BILL AS INTRODUCED H.241
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H.241 1
Introduced by Representatives Birong of Vergennes, Bartley of Fairfax, 2
Bluemle of Burlington, Bosch of Clarendon, Branagan of 3
Georgia, Burditt of West Rutland, Burkhardt of South 4
Burlington, Canfield of Fair Haven, Cole of Hartford, Critchlow 5
of Colchester, Feltus of Lyndon, Galfetti of Barre Town, Greer 6
of Bennington, Gregoire of Fairfield, Harrison of Chittenden, 7
Harvey of Castleton, Higley of Lowell, Hooper of Randolph, 8
Howland of Rutland Town, Kascenska of Burke, Kleppner of 9
Burlington, Labor of Morgan, Laroche of Franklin, Lipsky of 10
Stowe, Luneau of St. Albans City, Maguire of Rutland City, 11
Malay of Pittsford, Marcotte of Coventry, Morgan, L. of 12
Milton, Morgan, M. of Milton, Morris of Springfield, Morrissey 13
of Bennington, Mrowicki of Putney, Nelson of Derby, Noyes of 14
Wolcott, Oliver of Sheldon, Olson of Starksboro, Page of 15
Newport City, Pritchard of Pawlet, Quimby of Lyndon, Sibilia 16
of Dover, Surprenant of Barnard, Sweeney of Shelburne, Toof 17
of St. Albans Town, Wells of Brownington, White of Bethel, 18
and Winter of Ludlow 19
Referred to Committee on 20
Date: 21 BILL AS INTRODUCED H.241
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Subject: Professions and occupations; Office of Professional Regulation; 1
health care professionals; optometrists 2
Statement of purpose of bill as introduced: This bill proposes to revise and 3
further define the scope of practice for optometrists. It would also create an 4
advanced therapeutic procedures specialty that would allow qualified 5
optometrists to perform certain advanced therapeutic procedures. 6
An act relating to amendments to the scope of practice for optometrists 7
It is hereby enacted by the General Assembly of the State of Vermont: 8
Sec. 1. 26 V.S.A. § 1703 is amended to read: 9
§ 1703. DEFINITIONS 10
As used in this chapter: 11
(1) “Board” means the State Board of Optometry. 12
(2)(A) The “practice of optometry” means any one or combination of 13
the following practices: 14
(A)(i) Examining the human eyes and visual system for purposes of: 15
(i)(I) diagnosing refractive and functional ability; or 16
(ii)(II) diagnosing the presence of eye and adnexa disease or 17
injury, treating the disease or injury with the appropriate therapeutic 18
pharmaceutical agents and procedures in accordance with this chapter, and 19
making referrals to the appropriate health care provider when warranted. 20 BILL AS INTRODUCED H.241
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(B)(ii) Diagnosing and correcting anomalies of the refractive and 1
functional ability of the visual system and the enhancement of visual 2
performance including the following: 3
(i)(I) prescribing and using ophthalmic lenses, prisms, 4
autorefractor or other automatic testing devices, frames, ophthalmic aids, and 5
prosthetic materials as consistent with the health of the eye; 6
(ii)(II) prescribing and employing contact lenses; and 7
(iii)(III) administering visual training, vision therapy, orthoptics, 8
and pleoptics. 9
(C)(iii) Prescribing and administering appropriate therapeutic 10
pharmaceutical agents, as defined in this section, for the diagnosis, 11
management, and treatment of the eye and adnexa. 12
(D)(iv) Removing superficial foreign bodies from the eye and 13
adnexa; epilating the eyelashes, including by electrolysis; and punctal dilation, 14
lacrimal irrigation, and punctal plugs insertion. 15
(E)(v) Managing the following types of glaucoma in patients who are 16
16 years of age or older: 17
(i)(I) adult primary open angle glaucoma; 18
(ii)(II) exfoliative glaucoma; 19
(iii)(III) pigmentary glaucoma; 20
(iv)(IV) low tension glaucoma; 21 BILL AS INTRODUCED H.241
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(v)(V) inflammatory (uveitic) glaucoma; and 1
(vi)(VI) emergency treatment of angle closure glaucoma. 2
(vi) For an optometrist holding an advanced therapeutic 3
procedures specialty issued pursuant to subchapter 5 of this chapter, 4
performing the following advanced therapeutic procedures: 5
(I) surgery to remove lesions from the eye and adnexa and the 6
accompanied restoration of tissue, including only the following: 7
