Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Hi, good morning. This is Senate Health and Welfare. It is Friday, January 30, and we're taking up S-sixty four, an act relating to the scopist practice for optometrists. This is a bill that we asked for that came to us from government operations and they'll probably take a look at it after we finish with it. Jen, trying to remember level have we been through a high level on this one or is this our emergency? We went through it. Mine had gone through it last year. Yeah, we went through it a little bit this year. Not gone through with me this year. Okay.

[Emily Carr (General Counsel, Office of Professional Regulation)]: Would you like me to do a Yeah. High level walk through?

[Sen. Virginia "Ginny" Lyons (Chair)]: I think a high level would be helpful. Up in there. Because there's a lot of words in there. And just so I'm down on those, but I think you wanna. But so folks know, this is the first day with the bill, and we have another day scheduled next week, and then as we go forward, we'll be looking at the issues within the bill, and having other testimony on it. And I know there's a huge amount of interest on the part of both optometrists and ophthalmologists. I know there's a history of this with OPR and I know that everyone has been hearing from all your friends who have been patients of either optometrists or ophthalmologists. So if you've a simple bill and we'll take some time. Okay. When you're ready?

[Jen Harvey (Office of Legislative Counsel)]: Yes. Okay, great. So for the record, Jen Harvey from the Office of Legislative Temple. And we'll put language up on the screen. S-sixty four is an acronym to amendments to the scope of practice for optometrists. It makes some changes the scope of practice and also creates a new advanced therapeutic procedure specialty that would allow optometrists who have specific training to do additional procedures. So, starts out, we are in the Title 26, which is Professions and Occupations, and we're in the chapter on optometrists, and there are some definitions. The first that gets amended is the definition of the practice of optometry, and most of the first changes are really just a couple of modifications, but just moving everything down a level from a subdivision standpoint. In order to add a new subdivision six here that allows an optometrist holding an advanced therapeutic procedure specialty, if we'll look at, to perform a list of advanced therapeutic procedures. So there's those procedures that are within the existing scope of practice, and then this would create a new additional set of procedures that someone with an advanced therapeutic procedure specialist could have performed. Surgery and laser procedures and other things. It does specify here the practice of optometry does not have been performing any of the practices set forth in 1720, which is a section that is amended here, and there's a list of prohibited practices. So, the practice of optometry does not include performing any prohibited practices in ALGO. And as a new definition of adverse, excuse me, adverse event, which is based on the definition from, the existing definition of adverse events, I to write down what it was, but from the patient safety surveillance and emergency system. So just an adverse event, this term gets used, but when a bad thing happens associated with delivery of healthcare services. Hence the definition of therapeutic pharmaceutical agent, which is a prescription or non prescription drug used in the diagnosis, prevention, treatment, medication of abnormal conditions in pathology of the human eye, or it's edmexa, which is a term I have to learn, this is like hurts that adjoin an organ. And then certain things that a therapeutic pharmaceutical agent does not include. We have renewal, so for under existing law, for renewal, optometry licenses must be renewed every two years. The same thing is true for licensees with an advanced therapeutic procedure specialty under September 5, but they also, during each period of a seizure period, must include an additional five hours of continuing education in the advanced procedures. Section three is that list of prohibited practices. So there are certain things an optometrist shall not perform, regardless of whether they have the advanced therapeutic specialty. And that is, they shall not perform any ophthalmic surgeries, with or without the use of lasers or injection procedures other than those that are specifically spelled out in this chapter, and it prohibits a number of procedures that I won't go through with you at the moment, although you can at a later time if you want, but certain things that optometrists shall not perform. Also prohibits an optometrist from prescribing or administering a drug or other substance that is a scheduled one or two controlled substance under the Federal Controlled Substances Act, with one exception, and that is that they can prescribe, they would be able to prescribe or administer hydrocodone in combination with analgesics within a very limited scope, not one that's seventy two hours and nobody else. Subchapter five, section four adds subchapter five, or amends subchapter five, but reframes it as the advanced therapeutic procedure specialty, and this allows an optometrist who is licensed under this sub chapter three to apply for an Advanced Therapeutic Procedures Specialty that authorizes them to perform specific Advanced Therapeutic Procedures that are set out in the dental mission section. In order to qualify for this specialty, the optometrist must, they have to get the specialty in order to perform the advanced procedures and report about optometry can grant the specialty to an applicant who is a licensed optometrist, meets the applicable requirements for education and demonstrating competency that are in this section, and has completed the specific exam requirements. The educational requirements are a little bit different depending on whether the optometrist graduated from an optometrist school or college prior to 2019, or 2019 or after. Some of what is taught in those programs change at that point, so if someone graduated prior to 2019, they have to complete a post graduate course sponsored by a board approved organization with a minimum of thirty two hours, and specific didactic classroom instruction. We'll go through at this point, but we can, again, repeat in a later date. An optometrist who graduated in 2019 or later does not have to complete the additional postgraduate coursework. My understanding is that before, for them, into the regular inquiry. There are also preceptorship requirements. So an optometrist has to do a preceptorship, working with a licensed practitioner during which they gain at least eight hours of clinical training supervised by the preceptor and then strike clinical proficiency. So, hands on experience performing a list of procedures on live human patients. And the preceptor must either be an optometrist with a substantially similar scope of practice who's been licensed in Vermont or another state, perform the advanced procedures, because that's what they're gonna be supervising and training on, for at least three years, or an ophthalmologist, which is a physician who specializes in eye issues. The preceptorship has to involve direct and in person supervision, take place in the state where the preceptor is licensed and authorized to perform the advanced procedures, and the preceptor has to certify that the optometrist is confidently required of the procedures and provide a law of two-four. There's also an examination requirement, and this is all for that specialty, the advanced advanced therapeutic procedure specialty. The applicant must successfully task written and clinical examinations administered by the National Board of Examiners on Autometry, and specifies at least two, and any others required by the board by rule. And then it's possible for the board to issue a specialty to an applicant by endorsement if they are licensed and in good standing in another US state, and they're already doing this kind of work and in good standing with that expanded scope of practice in that other jurisdiction for at least three years. And then, finally, it's required an optometrist to report any adverse event, that was one of those new definitions in the definitions section, related to an advanced procedure within 30 days, and then we have a, just a, kind of my group redesignation. And the act, so this bill was introduced last year, 2025, and had a 01/01/2027 effective date, so if you move forward with this, you may need to move the effective date out to allow OPR to do the work that's required to get this specialty ready. But I will defer to OPR to tell you that you care to. Okay, so now I ask you to describe each of the surgical. Thank you so much. Yes, that is not within my We got it.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you, Jen. Questions for Jen. Just sort of the order of the bill is pretty clear. And the conditions under which the scope would be expanded, the type of procedures that are included in the scope and those that are not. Yes, I will let the providers and OBR provide you specific differences. I've heard them talk about it, but it's certainly not my area of expertise. Thank you. And we'll come back to this again as we learn more. We'll come back and go through the deep dive. We're going to go to OPR, to check his office, professional regular, and so we understand the history of this, and we wanna be in seventh grade. Great. Both of them are

