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Dr. Elena Biffi is an associate professor of optometry at the New England College of Optometry (NECO) and an attending optometrist at the NECO Center for Eye Care. Dr. Meghan Sue is an assistant professor of clinical optometry at NECO and an attending optometrist at The Dimock Center and the Martha Eliot Health Center.
The median age of a Mainer is nearly 45 years, and Maine has the largest percentage of residents over 65 of any state. Expanding access to health care, especially vision and medical eye care, is essential to meet the growing needs of this aging population. Maine’s legislators are currently considering important bipartisan legislation, LD 1803, which we believe is the first step in modernizing the state’s outdated optometric scope of practice regulations and improving access to care for all citizens.
This legislation will allow optometrists to perform three specific minor, in-office, non-invasive laser eye procedures to treat glaucoma, provide after-cataract surgery care, and perform minor eye care procedures to remove styes and skin tags. These procedures are taught in optometry school through extensive classroom and laboratory education and training, but are not permitted to be performed by optometrists in Maine.
As faculty members at the New England College of Optometry, we teach optometry students about these procedures and the eye conditions that require them every day. As part of every optometry school curriculum, students learn general and ocular anatomy, medical optometry, general pharmacology, and system diseases diagnosis and management. Following four years of optometry school, optometrists earn doctorate degrees. This education is standardized nationally and regulated by state boards.
As part of their advanced surgical and laser procedures course, students learn a variety of microsurgical techniques. The curriculum covers pre-operative management and post-operative complications and treatment as well as hands-on training of the procedures included in LD 1803. Students also learn how to identify when a patient is the right candidate for laser and microsurgical procedures.
Even with this education and training, if an optometrist in Maine determines that a patient needs one of these procedures, the patient must be referred to an ophthalmologist for care. This extends the time patients must wait for care and can result in duplication of services, additional health care costs, and reduced quality of life. Authorizing optometrists to perform these procedures can provide more choice for patients in selecting where and when they receive care, enhance continuity of care, decrease costs, and allow ophthalmologists to focus on more complex care that only they can provide.
A recent study of the more than 140,000 laser procedures performed by optometrists in states with expanded optometric scope found a complication rate of 0.001 percent. This remarkable safety record can be attributed to the extensive didactic and hands-on training provided by all U.S. optometry schools, which continually adjust and evolve their curriculum to include the latest procedures and technologies. After graduation, practicing optometrists, like all health care professionals, continue to learn new skills and build upon their training through specialty courses and continuing education credits.
A recent workforce study published in the Journal of Ophthalmology anticipates a 24 percent increase in demand for these procedures while the number of ophthalmologists is expected to decline 12 percent by 2035 in the U.S. At the same time the number of students applying to optometry schools is increasing. While many of the students we teach are interested in practicing in Maine and throughout New England after graduation, they are often choosing to move to states with expanded scope of practice so they can practice to the full extent of their education and training.
During our tenure as students and now educators, we have watched the optometric curriculum evolve to include the latest procedures and techniques. Years ago, optometrists were not permitted to prescribe eye drops or dilate pupils. Today it would be unheard of to have to wait for a referral to another provider for that care.
LD 1803 is about giving patients more health care choices. It’s about enhancing Maine’s health care workforce and improving quality of life for patients. It’s time to modernize eye care in Maine by passing LD 1803.
