Editor’s note: This story has been updated to reflect the bill’s advance through the California Assembly.
Just before midnight on the last day of the legislative session, August 31, 2022, California Assembly bill AB 2236, a concurrence with amendments made by the Senate a few days earlier, passed by a vote of 44 to 11. The bill would expand the profession’s scope of practice in California to include several advanced procedures, including lasers and some incisional surgeries. It is expected to reach the desk of Governor Gavin Newsom sometimes in September.
Here is the story WO published earlier in August as the bill was advancing.
On August 11, the California State Senate Appropriations Committee will vote on whether to move out of its suspense committee a bill, AB 2236, which will allow ODs provide laser treatment to patients in California. The bill would expand optometric scope to practice to anterior segment lasers and minor procedures, including three types of laser treatment, lesion removal, eye injections and corneal crosslinking.
Both Amanda Dexter, OD, FAAO, current president of the California Optometric Association (COA), and the association’s Executive Director Kristine Shultz say the bill would provide access to valuable treatment to more patients, especially in more rural parts of the state. Members of the group have been working to get access to the lasers for years, Shultz says. They are hopeful that this is the year the bill will pass.
The bill hinges on three key benefits to public health: access, affordability and meeting the rising demand. Dr. Dexter says that lasers are becoming the standard in glaucoma treatment for its efficiency and ease, compared to requiring that the patient be compliant with daily drops.
As the supply of ophthalmologists remains level or may even decrease, the aging population means that the demand becomes even more acute. In addition, a limited number of ophthalmologists accept Medi-Cal. Dr. Dexter says it makes sense for optometrists to provide these treatments, as they account for about 80 percent of Medi-Cal’s coverage.
ODs = ACCESS
In addition, optometrists are present and accessible in more places than ophthalmologists are, with ODs practicing in nearly every county. Dr. Dexter says that expanding OD scope will help provide care to those in more rural and underserved of the state, too, and ease some of the pressure on ophthalmologists’ schedules, allowing them to focus on surgical interventions and specialty care. The bill stipulates that ODs undertaking expanded scope services undergo significant training, more than what has been required in the other 10 states that have approved similar scope expansions.
“It is the right treatment for the patient,” Shultz says. Training under the new bill would involve procedures on live humans, completion of a 32-hour course, passage of the national board’s Laser and Surgical Procedure Examination and completion of additional training, including rotations or a preceptorship. The bill would also require providers to complete a total of 29 procedures on live humans before certification.
Dr. Dexter also says it is frustrating that optometry students are trained in this specific type of laser treatment, yet not allowed to provide it to their patients in California. She was delighted that a number of students attended the COA legislative day – and demonstrated the lasers and what they can do. “I worry about our very talented optometry students and residents,” she says. “We don’t want to lose them to other states where they can do these procedures.”
In the past five years, the California legislature has passed two other scope expansion laws, and that may have helped lay the groundwork for this one, she says. “We have shown our colleagues that we can do these things safely,” says Dr. Dexter.
MAKE YOUR VOICE HEARD
This is the opportunity for California ODs to make their voices heard, they say. “We are in a stronger position with greater numbers,” Dr. Dexter says. This action shows again that optometry is a legislated profession and the need for advocacy to expand or protect scope is constant. Visit the COA website at coavision.org for direct connection to legislators or for additional information.