[John Nicole (Director, Office of Professional Regulation)]: Thank you so much for coming us today. For the record, my name is John Nicole, and I'm the director of the Office of Professional Regulation. And with me,

[Emily Carr (General Counsel, Office of Professional Regulation)]: Emily Carr, General Counsel of

[John Nicole (Director, Office of Professional Regulation)]: OPR. And this effort has certainly had a lengthy history at our office. We've studied this advanced specialty increased scope of the practice for optometrists, I believe since about 2019. That was before I was in the general council again. Our former general council did, and our staff attorneys did substantial work studying these issues, working with the Vermont Optometrist Association, working with Vermont Medical Society, the Ophthalmologists Society, stakeholders, having public meetings. So we have done a really deep dive on this, and ultimately, we do support S 64. So we'll

[Sen. Virginia "Ginny" Lyons (Chair)]: just I think historically, some of us understand that there was a sunrise Yes. That was negative Yes. And then there was a sunrise that was positive. Can you talk a little about So the yeah. So I'm gonna talk a little bit about our sunrise. Otherwise, we'll be talking about the hallway. Sunrise.

[John Nicole (Director, Office of Professional Regulation)]: Yeah. So we'll talk a little bit about our sunrise processes and reports, Then Emily will talk a little bit more about the statutory features that really to OPR, our lens is public protection and making sure that practitioners are safe. You've also heard testimony from our office this week that we really do want practitioners practicing at the top of their scope. That just increases the amount of health care access that people have in the state. And so our job is to make sure that there are ways that they can do that safely and confidently, particularly when we're talking about advanced practice. So we're confident this bill meets that, and we'll talk a little bit about why today. So, yes, we released a summarized report in 2020 after we did some study of these advanced procedures. And that report, think it's linked in our testimony, and if your community assistant doesn't if y'all don't have that, we're happy to forward that. But so the process for that report was that OPR met with the optometrist association, we met with BMS, we met with the Ophthalmologist Society, and we also met with some stakeholders who did not put a public meeting during that initial process. But we did reach out to every single optometrist school in The United States asking for more information about what they're teaching in their schools to see just like what are the educational requirements.

[Sen. Virginia "Ginny" Lyons (Chair)]: Is it 21 or 23 schools? Because I've heard both of those. Oh, great. Well, somebody will tell me. Great question. Okay. We'll find it. It's in the in the 20 It is in the report. Yes. But I I understand that there are 23, and that would be maybe they thought of a message or something. Yeah. I don't have that exact number. It's only gonna be oh, no.

