Optometrists Seek to Perform Surgery


UPDATE: 4-27-17: Study Bill

This bill was introduced as a proposed committee substitute in the House Health Committee. The proposed committee substitute would direct the Institute of Medicine to study this issue, and report their findings back to the General Assembly in October 2018.

The referrals to the House Insurance and House Appropriations have been stricken.

This bill was heard on the House floor on April 27, 2017. This bill passed second reading with a vote of 109-6, and will now move to the Senate.

UPDATE: 3-1-17: Both supporters and opponents testify before House Health Committee

Today the NC House Health Committee had an informational hearing to learn about HB 36 from the optometrists who support the expansion of their scope of practice as well as those, like the NCMS and the NCSEPS, who oppose the bill.

One of the primary sponsors of the bill, Rep. Justin Burr (R-Stanly) began the session claiming that HB36 would enhance access to eye care especially in rural areas of the state. He downplayed the difficulty of the surgical procedures allowed in the bill, stating they would be minor, level 1, surgeries. Two optometrists then testified that:

  • Optometrists would receive “vigorous training” in these new procedures. However, when asked by Donna McDowell White (R-Johnston) about what the Board of Optometry envisioned as the credentialing process to perform the surgeries, the President of the Optometry Board, H. Mike Johnson, OD, only said it would be ‘proper’ education, training and experience.
  • A Charlotte area ophthalmologist, Galen Grayson, MD, told the committee he supported the bill as long as optometrists had “proper training and certification.”
  • An optometrist from Oklahoma, where optometrists have been allowed to perform such procedures since 1996, testified there have been no complaints and malpractice rates have remained low. Greg Murphy, MD (R-Pitt), pointed out that malpractice cases are an indicator of negligence, not quality of care. Complication rates and the necessity to operate again to correct mistakes in the initial procedure are better measures of quality. He referenced a JAMA study that revealed a higher rate of re-operations for surgeries performed by optometrists.
Dr. Paul Cunningham testifies before the NC House Health Committee.

Dr. Paul Cunningham testifies before the NC House Health Committee.

Speaking in opposition to the proposal were Susan Burden, MD, an Associate Professor of Ophthalmology at Wake Forest University, Paul R.G. Cunningham, MD, NCMS president and Tom Fetzer, a lobbyist for the NCSEPS, who shared his personal story of eye surgery to illustrate the gravity of any procedure performed on or around the eye.

Dr. Burden highlighted the complexity of performing eye surgery, and the dire circumstances that result from missed diagnoses or poorly performed surgeries. She spoke about the extensive training ophthalmologists receive during their 3- to 5-year residency and fellowship programs after completing medical school including performing hundreds of surgical procedures on patients under the supervision of an experienced ophthalmologist. She noted that none of the VA facilities in the country allow optometrists to perform the procedures outlined in HB36.

Dr. Cunningham reminded the committee members of their obligation to protect the citizens of the state. “There is no such thing as ‘minor surgery,’” he said. “The state has a compelling obligation to ensure the safety of its citizens. While I hold optometrists in high regard, patients need highly trained surgeons with the skills and dexterity gained through experience to perform surgery.”

UPDATE 2-28-17: 

The House Health Committee is scheduled to meet this Wednesday, March 1, at 11:00 a.m. to discuss HB 36 – Enact Enhanced Access to Eye Care. No vote is expected at this committee meeting.  Please voice your opposition to allowing optometrists to perform surgery through our Action Alert!


HB 36 – Enact Enhanced Access to Eye Care Act

Primary Sponsors: Rep. Justin Burr (R- Stanly), Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie).


This bill seeks to expand optometrist’ scope of practice to include surgical procedures. As currently constructed, the bill does not define what optometrists are allowed to do because the bill only defines exclusions.  As proposed, optometrists would be excluded from performing just 18 surgeries while having an unlimited scope related to all other surgeries not defined in the bill. NCMS opposes optometrists doing any surgery because we do not believe that optometrists have the necessary training and experience to practice laser surgery.

The optometry scope of practice has changed significantly over the past twenty years.  They have been allowed to prescribe pharmaceuticals and do some limited injections that relate to the primary care of the eye.   Surgery is something completely different.  Eye physicians and surgeons train for three years under close supervision after completing graduate medical training.  Optometrist propose to receive any training they deem necessary through continuing education.

Our patients deserve the best care from the most trained practitioner when it comes to surgery on the eye whether utilizing a laser or a scalpel.  Optometrist perform a valuable function within the health care team but lack the necessary skills and training to be allowed to perform surgical procedures.


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  • Janelle Krasovich

    I absolutely oppose this for the safety of my patients

    • Chip Baggett

      Thank you for your support, Dr. Krasovich. The bill is expected to be heard on Wednesday in the House Health Committee for discussion (no vote). We’ll be updating the blog today with more information.