Many communities in the United States lack adequate access to eye care, exacerbated by a growing shortage of ophthalmologists. Prior evidence demonstrates that scope-of-practice expansions for healthcare practitioners, such as nurse practitioners and physician assistants, improve patient access generally, and this product investigates whether scope-of-practice expansions can specifically benefit eye care patients. The research finds that allowing optometrists to perform more advanced tasks increases access to vital eye care services among Medicare enrollees.

Key Findings:

• In roughly the past three decades, the per capita number of ophthalmologists has declined by 9.8 percent while the per capita number of optometrists has grown 45.7 percent.
• As of mid-2025, 14 states had expanded scope of practice for optometrists, allowing them to perform yttrium aluminum garnet (YAG) posterior capsulotomy, a medically necessary procedure to treat posterior capsule opacification.
• In states that have expanded scope of practice, optometrists have performed nearly 150,000 YAG surgeries, with only two examples of negative outcomes or complications.
• Empirical analysis of Medicare claims data shows a positive association between scope-of-practice expansions and YAG service utilization, especially in rural areas.

Policy Implications:

• Legislators interested in expanding access to eye care should consider reforming optometrist scope of practice regulations and allow these practitioners to perform more procedures.

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