[John Nicole (Director, Office of Professional Regulation)]: It is right here. It's we have 21. Now from my optometrist association is here today, so if I've got that incorrect, they'll actually Got it. We contacted all of those schools and asked for more information, like, in-depth about what's being taught in these courses on these advanced procedures. And we heard back from no one. So I think that was the big jam up in the first process. You know, we just didn't have enough information to assess whether there's adequate education so that we could make sure folks can do distance. So we also did reach out to patients who were identified by optometrists who had stories about access to surgeries and procedures through ophthalmologists and talked to them about their experiences and where they felt like maybe there were problems with access and whatnot. So we talked to those folks, but there weren't too many that we that identified, you know, substantial problems. I think a lot of the problems were, you know, it's far away for me to drive, and I've got eye problems. So, you know, I have to have somebody take me. So And the other issue seemed to be needing multiple appointments when they were going to ophthalmologists versus if they could just access the care through their optometrist, they felt that that would be more efficient. So in the first study, we could not conclude that that the public would be protected if we offered this advanced specialty because we just didn't have enough information about the edge speech. Then I believe there was a a bill in 2022, and that was the senate gov ops. And they asked OPR to go back and take another crack at it and look at every single state where these procedures are being offered, you know, get more information from the schools, and do, you know, do a a deeper dive, you know, a couple years after we did that first review. So we did that again. And this time, we also held public hearings. So I think we had two public hearings. I think there were about 70 people who participated, and we did a deep dive again on how every state who allows advanced procedures, what are their requirements, and what is the reporting back on negligence lawsuits? What's the reporting back on complaints to regulators about optometrists who are engaged in these advanced procedures? Are they having higher rates of reporting? And we did not see data that really suggested that optometrists who were performing these advanced procedures had higher rates of malpractice lawsuits or had higher rates of complaints with the regulators about injury arising from these procedures. So in our 2023 report, we did that VDOT, and Emily is gonna talk a little bit about our specific findings and recommendations of the report.

[Emily Carr (General Counsel, Office of Professional Regulation)]: Good morning. With the Leg Council's walkthrough, hopefully I have some additional information to provide and it's

[Sen. Virginia "Ginny" Lyons (Chair)]: not too redundant. Okay.

[Emily Carr (General Counsel, Office of Professional Regulation)]: So, yes, OPR's Optometry Scope of Practice report included recommendations and findings. And essentially, OPR said optometrists with adequate education, experience, and with the two examinations could safely perform specific surgeries, injections, and laser procedures. And these are already set out in the bill. There's a list of them. I'm going to avoid listing them out and trying to connect with the words. But also in the bill, in section seventeen twenty, you will notice that there is a large list of procedures that the optometrist would not be able to perform. So we are trying to provide, as Gin mentioned, procedures, greater access to certain procedures by avoiding going to ophthalmologists. Also, OPR decided that we needed additional safeguards for the optometrist to be able to provide these procedures, Those are also included in the bill, but specifically, we want them to report every two years the outcomes of all advanced procedures for Schulte III forms. And any adverse events within three weeks of occurring. And we also would like them to complete an additional five hours of continuing education every two years with their license renewal. And we need to clarify that optometrists with this specialty may prescribe and administer therapeutic pharmaceuticals that are prohibited from prescribing several one or two controlled drugs except hydrocodone in combination with analgesics, which would be allowed in minimum quantities. So I'm just gonna skip through my notes, find something that y'all haven't already heard about. So also, OPR does support the scope expansion. And the bill implements most of OPR's recommendations from the 2023 revised report. In addition to the education and examination and the experience, they will need to, the eight hours of working under a preceptor. And also, they will need to provide, be directly supervised by a qualified preceptor to perform certain procedures on live units. There's about seven of those procedures that they will be required to do before they can receive the specialty. In addition, I know that Legis Council noted that we might need to extend the timeframes for implementation of this bill because we will have to do rule making and we will have to donate some IT adjustments. Role making takes about eight months, so once this is passed, we would have to get the ball rolling on that. So we're asking for an effective date note earlier than drive nurse while we try

[John Nicole (Director, Office of Professional Regulation)]: and do it. In our first report, think we did also do a deeper dive about each of these procedures and what they are. I know that y'all are gonna be taking more detailed testimony about that at some point, but that is included in OPR's first report. So, essentially, yeah, I mean, we because we were able to get information from those educational institutions about what's required in their curriculum, we really saw that post 2019, this is being widely taught in all of these schools. Pre-twenty nineteen, we have that 32 course requirement just to make sure. That's not to say that some schools weren't teaching the materials before that, but after that 2019, it seems like all

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: of the schools between them.