(aa) excision and repair of nonrecurrent chalazia; 8
(bb) excision and biopsy of nonrecurrent lesions of the 9
adnexa without characteristics or obvious signs of malignancy, excluding any 10
lesion involving the eyelid margin, involving the lacrimal supply or drainage 11
systems, deeper than the orbicularis muscle, or larger than five millimeters in 12
diameter; 13
(cc) closure of wounds resulting from removal of a lesion; 14
(dd) repair of an eyelid laceration not larger than 2.5 15
centimeters, not deeper than the orbicularis muscle and not involving the 16
eyelid margin or lacrimal drainage structures; and 17
(ee) corneal crosslinking; 18
(II) the following laser procedures: 19
(aa) laser capsulotomy; 20
(bb) laser peripheral iridotomy; and 21 BILL AS INTRODUCED H.241
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(cc) laser trabeculoplasty; and 1
(III) the following injections: 2
(aa) injections of therapeutic pharmaceutical agents into the 3
eyelid or its adnexa, including into the subconjunctival space, and including 4
injections for the removal of chalazia and injections to administer local 5
anesthesia; 6
(bb) injections to perform fluorescein angiography; 7
(cc) injections of epinephrine for treatment of anaphylactic 8
shock; and 9
(dd) if authorized by the Commissioner of Health during a 10
public health emergency, vaccinations for systemic health reasons. 11
(B) The practice of optometry does not include performing any of the 12
practices set forth in section 1720 of this chapter. 13
* * * 14
(6) “Adverse event” means any untoward incident, therapeutic 15
misadventure, iatrogenic injury, or other undesirable outcome directly 16
associated with care or services provided by a health care provider or a health 17
care facility, as those terms are defined in 18 V.S.A. § 9402. 18
(7)(A) “Therapeutic pharmaceutical agent” means any prescription or 19
nonprescription drug used or prescribed for the diagnosis, prevention, 20 BILL AS INTRODUCED H.241
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treatment, or mitigation of abnormal conditions and pathology of the human 1
eye or its adnexa. 2
(B) “Therapeutic pharmaceutical agent” does not include: 3
(i) any drug or other substance that must be administered by 4
intraocular injection or intraocular implementation, except as authorized by 5
subdivision (2)(A)(vi)(III) of this section for an optometrist holding an 6
advanced therapeutic procedures specialty issued pursuant to subchapter 5 of 7
this chapter; or 8
(ii) any drug or other substance that is prohibited under subsection 9
1720(b) of this chapter. 10
Sec. 2. 26 V.S.A. § 1716a is amended to read: 11
§ 1716a. RENEWAL 12
(a) Licenses shall be renewed every two years upon payment of the 13
required fee, provided that the person applying for renewal completes at least 14
40 hours of continuing education, approved by the Board, during the preceding 15
two-year period and holds a current cardiopulmonary resuscitation 16
certification. 17
(b) Licensees holding an advanced therapeutic procedures specialty 18
pursuant to subchapter 5 of this chapter shall, during each two-year licensure 19
period, complete an additional five hours of continuing education, approved by 20
the Board, in the advanced procedures. 21 BILL AS INTRODUCED H.241
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Sec. 3. 26 V.S.A. § 1720 is added to read: 1
§ 1720. PROHIBITED PRACTICES 2
(a) An optometrist shall not perform any ophthalmic surgeries, with or 3
without the use of lasers, or injection procedures, other than those set forth in 4
subdivision 1703(2)(A)(vi) of this chapter. This prohibition includes the 5
following procedures, which an optometrist is prohibited from performing: 6
(1) retinal laser procedures, laser-assisted in situ keratomileusis 7
(LASIK), photorefractive keratectomy, laser epithelial keratomileusis, or any 8
forms of refractive surgery; 9
(2) penetrating keratoplasty, corneal transplant, or lamellar keratoplasty; 10
(3) the administration of general anesthesia; 11
(4) surgery done with general anesthesia; 12
(5) laser or nonlaser injection in the posterior or vitreous chamber of the 13
eye to treat any macular or retinal disease; 14
