Patients across the nation struggle to access healthcare, particularly in rural regions. These areas often require long drives to see specialists. Eye care is one domain facing acute service shortages, with demand rapidly exceeding the supply of ophthalmologists. Meanwhile, optometrists—a large, skilled workforce—are limited by laws that prevent them from performing necessary procedures.
Over a dozen states permit optometrists to carry out a YAG laser capsulotomy. This straightforward in-office procedure addresses “secondary cataracts,” a condition that clouds vision post-cataract surgery. More than 500,000 elderly Americans undergo this procedure yearly, and it has an excellent safety record. Despite this, most states allow only ophthalmologists to perform it.
Restrictive practices on optometrists come at a substantial cost to patients. In 2020, the U.S. had about three times more optometrists than ophthalmologists. With ophthalmologists concentrated in urban centers, over 99% of Americans live in a county with an optometrist. Consequently, patients needing YAG procedures face extended wait times and costly travel to see an ophthalmologist.
Concerns about patient safety persist. However, optometrists in the U.S. complete comprehensive doctoral training in eye care, often including YAG surgery. Those who don’t receive additional training or certification. A review of nearly 150,000 laser procedures by optometrists showed only 0.001% resulted in negative outcomes, demonstrating high safety. In the U.K. and New Zealand, optometrists have performed these procedures safely for years.
The Pacific Legal Foundation’s policy brief highlights that expanding optometrists’ practice scope for YAG procedures has significantly raised their utilization. Medicare patients in states that expanded optometrist roles between 2013 and 2023 received 19% more YAG procedures than those in states with restrictive laws. States expanding before 2013 showed even higher rates—almost 42% higher.
This expansion improves eye care access. Patients who remain untreated due to travel, scheduling issues, or lack of specialists finally receive necessary care. Policymakers can glean two insights: First, scope-of-practice expansions’ effects grow with time, suggesting the eye care market gradually adapts to new regulations. Acting now maximizes long-term benefits. Second, increased YAG utilization from scope expansions is more significant in non-metropolitan areas, indicating that geographically isolated patients benefit most.
This reform isn’t without precedent. In the past two decades, many states broadened scope-of-practice laws for non-physician providers like nurse practitioners and physician assistants. Evidence overwhelmingly supports these expansions: access improves, costs decline, and healthcare becomes more flexible. Optometry should follow suit.
Despite potential opposition from organized ophthalmology groups, the focus should be on patient care rather than procedure control. As the U.S. population ages and eye care demands increase, the ophthalmologist shortage will worsen. Reducing care delays in underserved areas requires leveraging every tool. Enabling optometrists to do more is an effective step to ensure patients receive needed services.
Kihwan Bae, Ph.D., is an assistant professor in the Department of General Business and a research fellow at the Knee Regulatory Research Center at the John Chambers College of Business and Economics, West Virginia University. Liam Sigaud is a research analyst at the same center.
© 2026 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.