[John Nicole (Director, Office of Professional Regulation)]: That's it. OPR supports this bill. We feel confident that the public will be protected because folks have adequate training, education, and they have to take those skills and examine each. So that was really a hard line for us too. We did not want to not require that, and my understanding is folks will have to travel for those examinations, but that was a very firm frontline that we thought was necessary. Okay,

[Sen. Virginia "Ginny" Lyons (Chair)]: great. Thank you. I do have a couple questions and the committee may have questions of you. I understand that you said that the first report will have a distribution of the procedures and we do want to look at that. The two reports, Celeste is going to be putting up on our webpage, so we'll have access under today's date for those. But my question of you is how did you make a determination about which procedures to include or not to include?

[John Nicole (Director, Office of Professional Regulation)]: I think that making the connection between what was required in the coursework and the curriculum and the skills examinations with respect to those specific procedures, my understanding is that that was the work that our office was doing to ensure that people would have adequate education around those procedures. And did that include any communication with an optometrist in our state or the ophthalmologist in our state? Yes, I mean throughout this process we worked with optometrists in our state and heard from optometrists in our state, and we also heard from MDs, ophthalmologists in our state. So, we did engage substantially with those folks. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: All right, what was the other one? Oh, oversight. So, you're concerned about safety. Yes. Top of scope, and also sounds like you're very interested in access. So, the oversight of these new procedures and the process, what does that look like through your office?

[John Nicole (Director, Office of Professional Regulation)]: Right, so first of all, the training that everyone, that eight hour preceptorship afterwards to ensure that the hands on clinical skill is there, that was a significant part of.

[Sen. Virginia "Ginny" Lyons (Chair)]: But no, but what I'm thinking is sure that's in place in the bill you're going to have folks who begin to engage with a preceptor, a question about it. Yes. And then you're going to have a self reporting of problems. Right. So how do you know that the preceptor and the practitioner are working together? What kind of reporting is there on that? And how do you know that the reporting for the good work and the bad work is there? The same question would go for medical practice, would think. How do we

[John Nicole (Director, Office of Professional Regulation)]: know that? Right. Like any of our professions, we have a robust enforcement process where people can make complaints online about any kind of service they receive from a licensed professional. Believe me, we get a thousand complaints a year. Sounds like the legislature. Yeah, it was that. We get a thousand complaints a year. We investigate probably 600 of those and prosecute other around 200. Area would be no different. Patients, witnesses, family members, anybody who wants to make a complaint to us about a procedure, we're gonna take a look at that, we're gonna screen it, and if it appears to have a basis in the law, we're gonna investigate that and get to the bottom of it. So just as in any of our professions, we wanna have that robust enforcement process.

[Sen. Virginia "Ginny" Lyons (Chair)]: So it's a complaint driven system? Yes. Just like a lot of private parts of All of our

[John Nicole (Director, Office of Professional Regulation)]: other healthcare licenses. That's right. Any questions, committee? Yes, ma'am. Oh, sorry. Okay. Thank you. Thank you, madam chair. I was just wondering if you looked at if if there's been any follow-up from 2023 to now, 2026, in terms of the number of reporting, the cases of reporting across the country. Yeah. So I was reading, and actually I'm glad you asked that question because last night I was like, I I need to do a little bit more looking into this since we, you know, concluded that work around the the report. And I was looking at a publication from an optometrist organization, a national organization, It was an article from January 2025. They were showing, comparing complaints and malpractice cases against ophthalmologists versus optometrists who are doing these advanced procedures.

[Sen. Virginia "Ginny" Lyons (Chair)]: For the same procedures or for

[John Nicole (Director, Office of Professional Regulation)]: total? I don't think it was as drilled down into That could be a problem. That could be a problem. And I'm sure from the optometrist associations, you're going hear more from them about this. My understanding of the data is there's not an appreciable difference between ophthalmologists performing these procedures and optometrists performing these procedures. Like, there's no big statistical difference in malpractice students or reporting to regulators about problems. Okay. Awesome.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Yeah. Alright. Super horrible. Yeah. Go ahead. This might be

[John Nicole (Director, Office of Professional Regulation)]: a question for someone else, but do you know how many of these procedures are performed in our state every year? That is not information I know often times about yet. I'm happy if you don't hear that from the upcoming news today. I'm happy to find that information. That would be great. And then my last question, on page 11 where it talks about the preceptorship and the preceptor, the preceptor, there a definition for that, Bill? Is a preceptor a surgeon? A

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: you know?

[John Nicole (Director, Office of Professional Regulation)]: I think it talks about the qualifications of the preceptor. Has to be what page? 11.

[Sen. Virginia "Ginny" Lyons (Chair)]: Number two.

