It’s Time to Remove Barriers to Eye Health Practice and Care

Access to high-value, affordable health care is a right — not a privilege. Yet U.S. patients increasingly find it harder to get the care they need and deserve. The recent ruling regarding the Patient Protection and Affordable Care Act further places future patient care and access into question, reinforcing the urgent need for a change in our country’s health care delivery system.

We must address the gaps in the value and efficiency of care that have led to higher costs and poor health outcomes for millions of patients. Fortunately, the administration is taking positive steps to tackle these concerns in the 2018 report “Reforming America’s Healthcare System Through Choice and Competition.”

The report highlights important recommendations to improve safe patient access to an efficient health system that maximizes resources and care. It also urges federal and state governments to remove regulations and policies that inhibit choice and competition, including the laws around scope of practice across the country.

Ensuring that health care providers nationwide are able to practice to the full extent of their education and training is a critical component to increasing patient health care choice and access. For instance, in Oklahoma, Louisiana and Kentucky, doctors of optometry are authorized to provide some laser surgical treatments to patients, while in other states, they are not permitted to provide any type of laser surgery. This is alarming when research shows up to 16 million Americans struggle with undiagnosed and untreated vision impairments.

Combined with the fact that eye diseases, vision loss and eye disorders create an estimated $139 billion economic burden, our country is facing a significant public health challenge. As America’s primary eye health care providers, doctors of optometry are uniquely positioned to address this challenge, but only when they are not constrained by antiquated and unfounded restrictions.

The administration report proposes the clear and necessary actions necessary to advance and enhance care, while maintaining patient safety, by revisiting state laws to ensure they reflect the training and skills of physicians, including doctors of optometry.

Doctors of optometry don’t just examine vision acuity. During an in-person, comprehensive eye exam, they examine, diagnose, treat and manage diseases of the eye. They also play a major role in patients’ overall health and often are the first to detect and diagnose systemic disorders, including diabetes, hypertension and even cancer. Despite being a critical key to facilitate early and effective preventative care, many patients are restricted from getting a full range of optometric care and services, even though doctors of optometry have been expertly trained in those very disciplines.

The variation of laws across states not only creates a lack of uniformity and access, but also serves to limit the bounds that doctors of optometry can practice. A recent study by the American Optometric Association Health Policy Institute found that doctors of optometry practice in counties that account for 99 percent of the U.S. population. Unfortunately, patients living in underserved or rural areas can often be impacted the most, as they may face more obstacles to accessing eye and vision care than urban residents.

Restrictive state practice laws that are based on an antiquated perception of education and skills are holding patient care hostage, and it is only when we evolve these laws that patients will have access to the right kind of care. The bottom line: With more doctors of optometry geographically accessible, particularly in underserved areas, expanding their scope of practice makes good sense.

I urge our elected officials to make the right choice by increasing patients’ access to affordable, quality eye and vision care.


Samuel D. Pierce, O.D., serves as current president of the American Optometric Association and is a practicing doctor of optometry in Trussville, Alabama.

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