As a practicing optometrist, I became a business owner for many reasons. One of those reasons was the desire to provide exceptional care to my patients by utilizing the latest training and technology. While my team and I are qualified to provide this care, we’re waiting for New Hampshire’s legislators to authorize us to do so.
In New Hampshire, like all states, optometry is a regulated profession. That means state lawmakers determine the scope of practice for health care providers, regardless of our training and education. That’s why I’m supporting HB 349, which will allow optometrists to perform three in-office, minor, non-invasive laser procedures to treat chronic and acute emergency glaucoma and remove a film that commonly develops after cataract surgery. Currently, these procedures can be performed only by ophthalmologists in our state. Yet, optometrists in other states and within the U.S. Department of Veterans Affairs’ Community Care Program have safely performed more than 140,000 of them since 1988.
One of those procedures, selective laser trabeculoplasty (SLT), is used to treat glaucoma, which affects about 3 million Americans and is the second leading cause of blindness worldwide. People over age 60 are at higher risk for the condition, and as our population ages, the need for treatment will increase. In other developed countries, SLT is the first line of treatment for glaucoma, meaning it is recommended before eye drops. In the U.S., eye drops are prescribed for initial treatment. This is problematic because of non-compliance with daily medication use, increased prescription co-pays, and risk of side effects and allergic reactions, especially for individuals with inflammatory conditions.
When optometrists are able to perform SLT procedures, patients are able to safely and effectively receive treatment from their eye doctor’s office, often the same day. Opponents of this legislation claim there are enough ophthalmologists, particularly in southern New Hampshire, to provide this treatment. However, appointment wait times for SLT procedures still average 2-3 months. Additionally, expecting patients to make additional appointments, build relationships with new doctors, travel farther from home, and incur additional co-pays can be challenging, especially for older adults caring for aging spouses or unable to drive. If patients don’t follow through with treatment, they risk losing their vision or even blindness.
Optometrists complete a four-year, postgraduate, doctoral-level degree program, and many, including myself, complete residencies after graduation. Our training includes the diagnosis and management of complex eye diseases, including glaucoma and cataracts, through extensive classroom, laboratory, and clinical training at an accredited school of optometry. This clinical training includes the use of advanced treatment methods such as non-invasive lasers under the supervision of attending optometrists.
Optometrists already diagnose and manage follow up treatment for glaucoma and post-cataract care. By allowing optometrists to perform the procedures to treat these conditions, we could enhance continuity of care for our patients.
Like all health care professionals, if optometrists determine patients require more specialized treatment, we refer them to colleagues with expertise in those areas. This is true even if our license and certification permit us to provide the care. For example, New Hampshire’s optometrists have had prescriptive privileges for decades; however, many never prescribe medications, while others may only write a few prescriptions a week. Authorizing optometrists to perform the procedures outlined in HB 349 would have similar outcomes. Optometrists who don’t have the infrastructure or aren’t able to invest in the technology wouldn’t provide this care.
For many optometrists, the ability to practice to the full extent of their education and training is an important consideration when moving to or remaining in a state. New Hampshire already has challenges recruiting health care providers. To continue attracting and retaining the best and brightest, our legislators must approve this legislation.
HB 349 is about giving patients the choice to receive care when and where they need it. It’s about enhancing our state’s health care workforce and improving quality of life for patients by reducing costs and eliminating unnecessary travel and wait times. Optometrists are dedicated to providing positive outcomes for our patients. Our priority is, and always will be, patient safety. Passage of HB 349 won’t change that.
