Janelle Irwin Taylor
An effort years in the making to expand optometrists’ scope of practice is one step closer to becoming reality after the House Health Professions and Programs Subcommittee cleared a measure Thursday.
The bill (HB 449) received split-party support. Three of the six committee members who voted against the measure were Democrats, and three were Republicans. Meanwhile, two Democrats voted in favor, and 10 Republicans gave the measure a nod.
The Committee cleared a committee substitute for the bill, which makes some minor modifications to the original measure but maintains the legislation’s general goal.
Opposed by ophthalmologists, it again seeks to allow optometrists to call themselves Doctors of Optometry (O.D.) or “optometric physicians” in advertisements despite significant differences in medical training and education.
Ophthalmologists complete medical school and a required residency, which typically represents a decade or more of medical training and more than 17,000 hours of patient contact training before such medical doctors are permitted to practice independently. By contrast, optometrists complete a four-year course in optometry, and not all of the programs require a college degree. The training does not include residency or surgical training.
Sponsored by Rep. Alex Rizo, the bill would, among other provisions, allow an optometrist to advertise themselves as an optometrist, licensed optometrist, doctor of optometry, optometric physician, board-certified optometrist, American Board of Optometry certified, Fellow of the American Academy of Optometry, Fellow of the College of Optometrists in Vision Development, residency-trained, or a diplomate of the American Board of Optometry.
It also includes revisions to existing law that would broaden an optometrist’s scope of practice to include additional surgical procedures and prescribing authority.
The committee substitute further redefines “certified optometrist” to include administering and prescribing ocular pharmaceutical agents, medications used to treat or diagnose eye conditions. It also amends educational and certification requirements for administering ocular pharmaceutical agents and authorized ophthalmic surgeries, including the ability to perform laser and non-laser procedures. However, the bill would not allow an optometrist to perform procedures requiring preoperative medications or drugs that alter consciousness, such as general anesthesia. To be certified for authorized procedures under the bill, optometrists must complete a course and pass an examination successfully.
Ophthalmologists remain opposed, however. Before the committee substitute passage, the Florida Society of Ophthalmology urged lawmakers to vote down the bill, arguing it would endanger patients by allowing less trained optometrists to perform more advanced procedures.
“Optometrists play an important role in eye health care, providing essential services such as vision testing, prescribing corrective lenses, and detecting certain eye conditions. However, their scope of practice typically does not include surgical procedures involving lasers, scalpels, or injections on or around the eye. These advanced interventions require the specialized medical education, extensive surgical training, and clinical expertise of ophthalmologists,” said Dr. Raquel Goldhardt, the President of FSO.
FSO pointed to research published in the Journal of the American Medical Association on a type of laser surgery to treat glaucoma. It was found that patients who receive treatment from an optometrist are significantly more likely to require additional surgery. FSO further cited incidents of “sight-threatening complications” following optometrist-administered procedures in other states, including Oklahoma, Louisiana, and Kentucky.
Still, those who support the scope of practice expansion argue it increases access to eye care. However, ophthalmologists say most Floridians live within a 30-minute drive to an ophthalmologist, and there is currently no backlog of patients seeking ophthalmologic care in the state.
Rizo has fired back against the critique.
“What exactly this bill does (is make it so) you don’t have to go to an ophthalmologist, necessarily, if there’s a condition that calls for this particular procedure or pain medication,” he previously told Florida Politics. “No surgery, nothing like that. It’s basically an advanced first-aid procedure to release inter-corneal pressure.”
Rizo carried a similar bill in 2021, but it and its Senate analog died before reaching a floor vote.
The “eyeball wars” date back years, at least to Sen. Don Gaetz’s reign as Senate President, a leadership role he held from 2012 until 2014.
Gaetz coined the term “eyeball wars,” and in 2013, he believed he resolved the turf war between ophthalmologists and optometrists. The two sides settled on a compromise allowing optometrists to prescribe oral medications but not to perform surgery.
But the fight resurfaced a few years later.
A bill similar to this year’s effort (SB 1112) died last Session after the House and Senate failed to reconcile. Then-Senate President Kathleen Passidomo, whose father was an ophthalmologist, filed priority legislation that would have blocked the use of the term doctor or physician in certain circumstances, including for optometrists.
The House amended the bill to allow optometrists to use the terms in advertisements. Passidomo successfully ushered the measure through (2023’s SB 230), but Gov. Ron DeSantis vetoed it. Rizo voted that year against efforts to allow optometrists to refer to themselves as doctors of optometry.
This year’s measure has one Committee stop remaining before reaching the House floor, the Health and Human Services Committee.
A Senate companion has not yet been filed.
If passed and signed by the Governor, the measure would take effect July 1.