[John Nicole (Director, Office of Professional Regulation)]: Okay. I'm reading that. That could be a licensed optometrist in the state who's had authority to do these advanced procedures for at least three years, or it can be an ophthalmologist, or it can be somebody from out of state who has the training and required licensure in that state to perform those advanced procedures, and the practitioner would have to, I think, be in that state do those Got it. Thank you. Awesome. I appreciate that. That's it. Can you provide any

[Sen. Virginia "Ginny" Lyons (Chair)]: Senator Benson and Senator Cummings.

[Sen. John Benson (Member)]: I just had a few items, and I looked at it, it's like, well, it was my old license, so I understand the procedure and it's also how things can be filed and But so and I thank you for your work and your diligence in really researching this, and your support for the field. Think this is interesting because the people rely on those licenses to ensure that public safety is occurring, and so I think that's very important.

[John Nicole (Director, Office of Professional Regulation)]: It comes back very seriously.

[Sen. John Benson (Member)]: And the other part of this is, and I know this through my own profession, is because you're told the license doesn't mean that you practice in that field. That it's up to each individual to actually practice within the range of their knowledge base. So just because they have the license doesn't mean that they have to perform that particular procedure. And it's also true that the patient, if they're not comfortable with that particular provider performing that procedure, they do not have to have that individual perform the procedure. So they're free to go through and ophthalmologist if that is what they are more confident in doing. So this simply gives within the authority their ability to obtain the required training experience to actually perform these services underneath that license. That's right. I follow Mr. Barrett Pratt.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, that's right. And

[John Nicole (Director, Office of Professional Regulation)]: one of the features of this field that was really important also is that if you have this specialty, every time you renew, you have to have CE requirements just to make sure that you're staying

[Sen. Virginia "Ginny" Lyons (Chair)]: making real juice for this.

[John Nicole (Director, Office of Professional Regulation)]: Lawyers have a lot too. We don't regulate lawyers, but yeah. So we do have that CE requirement too so that they're staying abreast of of these procedures and, you know, maybe if there's changes or evolution in how these procedures are done. So thank you. Yes.

[Sen. Virginia "Ginny" Lyons (Chair)]: I understand how this preceptor was running and we have records. I'm a little concerned about starting out. Yes, ma'am. That we're not gonna have anyone in well, we may have someone that's gotten the education, but they haven't been allowed to do it in this state. So you haven't been allowed to do this procedure, are you really qualified as you haven't done anything in five years to supervise somebody else? And if we go out of state, how do we know that the person doing the the oversight isn't somebody that's had a large number of malpractice or You know, until we get our own because if something goes wrong, this is gonna kill us for everybody. We go back to nothing. It just seems a little

[John Nicole (Director, Office of Professional Regulation)]: tricky to get it going.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, a little loose at that.

[John Nicole (Director, Office of Professional Regulation)]: I hear what you're referring to. First of all, advanced procedures have been launched in 12 other states. Believe the number is 12. In other words, they also have the same transition in getting the situation going. It was really important that we included ophthalmologists in being able to be the preceptors, because we do have ophthalmologists in Vermont who will help train optometrists to be able to do this work.

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm picking that up.

[John Nicole (Director, Office of Professional Regulation)]: Well, one can hope anyway. We will have the ability to have an ophthalmologist do that, and folks from other states who have the credential and who have that expertise can also oversee that. I think so. But I appreciate that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Think so comfortable if we said the persons from other states are actively practicing these procedures and we have a clean record. I wouldn't want to see some enterprising person become a preceptor now. Right.

[John Nicole (Director, Office of Professional Regulation)]: So if you feel that additional requirements for the preceptor would be Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: They have been actively forming these procedures and that they're better to be clear. I had a wheelchair's license but there were several years where I wasn't practicing. So Senator what I want to suggest is that comments that you're making now will be important when we go to Bill Marco so don't lose your thoughts and so because we have a lot of we have a long way to go. Have a lot of people looking to.

[John Nicole (Director, Office of Professional Regulation)]: And we've made a note of that. We'll have conversations about that. There are a

[Sen. Virginia "Ginny" Lyons (Chair)]: lot of questions like that. Yes. Okay. One?

[John Nicole (Director, Office of Professional Regulation)]: One quick last one. 12 states have launched procedures. Do you know if there are others that are in the process of potentially launching? I believe there are, and I would guess that the VOA would have additional information about nationally what the pictures look like right But we'll look into it if you don't hear that today. Yeah. Thanks. Great. Thank

[Sen. Virginia "Ginny" Lyons (Chair)]: you. Thanks so much. We're good. Appreciate it. We'll look at, We will have questions as we go along. Not on the hook yet.

