House passes bill expanding optometrists’ authority after heated debate

The Vermont House voted 93–38 on May 28 to pass S.64, a bill that creates an advanced therapeutic specialty endorsement allowing optometrists who meet specified training and competency requirements to perform a defined list of laser, injection and minor surgical procedures.

Supporters said the change will expand access in rural parts of the state where ophthalmologists are scarce and help retain and recruit optometrists who have trained for these procedures. "By allowing optometrists to practice to the full extent of their education and training, we expand the number of clinicians available to care for Vermonters," a member advocating for the bill said during floor debate.

Opponents warned the statutory expansion sets a low threshold for hands‑on experience and posed patient‑safety risks. A member reading testimony from national medical groups and governors who vetoed similar measures elsewhere argued, "S64 requires very limited hands‑on supervised practice and as few as two supervised procedures for a subset of the allowed surgeries before an optometrist may operate independently. Surgical competency is built through operative experience, not classroom instruction." That speaker also quoted warnings about rare but serious complications and urged caution.

Key provisions in the enacted version include a new subchapter establishing an "advanced therapeutic procedures" specialty, additional continuing‑education requirements for specialty holders, mandatory reporting of adverse events to the Office of Professional Regulation (OPR) within 30 days, and a July 1, 2028 effective date to allow time for implementation and credentialing. The bill also prohibits optometrists from performing a specified list of more complex ophthalmic surgeries and limits controlled‑substance prescribing related to those procedures.

The House floor heard multiple committee reports: the Office of Professional Regulation provided a multi‑hundred‑page analysis and recommended expansion subject to training conditions; the Government Operations and Military Affairs Committee outlined proposed safeguards and said it voted the bill out favorably; Ways and Means noted a modest license‑fee revenue projection tied to an estimated number of specialty applicants.

During debate Representative Nent of South Burlington offered an amendment to change the composition of the optometry board, adding two members and requiring one of the new seats be filled by an ophthalmologist; the amendment also required at least one optometrist on the board to have experience performing the advanced procedures by 2031. The amendment passed on the floor.

Several speakers described difficult access to ophthalmic care across Vermont’s rural counties and cited long wait times; other speakers cited studies and examples from other states questioning whether scope expansion materially improved access or reduced costs. One proponent summarized available workforce data presented to committees: Vermont has far more optometrists located outside of Chittenden County than ophthalmologists, and OPR estimated up to about 50 optometrists might seek the endorsement.

The bill drew intense public and professional attention in committee and on the floor; members frequently read or summarized testimony from OPR, the Joint Fiscal Office and national medical organizations. After debate, the House ordered a roll‑call vote. The clerk recorded 93 members voting yes and 38 voting no; the chamber then suspended its rules and messaged the action to the Senate.

Next steps: the enacted provisions take effect July 1, 2028, providing OPR and the relevant boards time to develop implementation details, credentialing steps and reporting processes. OPR and the board are expected to publish guidance and the continuing‑education and clinical proficiency requirements referenced in the law.