(6) surgery related to removal of the eye or adnexa, including the 15
eyeball, from a living human being; 16
(7) surgery requiring full-thickness incision or excision of the cornea or 17
sclera other than paracentesis in an emergency situation requiring immediate 18
reduction of the pressure inside the eye; 19
(8) surgery requiring incision of the iris and ciliary body, including iris 20
diathermy or cryotherapy; 21 BILL AS INTRODUCED H.241
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(9) surgery requiring the incision or removal of the vitreous; 1
(10) surgery requiring incision of the retina; 2
(11) surgical extraction of the crystalline lens; 3
(12) surgical intraocular lens implants; 4
(13) incisional or excisional surgery of the extraocular muscles; 5
(14) surgery of the eyelid for suspected malignancies, for cosmetic 6
purposes, or for cosmetic or mechanical repair of blepharochalasis, ptosis, and 7
tarsorrhaphy; 8
(15) surgery for the removal of lesions involving the eyelid margin, 9
lacrimal supply, or drainage systems; 10
(16) repair of an eyelid laceration larger than 2.5 centimeters, deeper 11
than the orbicularis muscle, or involving the eyelid margin or lacrimal drainage 12
structures; 13
(17) surgery of the bony orbit, including orbital implants; 14
(18) incisional or excisional surgery of the lacrimal system other than 15
probing or related procedures; 16
(19) surgery requiring full-thickness conjunctivoplasty with graft or 17
flap; 18
(20) pterygium surgery; 19
(21) ionizing radiation; 20
(22) intraocular injections penetrating the globe; and 21 BILL AS INTRODUCED H.241
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(23) retrobulbar or intraorbital injections. 1
(b)(1) An optometrist shall not prescribe or administer a drug or other 2
substance that is listed as a Schedule I or II controlled substance pursuant to 3
the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., as amended, 4
except as set forth in subdivision (2) of this subsection. 5
(2) Notwithstanding subdivision (1) of this subsection, an optometrist 6
may prescribe or administer hydrocodone in combination with analgesics, 7
provided that an optometrist shall not prescribe more than a 72-hour supply of 8
hydrocodone and shall not provide any refills of the prescription. 9
Sec. 4. 26 V.S.A. chapter 30, subchapter 5 is amended to read: 10
Subchapter 5. Diagnostic Pharmaceutical Agents Advanced Therapeutic 11
Procedures Specialty 12
§ 1723. ADVANCED THERAPEUTIC PROCEDURES SPECIALTY 13
An optometrist who is licensed pursuant to subchapter 3 of this chapter may 14
apply for an advanced therapeutic procedures specialty that authorizes the 15
optometrist to perform the advanced therapeutic procedures set forth in 16
subdivision 1703(2)(A)(vi) of this chapter. 17
§ 1724. QUALIFICATIONS FOR ADVANCED THERAPEUTIC 18
PROCEDURES SPECIALTY 19
(a) Generally. An optometrist shall obtain an advanced therapeutic 20
procedures specialty in order to perform the advanced therapeutic procedures 21 BILL AS INTRODUCED H.241
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set forth in subdivision 1703(2)(A)(vi) of this chapter. The Board may grant 1
an advanced therapeutic procedures specialty to an applicant who: 2
(1) is licensed as an optometrist pursuant to subchapter 3 of this chapter; 3
(2) meets the applicable requirements for education and demonstrated 4
competency set forth in subsections (b) and (c) of this section; and 5
(3) has completed the examination requirements set forth in subsection 6
(d) of this section. 7
(b) Educational requirements. 8
(1) In order to obtain an advanced therapeutic procedures specialty, an 9
optometrist who graduated from an optometric school or college prior to 2019 10
shall have completed a postgraduate course sponsored by an organization 11
approved by the Board of Optometry that had a minimum duration of 32 hours 12
and included the following didactic classroom instruction: 13
(A) laser physics, hazards, and safety; 14
(B) biophysics of lasers; 15
(C) laser application in clinical optometry; 16
(D) laser-tissue interactions; 17
(E) laser indications, contraindications, and potential complications; 18
(F) gonioscopy; 19
(G) laser therapy for open-angle glaucoma; 20