[John Nicole (Director, Office of Professional Regulation)]: Happy to come back. Thank

[Sen. Virginia "Ginny" Lyons (Chair)]: you. Right, so we have Dean Barcelo who's here. Soon as the chair is yes. So senator Oh, sorry. Senator Morley has the B and another.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Ready when you are. Ready. I'm Dean Barksmode. I'm the immediate past president of the Law Optometric Association. I wanna thank all of you guys for taking time, especially Center Lyons, for taking time to visit schedule to join us in this I've worked my entire career here in Vermont, and I follow both my father and my grandfather in the profession of optometry in the same practice located in South Wales and Vermont. Because of that, I have a unique perspective on how optometry has changed for the last three generations of practice. There are no healthcare providers who practice the same way they did ten years ago. We work in an industry that's constantly changing for the better. Optometry has on occasion come before the legislature and asked for change to our statutory requirements and will return it to ask them. In the past, this committee took testimony when we wanted to treat Lyme disease called Leukoa, And for those who are here, you'll remember that we took a testimony that said optometrists treating glaucoma would increase the mortality and the morbidity of patients. None of that has come to this. There has never been an optometric scope expansion in Vermont that was repealed, and there's never been one in the country that was repealed. S 64, in its simplest terms, asked the legislature to allow them to perform some additional in office straightforward chairside procedures. These procedures are performed by optometrists across the country and are taught to every optometrist who graduates from a doctoral level program in The United States. The bill is nonpartisan, had strong senate support, has passed five for five out of government ops, and has the support of OPR, and it benefits your constituents. Sorry, you're fine. This legislation represents, as you've heard, more than six years of careful work and collaboration. OPR supports language and it's added its requirements for additional training of the Gulah optometric birthplace. These requirements, when tasked, will make Vermont optometrist path for advanced procedure advanced practice the most stringent in the country. It will be more than any of the and not correct very well informed consent states that have substantially similar story. The testimony we plan to present to this committee will address the national landscape, our extensive education and training in optometry school, which includes eight or more years of post secondary education and a curriculum requiring a minimum of 2,000 patient impairments. This education is why federal government, CMS, has classified optometrists with dentists, podiatrists, doctors of osteopathy, and medical doctors as physician status. We will also cover the positive impact on workforce capacity and the potential to reduce overall eye care spending in Vermont. The time is right to move this bill forward, plus we've been working on it for a while. It represents a clear win for Vermont patients and aligns squarely with the state's objective of strengthening rural health care. Meaningful engagement with stakeholders is essential to address questions and correct misinformation. We're prepared to do so and are confident that the training, education, and evidence support this policy direction. The expansion of practice addresses several of the most prevailing challenges currently facing the legislation on the island's health care. The reason for requesting this change is simple. It increases access to patient care. Patients can be seen sooner. That reduces wait times. They're often three months or more for an initial visit. It will remove redundant care, effectively reducing wait times not only for these procedures, but also for others we don't perform. It will decrease travel times by providing care closer to home and lower costs by moving this care into a more appropriate setting. Vermont is becoming less competitive on the national stage. There are 25 states that allow optometrists to practice at a higher level than the State of Vermont does. And as I just said, 14 of those have language that's substantially similar to the proposed language. We have submitted several documents, but the first two I'd like to share. This one is the 14 states, and this is the scope of practice for every state in the And if you'd like to review those, please submit them.

[Sen. Virginia "Ginny" Lyons (Chair)]: Do you have those under different names? Or do I have the refreshed?

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Between my office in Bethel and here at the steakhouse in Montpelier, we've lost four eye care providers who couldn't sell their practice and didn't have anybody come in, and so they closed up shop in the last several years. This legislation would help make our state on par with the education young professionals are graduating with, increasing the attractiveness to work here. Additionally, we all know that Vermont is among the oldest populations in the country. This means more medical care and in turn more eye care. Vermont has about three times more optometrists than our colleagues in ophthalmology. I have a second panel. The first here is the distribution of optometrists by quality of the body. So with the exception of the top two corners, optometry has at least three optometrists in every county. If you compare that to ophthalmologists, there are only two counties that have three practicing ophthalmologists. So it'd be Rutland and Burlington. We have five that don't have any, and then it's just a matter of the performance. Speaks to the distribution of eye care. Ophthalmology is disproportionately located in Vermont's larger cities and towns. Additionally, the number of ophthalmologists is shrinking just when economists project an increased need for services. In an article published in the Review of Ophthalmology, published by Ophthalmology, They project a 12% decline in the number of ophthalmologists between now and 2035, but a 24% increase in demand. Please remember that ophthalmology often subspecializes in particular aspects of patient care, as their own article that I just pointed out, points out. And that makes the number of ophthalmologists who are willing to do small in office procedures even smaller. Allowing optometrists to increase the scope of practice will encourage more eye care coverage in wilderness. We've submitted a brief from McFadel Institute as well as one from West Virginia University that state that scope of practice changes expand access So Dean,

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm gonna interrupt you because Melissa does not have the documents that you're talking about. Someone else may have sent them to me or just earlier,

[John Nicole (Director, Office of Professional Regulation)]: but if you could consolidate

