The Hill: Envisioning expanding access to eye care
Across the country, patients are struggling to access health care services — particularly those in rural areas, where driving long distances to see a specialist has become increasingly common. One area of acute shortage is eye care, where demand for services is rapidly outpacing the supply of ophthalmologists.
Meanwhile, a large, highly trained workforce of optometrists remains sidelined by laws that prevent them from performing routine and medically necessary procedures.
More than a dozen states permit optometrists to perform what is known as a YAG laser capsulotomy — a simple, in-office procedure to treat “secondary cataracts,” a condition that often develops after cataract surgery and causes cloudy vision. Over half a million elderly Americans receive this procedure each year, and its safety record is excellent. Yet in most states, only ophthalmologists are allowed to perform them.
Restricting optometrists’ scope of practice comes at a real cost to patients. In 2020, the U.S. had about three times more optometrists than ophthalmologists. And while ophthalmologists tend to be concentrated in urban centers, more than 99 percent of Americans live in a county with a practicing optometrist. As a result, patients needing a YAG procedure often face long wait times and high travel costs to be seen by an ophthalmologist.
We understand concerns about patient safety. No one wants to allow unqualified providers to perform dangerous procedures. In this case, there is little cause for alarm. Optometrists complete four years of doctoral training in eye care in the U.S., often incorporating YAG surgery in the curriculum. Otherwise, they are required to obtain additional training or certification before performing YAG procedures. A review of nearly 150,000 laser procedures performed by optometrists in the U.S. found that only 0.001 percent resulted in negative outcomes, indicating a high level of safety. Similarly, in the U.K. and New Zealand, optometrists have been safely performing these procedures for years.
A policy brief just released by the Pacific Legal Foundation finds that expanding optometrists’ scope of practice to include YAG procedures is associated with a substantial increase in their utilization. Adjusting for population, we found that Medicare patients living in states that expanded optometrist scope-of-practice between 2013 and 2023 received 19 percent more YAG procedures than in states with restrictive practice laws. Moreover, we discovered that states that expanded optometrist scope-of-practice prior to 2013 had even higher rates of YAG surgery — almost 42 percent higher than restrictive states.
This pattern suggests that expanding optometrists’ scope of practice improves access to vital eye care. In some cases, patients who would otherwise go untreated — because of travel burdens, scheduling delays, or lack of access to specialists — are finally getting the treatment they need.
Policymakers can draw two other insights from our findings: First, the effects of scope-of-practice expansion appear to grow over time, consistent with the notion that the market for eye care gradually adapts to new regulatory environments. To obtain the greatest long-term benefits, states need to act now.
Second, our analysis reveals that the increase in YAG utilization associated with scope-of-practice expansions is larger in non-metropolitan areas than in metropolitan areas, implying that geographically isolated patients with more severe access barriers may benefit most from allowing optometrists to work to the full extent of their training.
This kind of reform isn’t unprecedented. Over the past two decades, many states have broadened scope-of-practice laws for non-physician providers, including nurse practitioners, physician assistants, and certified nurse midwives. The evidence from these expansions is overwhelmingly positive: access improves, costs decline, and the healthcare system becomes more flexible and resilient. Optometry should be no exception.
Despite this, policymakers are likely to face opposition to these reforms from organized ophthalmology groups. That’s no surprise: professional turf battles are as old as medicine itself. But the question shouldn’t be about who controls the procedure — it should be about what’s best for patients.
As the U.S. population ages and the need for eye care grows, the ophthalmologist shortage will only deepen. If we want to reduce care delays, especially in underserved communities, we need to use every tool available. Letting optometrists do more is one of the easiest and most effective steps we can take to ensure patients receive the services they need.
This op-ed was originally published in The Hill on June 6, 2026.