(H) laser therapy for angle closure glaucoma; 21 BILL AS INTRODUCED H.241
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(I) posterior capsulotomy; 1
(J) common complications involving lids, lashes, and the lacrimal 2
system; 3
(K) medicolegal aspects of anterior segment procedures; 4
(L) peripheral iridotomy; 5
(M) laser trabeculoplasty; 6
(N) minor surgical procedures; 7
(O) overview of surgical instruments, asepsis, and occupational 8
safety and health considerations; 9
(P) surgical anatomy of the eyelids; 10
(Q) emergency surgical procedures; 11
(R) chalazion management; 12
(S) techniques for and complications with local anesthesia; 13
(T) anaphylaxis and other emergencies that may occur in an office 14
setting; 15
(U) radiofrequency surgery; 16
(V) postoperative wound care; and 17
(W) clinical or laboratory experience that includes both video 18
demonstration and in vitro observation or participation. 19 BILL AS INTRODUCED H.241
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(2) An optometrist who graduated from an optometric school or college 1
in 2019 or later shall not be required to complete additional postgraduate 2
coursework in order to obtain an advanced therapeutic procedures specialty. 3
(c) Preceptorship requirements; competency demonstration. 4
(1) In order to demonstrate competency for an advanced therapeutic 5
procedures specialty, an optometrist shall complete a preceptorship during 6
which the optometrist gains at least eight hours of clinical training that is 7
supervised by a preceptor and demonstrates clinical proficiency with hands-on 8
experience performing the following procedures on live, human patients: 9
(A) at least two laser trabeculoplasties; 10
(B) at least two posterior capsulotomies; 11
(C) at least two laser peripheral iridotomies; 12
(D) at least two chalazion excisions; 13
(E) at least two chalazion intralesional injections; and 14
(F) at least two excisions or drainages of an authorized lesion of two 15
millimeters or greater in size. 16
(2) The preceptor shall be either: 17
(A) an optometrist with a substantially similar scope of practice who 18
has been licensed in Vermont or any other U.S. jurisdiction to provide the 19
advanced procedures set forth in subdivision 1703(2)(A)(vi) of this chapter for 20
at least three years; or 21 BILL AS INTRODUCED H.241
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(B) an ophthalmologist. 1
(3) The preceptorship shall involve direct and in-person supervision of 2
the optometrist by the preceptor. 3
(4) The preceptorship shall take place in a state in which the preceptor is 4
licensed and authorized to perform the advanced procedures. 5
(5) The preceptor shall certify that the optometrist has competently 6
completed the required procedures and provide a log of the completed 7
procedures to the Board. 8
(d) Examination requirements. The applicant shall successfully pass 9
written and clinical examinations administered by the National Board of 10
Examiners in Optometry (NBEO), including the NBEO Injections Skill 11
Examination (ISE), the NBEO Laser and Surgical Procedures Examination 12
(LSPE), and any other examination required by the Board by rule. 13
(e) Advanced therapeutic procedures specialty by endorsement. 14
(1) The Board may issue an advanced therapeutic procedures specialty 15
to an applicant who is licensed and in good standing in another U.S. 16
jurisdiction and who: 17
(A) has an expanded scope of practice that is substantially equivalent 18
to or broader than the expanded scope of practice permitted by this subchapter; 19
and 20 BILL AS INTRODUCED H.241
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(B) has been in good standing in the expanded scope of practice in 1
the other jurisdiction for at least three years. 2
(2) An optometrist whose advanced therapeutic procedures specialty 3
was issued by endorsement pursuant to this subsection may serve as a 4
preceptor in this State. 5
§ 1725. REPORTING REQUIREMENTS 6
An optometrist shall report any adverse event related to an advanced 7
procedure within 30 days following the event. 8
Sec. 5. 26 V.S.A. § 1727 is redesignated to read: 9
§ 1727 1705. EXPIRATION DATE 10
Sec. 6. EFFECTIVE DATE 11
This act shall take effect on January 1, 2027. 12