[Sen. Virginia "Ginny" Lyons (Chair)]: those so we have that because they have a lot of good data.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Thank you. So these research briefs state that scope of practice expands access to eye care. We present a paper from West Virginia which concludes that states that support scope of practice changes for LASR procedures benefit populations in non metro areas disproportionately to metro areas, with its greatest effect happening in rural areas. In particular, and I quote, benefiting the elderly, low income, and then marginalized populations. In addition to benefits to Vermonters, scope expansion will reduce the cost of procedures to the healthcare system. As this committee knows, procedures performed in a hospital setting have a higher cost than those performed in private practice, independent of provider type. Patients referred from private practice optometry to private practice ophthalmology still require a repeat examination to confirm the existing condition before the procedure is considered. This might be another full examination, additional testing, and serial visits in order for the ophthalmologist to be comfortable enough with the patient and the patient comfortable enough with the provider to proceed with the procedure. Each of these redundant visits increases cost to the system. We maybe haven't provided you yet, but we will. We provided a couple of graphs outlining two of the procedures that we're asking for that are laser procedures that compares just in the optometry office versus a hospital and versus a private practice ophthalmologist. It's also worth considering that for many of the procedures we're talking about, they substitute attention for medication, and medication is also a constant health care system. In conclusion, S-sixty four will help Vermont. It will help address the projected future need for eye care as the number of ophthalmologists declines. It will increase access to eye care, in rural areas, and will work to make Vermont more attractive for recent graduates. It reduce cost of patients in the health care system as you go. I would ask if you guys support S-sixty four, ask any hard questions that you might have, and let's talk about it.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. So can you talk really briefly about your role as the president of the Vermont Optometric Association, and maybe it's different from the board of optometry that oversees, and we're gonna wanna understand a little bit about the board of optometry, but how many folks belong to your organization, and do you have both New Hampshire and New Hampshire? Sure. So, the

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Broad Optometric Association is probably best described as a trade organization. Yes. It's optometrists who get together, we help provide the continuing education for the state. That is separate from the Board of Optometry, which falls under the Office of Professional Regulation. They are really charged with making sure that the public is safe and administering licensure and answering questions. We sometimes answer questions about licensure. I get questions all the time, but there is sort of a distinct difference. The Board of Optometry, I suppose there is a mechanism for the board of optometry to pursue this. I think they are often reluctant to to dive head in to legislation because they are also trying to We would

[Sen. Virginia "Ginny" Lyons (Chair)]: would ask we're gonna ask the OPR. Yeah. Yeah. I understand the separation So we

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: all spawned the organization, the Baro Optometric Association, to bring this kind of legislation forward with that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yes. Thank you, Senator Gulick. Thank you, Madam Chair. Thank you for your testimony. Thanks.

[Sen. Martine Larocque Gulick (Vice Chair)]: I appreciate it. You mentioned that four eye care providers that closed in your region, were they optometrists or ophthalmologists?

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: One ophthalmologist and three optometrists. Thought they bypassed that. So I don't know if

[Sen. Virginia "Ginny" Lyons (Chair)]: We'll get that stuff. J. Kimberly. Midnight reading.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Yeah, right down the road. Don't if it might go. Thank you,

[John Nicole (Director, Office of Professional Regulation)]: I was just curious.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Ripley, Very Optical, Kimberly, and Doctor. Sears. Okay.

[Sen. John Benson (Member)]: I can't pronounce I say I What percentage of oh, in your profession have the training currently that it

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: is now that we require the form that services, the expanded services? Sure. It depends on whether we're running off OPR's definition or not. I mean, when I graduated from optometry school in 2009, I had gone through all of this. I performed these procedures, many of these procedures, on live patients during my residency. Unfortunately, by the time we pursued this, had been ten years and those records are gone. I would probably tell you that somewhere between ten and twenty percent of Vermont's optometrists have had, they had like real expensive training in this. And I think you're gonna find that my father's generation is happy to shift to other providers. We're looking, we're really looking at providers who graduate in the last ten years. That's an off the cuff.

[Sen. John Benson (Member)]: Yeah, I'm just curious.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Other Yeah. Questions? I do have a couple questions. So for optometrists currently, I know you were talking about wait time and the consolidation of folks in Chittenden County and other parts of the state. Don't think that the doctor can remember my own county. But what are the current wait times for optometrists for their current service delivery.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Did you get an appointment at Yeah. My Three weeks maybe. Three weeks, yeah. And so

[Sen. Virginia "Ginny" Lyons (Chair)]: we'll fill that.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: I'm happy to call and

[Sen. Virginia "Ginny" Lyons (Chair)]: ask them. I had a longer wait time, that's why I asked.

[Emily Carr (General Counsel, Office of Professional Regulation)]: But I like my optometrist.

