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Optometrists in North Carolina hope to expand patient access to care by adding laser procedures to their scope of practice, continuing optometry’s ongoing goal of best patient care possible.
HB 36, also known as the Enhanced Access to Eye Care Act, would allow ODs in North Carolina to perform:
• YAG capsulotomy (YAG)
• Laser peripheral iridotomy (PI)
• Selective laser trabeculoplasty (SLT)
• Removal and identification of skin lesions around the eye
HB 36 passed its first reading and awaits a hearing in the House Health Committee. North Carolina Optometric Society (NCOS) leadership hopes this hearing takes place by mid-March, although the hearing has not yet been scheduled.
Three states-Oklahoma, Kentucky, and Louisiana-allow optometrists to perform laser procedures. Oklahoma ODs earned laser privileges in 1998, Kentucky ODs expanded their scope in 2011, and Louisiana ODs followed in 2014.
HB 36 is modeled after the precedent of those states and follows the language of Kentucky’s scope, according to Jill Bryant, OD, FAAO, FSLS, president of NCOS and chief operating officer of National Board of Examiners in Optometry (NBEO).
“Some of our ophthalmology colleagues do not understand the value of optometric services,” she says. “We have an exemplary record of safety care. Oklahoma ODs have performed more than 25,000 procedures with great outcomes. Malpractice rates in Oklahoma, Kentucky, and Louisiana have not increased due to the expanded optometric scope.”
NCOS Executive Director Adrianne Drollette says North Carolina has a long history of a strong scope of practice.
“We see this bill as the next logical step,” she says. “Our leadership has been looking at this for a number of years. I’m not sure it has much to do with geography.”
According to Dr. Bryant, NCOS leadership met with organized ophthalmology in North Carolina, but both groups agreed to disagree on the topic of expanded scope for optometrists.
NCOS leadership says allowing optometrists to perform these laser procedures expands access to care.
Optometry is strongly accessible in North Carolina, says Dr. Bryant. Optometrists have primary-practice locations in 88 out of 100 counties and branch offices in 98 counties compared to ophthalmology primary practices in 60 counties. She did not have a count on how many counties have branch ophthalmology offices.
“We have patients who wait a long time for appointments with ophthalmologists and have great distances to drive,” she says. “When I was in practice in a metro area, it was not uncommon for a patient to wait six weeks for these procedures. In more rural areas, it could be months before a patient could have an appointment.”
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Ted Watson, OD, who practices in rural eastern North Carolina, says that access to care in some parts of the state affects patients’ ability to receive treatment. Ophthalmologists have satellite offices in rural areas, but the doctor may be in that office only once a month, usually for pre- and postop cataract visits, he says.
He has recently seen glaucoma patients with closing angles and high intraocular pressures (IOP), and patients are asking him to remove lid lesions. He must refer these patients to care 90 minutes away, which is a three-hour round trip.
“One patient didn’t have a car,” he says. “She had to get a ride to my office, and now I’m telling her I have to refer her farther away for a consult for peripheral iridotomy. Then she needs to get on the schedule, find transportation, and coordinate that with the appointment.”
Most patients require follow-up visits with the ophthalmologist after the consult and procedure visits. Multiple appointments are a barrier to care, he says.
“If we were able to do these procedures-and we are trained to do them-then we would have the ability to take care of the patient at the time she needs it without burdening her and creating a barrier to the next level of care, which now is the ophthalmologist,” he says.
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If HB 36 passes its hearing in the House Health Committee, it must then pass through the Insurance and Appropriations Committees before it moves to the House floor.
North Carolina has a five-to six-month legislative session.
NCOS leadership is also considering a companion bill in the Senate, but a final decision has not yet been made.
Drollette says that decision will be predicated upon the fate of HB 36.
“We certainly hope that we are successful this year,” she says. “But if we are not, we’re not going to give up.”