Gap in scope of practice between US and Australian optometrists widens

by Nicola Mountford
Optometry Advancement Officer, Optometry Australia

Legislative changes in Montana and West Virginia, set to take effect in July 2025, will bring the total number of US states granting optometrists laser privileges to fourteen. This significant shift, highlighted in a recent Review of Optometry article, underscores a widening gap in scope of practice between US and Australian optometrists.

The use of lasers by optometrists in the USA began in Oklahoma in 1988¹. Since then, suitably trained optometrists in the UK, New Zealand, and an increasing number of US states have been safely and effectively performing procedures such as SLT, YAG Capsulotomy, and YAG Peripheral Iridotomy following specific competency requirements^2-5. Crucially, all 23 undergraduate optometry programs in the US now incorporate laser procedure training.

The benefits of this expanded scope are clear. A US study demonstrated distinct advantages for marginalised and ethnically diverse populations, alongside a 12% reduction in the prevalence of visual impairment, directly attributed to historic expansions in optometric scope of practice⁶. Furthermore, a recent survey of patients who underwent post-cataract surgery YAG capsulotomy with optometrists across 10 US states reported reduced waiting times and high satisfaction levels concerning with regards to both convenience and cost⁷.

Perhaps most compelling is the evidence of safety. A retrospective audit of 146,403 optometrist-performed laser procedures across 12 US states revealed an incredibly low complication or negative outcome rate of just 0.001%².

While optometrists in other developed nations are embracing advanced procedures to improve patient access and outcomes, the current regulatory environment in Australia lags behind. The global trend towards expanding optometric scope, backed by robust safety data and patient satisfaction, presents a compelling case for re-evaluating the role of Australian optometrists in delivering comprehensive eye care.

1. Cooper SL. 1971 – 2011: Forty year history of scope expansion into medical eye care. Optometry. 2012;83(2):64-73.
2. Lighthizer N., Patel K., Cockrell D., Leung S., Harle DE., Varia J., et al. Establishment and review of educational programs to train optometrists in laser procedures and injections – PubMed. Clinical & experimental optometry. 07/24/2024.
3. Spiegle L. How Scope Expansion is Shaping Optometry’s Future. Review of Optometry. 2025.
4. Konstantakopoulou E, Varia J, Parmar J, Nathwani N, Hau S, Low WS, et al. Optometrist-delivered selective laser trabeculoplasty in the HES – a training protocol and early service evaluation. Eye 2024 38:13. 2024-05-03;38(13).
5. Optometrists and Dispensing Opticians Board. Ophthalmic Laser Surgeries Guidelines for New Zealand Optometrists. 2023.
6. Bae K, Timmons E, Nandy P. Seeing is Believing: The Effects of Optometrist Scope of Practice Expansion. SSRN Electronic Journal. 2023.
7. American Optometric Association. YAG procedures by doctors of optometry after cataract surgery better for patients’ care and convenience, AOA survey says. 2023.