Lawmakers hear sharply divided testimony on S.64 to expand optometrists' procedural scope

Dr. Greenberg, representing the Vermont Board of Medical Practice, told the Senate Health and Welfare Committee that the board reviewed S.64 repeatedly (October 2023, January 2025 and January 2026) and remains opposed because available evidence does not show clear cost or access benefits and because the board’s work is focused on licensure and patient safety. “Our stance is still opposed to the change,” Dr. Greenberg said, stressing that the board evaluates complaints, malpractice settlements and legal issues and that its lens is quality and licensure rather than system financing.

Tina Keshava, an optometrist in Rutland and president of the Vermont Optometric Association, argued the bill would expand access for rural Vermonters and reduce costs associated with extra referrals and hospital facility fees. Keshava cited optometry training benchmarks—“10,000 hours of education and 2,000 patient encounters before we graduate”—and described the bill’s pathway for an advanced‑procedure specialty license that would require additional training, a preceptorship, proctored procedures and adverse‑event reporting. She said OPR supports the bill and that an Oliver Wyman analysis and a recent 2025 study suggest scope expansion can have greater impact in rural areas.

Ophthalmologists, represented at the hearing by Dr. Jessica McNally of the Vermont Ophthalmological Society, urged caution. McNally emphasized that ophthalmologists complete medical school plus an ophthalmology residency and frequently fellowship training, and she described residency training and formal competency assessment processes. She warned that much hands‑on surgical training for ophthalmologists occurs in residency under attending supervision and pointed to examples in other states that, she said, raise questions about oversight and malpractice where boards or processes failed. To illustrate procedural complexity, McNally showed a roughly seven‑minute video of eyelid and laser procedures and described risks, including bleeding, infection and rare complications such as arterial occlusion from injections.

Committee members pressed witnesses on empirical evidence. Dr. Greenberg and Dr. McNally said the literature is limited and mixed: they noted a 2023 study and OPR reports that found little evidence of improved access after scope expansion in some states, while Keshava cited a 2025 study indicating larger impacts in rural areas. Members asked about concrete numbers: the transcripts record the committee hearing that Vermont has about 168 optometrists and 32 ophthalmologists and that ophthalmology residencies commonly involve hundreds of surgical cases, versus far smaller hands‑on procedural counts in optometry programs.

Neither side disputed that S.64 would create a rule‑based specialty license with additional training requirements; their disagreement centered on whether the training and oversight proposed in the bill (and in OPR’s recommendations) would be sufficient to protect patients while improving access. The committee did not take a vote during the session and later moved on to additional agenda items, including an AHS briefing on hospital transformation. The debate is likely to continue in subsequent committee sessions as members seek more data on utilization, complication rates and how any new specialty license would be implemented and overseen.

The committee is expected to receive additional materials referenced at the hearing, including OPR reports, the Oliver Wyman analysis and the studies witnesses cited; no formal action on S.64 was recorded in this session.