution of specialists and ensure that care reaches those who need it most. The data supports this approach, showing that non-metropolitan areas experience the most substantial gains from such changes. These regions, where access barriers are more pronounced, stand to benefit greatly from enabling optometrists to provide full-spectrum care.
Towards a More Resilient Healthcare System
Allowing optometrists to perform YAG laser capsulotomies is not just a matter of convenience — it is a critical step in building a more resilient healthcare system. The flexibility gained through such reforms enables providers to respond to shifting patient needs and demographic trends. As the population ages, conditions like cataracts and secondary cataracts will become more prevalent, requiring a scalable and sustainable approach to treatment.
While the expansion of scope-of-practice laws has faced scrutiny, the evidence points to positive outcomes. For instance, in the United Kingdom and New Zealand, optometrists have safely performed YAG procedures for years, further validating their competence. These international examples provide a blueprint for U.S. states seeking to modernize their healthcare frameworks.
Now is the time for policymakers to act decisively. The long-term benefits of scope-of-practice expansion are evident, and delaying action risks worsening the crisis in rural eye care. By removing unnecessary restrictions, states can ensure that patients are not left waiting for treatment, while also reducing the financial strain on the healthcare system. The path to improved access lies in recognizing the value of optometrists and empowering them to contribute more fully to patient care.
In conclusion, the expansion of optometrists’ capabilities represents a vital reform. It addresses immediate access challenges, aligns with proven healthcare trends, and positions the system to meet future demands. As the need for eye care grows, the urgency to act becomes clearer. The question is no longer whether optometrists can perform these procedures — it is whether we can afford not to.
