As an optometrist in the small Arkansas town of Osceola, Matthew Jones must tell patients several times a week to seek treatment elsewhere — sometimes as far as an hour away — for procedures he says he’s fully capable of performing.
“They look at me and ask, ‘Why don’t you just do it?’ I tell them, ‘I’m not legally allowed to do it,'” Jones said.
He and other optometrists hope to change that after successfully lobbying Arkansas’ Legislature to change the law to expand the procedures they can perform. It prompted an unexpectedly expensive and heated lobbying fight in the Statehouse, with ophthalmologists arguing the law will put patients at risk. The change is now on hold and could go before voters next year.
It’s an unusually high-profile example of a fight that’s being waged in other medical fields, as policymakers try to find ways to expand access to care and cut costs.
“This is, to me, a marker of a whole new era where we’re going to see a lot more of this stuff,” said Ashish Jha, a professor of health policy at the Harvard T.H. Chan School of Public Health.
The Arkansas law would allow optometrists to perform several procedures that currently only ophthalmologists can, including injections around the eye, removing lesions from the eyelids and certain laser eye surgeries. Much of the debate has focused on whether optometrists have the necessary training. Optometrists complete a four-year program on eye care after graduating from college and are licensed by the state Board of Optometry. Ophthalmologists are physicians licensed by the state Medical Board who have graduated from medical school, completed a yearlong hospital internship and at least three years of residency.
“There is no minimally invasive surgical procedure of the eye,” said Laurie Barber, an ophthalmologist in Little Rock and the chairwoman of Safe Surgery Arkansas. Her group, which is trying to repeal the law, says the procedures should be performed by medical doctors who have surgical experience.
Supporters of the law change say optometrists are already trained to perform the procedures and that forcing them to send their patients elsewhere poses a hardship in a mostly rural state where ophthalmologists aren’t easy to find. Jones, for example, estimates that about one in five of his patients walk or bike to his clinic in Osceola. He also has a clinic in neighboring Blytheville.
“When you’re sitting right there and you can have a procedure taken care of, you should be able to,” said Barbara Horn, president of the American Optometric Association.
Carolyn Lay, who has been seeing Barber for 20 years, said she would rather see an ophthalmologist for the procedures detailed in the state law.
“I don’t think they should ever be equal until both parties have to do the same amount of school,” Lay said.
Alaska, Kentucky, Louisiana and Oklahoma have laws similar to the one approved by the Arkansas Legislature. Similar legislation expanding what optometrists can do has been proposed in several other states, according to the National Conference of State Legislatures.
The debate over expanding “scope of practice” for some medical fields isn’t new, especially in states where lawmakers are trying to find ways to expand access to patients in rural areas. Hundreds of such bills come up in state legislatures every year, including efforts in several states to allow nurse practitioners to see patients without partnering with a doctor. Those efforts have faced similar pushback from doctors’ groups who warn that it would put patients at risk. Efforts to loosen restrictions on nurse anesthetists and advanced practice registered nurses failed in the Arkansas Legislature this year.
A lobbyist for the Arkansas Ophthalmological Society spent more than $111,000 on the group’s unsuccessful effort to the defeat the optometry expansion in the Legislature, according to figures compiled by the Arkansas Democrat-Gazette. Safe Surgery Arkansas has spent more than $150,000 gathering signatures to put a referendum on the law on the November 2020 ballot. State officials are now verifying whether the group gathered enough valid signatures after it submitted petitions on Tuesday.
Supporters of the optometry law signaled they’ll challenge the petitions, arguing that many of the signatures submitted are invalid because canvassers hadn’t filed necessary paperwork with the state. Safe Surgery has said it’s confident it’s complied with the law.
“It’s important that the state as a whole be able to vote on this issue,” Alex Gray, an attorney for Safe Surgery Arkansas, said.
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