Laser Eye Surgery Privileges for Optometrists Do Not Improve Patient Access

Laser eye surgery privileges for optometrists has not led to shorter travel times to receive care, according to a study published in JAMA Ophthalmology.

Researchers performed a retrospective cohort database study combining data from Medicare Part B claims, the 2020 US Census, geographical data from the Melissa Data application programming interface, TomTom road geometries, and TomTom historical traffic data from 2016 to 2020 to compare patient access to laser surgery eye care by estimated travel time and 30-minute proximity to an optometrist or ophthalmologist. The analysis included the following states: Oklahoma, Kentucky, Louisiana, Arkansas, and Missouri. A total of 1,564,307 individual claims were included in the analytic cohort. 

Optometrists in Oklahoma provided the most laser eye surgery procedures, including laser peripheral iridotomy (LPI, 33.2%), selective laser trabeculoplasty (SLT, 25.7%), and YAG laser capsulotomy (37.1%). Louisiana optometrists performed the lowest percentage of procedures among states with expansion of optometric scope of practice before 2016. 

Except for YAG and SLT in Oklahoma, fewer than 5% of the population within 30 minutes had access to only an optometrist for laser eye surgery in states with expanded scope. Isochrone maps indicate that optometrists performing laser eye surgery tend to operate in areas where ophthalmologists are already present in each state.

In Kentucky, patients drove a median of 49 minutes for YAG procedures performed by optometrists compared with a median of 23 minutes for ophthalmologists. These drive times were similar in Oklahoma and Arkansas. For LPI, patients in Kentucky drove a median of 61 minutes to see an optometrist, compared with a median of 21 minutes for an ophthalmologist. The drive time was shorter for new laser eye procedure patients seeing an optometrist in all states. Upon investigating the accessibility of healthcare professionals for YAG procedures in Kentucky, patients who chose an optometrist were within a 30-minute drive of an ophthalmologist (89.0%; 95% CI, 87.6%-89.3%) and the nearest optometrist (87.0%; 95% CI, 85.9%-87.4%). Opting for the nearest healthcare professional could reduce the median estimated travel time from 49 to 15 minutes.

“One of the primary arguments made for increasing optometric scope of practice is the possibility of improved access to care for patients. However, with the exception of YAG and SLT in Oklahoma, the percentage of the population within 30 minutes of only an optometrist for laser eye surgery procedures was less than 5% in the states with expanded scope; isochrone maps for each state showed that most optometrists performing laser eye surgery are doing so where ophthalmologists already practice,” the researchers report.

Study limitations include anomalies in the Medicare data including patients older than 120 years and out-of-scope procedures and the claims were limited to 2016 to 2020.

Disclosure: Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.