[Sen. Virginia "Ginny" Lyons (Chair)]: I like my ophthalmologist.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Yeah. I think that varies a lot. Vermont is funny in the way that people flow when they travel for things. Yeah. Understood.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Population

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: based is important. I will tell you, I see more patients out of Montpelier and Bethel, Vermont than I ever thought was possible in recent years. It's why it

[Sen. John Benson (Member)]: is, yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: The other question I have is, so with regard to geographic distribution, if this were in place, how would we guarantee that the optometrists who are not currently situated would simply expand to their scope, and then the rest of the state would remain sort of deserts here and there? How do we know that we would see an expansion of care provided? I mean, in a way It's probably question not

[John Nicole (Director, Office of Professional Regulation)]: of a

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: You're sort of relying on capitalism to work there, right? Exactly. You move to the void. I think it will take time, way this is written, somebody asked, you asked specifically about how we're going to get the training kind of up and running from step one. That's something that we're pretty concerned about, too. But we've been assured by the schools that they've got training in place and they have people who can work with us. We've actually been told by a couple of ophthalmologists they've looked at us. That's good

[Sen. Virginia "Ginny" Lyons (Chair)]: that I can do that. The other thing is, a few years ago we had a dental assistant fill and one of the conditions we put in was that they had to start in the less populated parts of the state. So there were some of those conditions putting. I'm not suggesting that it will happen here, it came to mind as you worked with the doctor.

[Sen. John Benson (Member)]: I

[Sen. Virginia "Ginny" Lyons (Chair)]: think that's it for now. I know that you will be back. I'd be happy to. No, we can talk about that. That's been a huge discussion at the Vermont State Colleges, BSC.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: Is interesting that that dental therapist comes up when we talk. I assure you when this passes, optometry will take this off for our patients. Oh, I'm sure.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Have do I have the whole list of people? I have Doctor. Nate Leithniz over here.

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: He's right behind me on the screen.

[Sen. Virginia "Ginny" Lyons (Chair)]: There you are. Thanks for being here. You wanna stay

[John Nicole (Director, Office of Professional Regulation)]: up here? If there's no seats, just Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: Go ahead, Doctor. Leitheizer. Welcome.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Thank you for having me. Good morning, everybody. Can you guys hear me?

[Sen. Virginia "Ginny" Lyons (Chair)]: Where the sound issue if you two things. One, turn your volume up as much as possible, and then get as close to the mic as you can.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: K. Testing 12. 12. Can you guys hear me?

[Sen. Virginia "Ginny" Lyons (Chair)]: That's very good. Thanks.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Okay. Good morning everybody. I hope you guys are doing well. My name is Doctor. Nate Lighthizer. I'm an optometrist here in Oklahoma, a faculty member, and I serve as the Dean of the NSU Oklahoma College of Optometry. So I'm one of the there's currently, as you see, guys said, 23 colleges of optometry across the nation. I am one of the 23 deans. I happen to be the Dean of the Oklahoma College of Optometry. Can I share my screen? Is that okay if I share my screen?

[Sen. Virginia "Ginny" Lyons (Chair)]: I've got permission.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Okay. I'm gonna see. Can you guys see

[Sen. Virginia "Ginny" Lyons (Chair)]: We see all the slides.

[John Nicole (Director, Office of Professional Regulation)]: Can you

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: can you see my slides there?

[Sen. Virginia "Ginny" Lyons (Chair)]: Not yet. No. There no. There's nothing.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Yeah. It's okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's stuck. Now it's you.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Now it's me.

[Sen. Virginia "Ginny" Lyons (Chair)]: Good. Take your time. Take some work. Good. We didn't see them, but they were all on the screen. Yeah. It was all K.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Let's see. Let's see if you can see it this way. I got two screens set up here, so that's why I'm like, what? I'll share this again. Can you see him there?

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, I got it. I'm good. You got it.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: It's not full screen because when it went full screen, I don't know why it wasn't showing anymore.

[John Nicole (Director, Office of Professional Regulation)]: No. You're okay. You're okay.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: I am here in support of the Vermont optometrist moving forward with their laser and surgical procedures. They're in office procedures in Vermont. I have extensive experience in performing these procedures. I'm a 2,009 graduate of Pacific University in Oregon, actually a North Dakota boy, born and raised in North Dakota, spent the first twenty three years of my life in North Dakota, did my optometry school in Oregon. And I went down to Oklahoma for my residency training and did my residency at the Oklahoma College of Optometry in 02/2010, joined the faculty at the completion of my residency and have been here in Oklahoma ever since. I have again been practicing for close to sixteen years and have been fortunate to have done or supervised students and residents thousands and thousands and thousands of these procedures that are outlined in the bill that you guys are discussing today, from laser procedures to eyelid injections, removals of various lesions of the eyelids, things like that. So there are currently 14 states across The United States that authorize optometrists to perform laser procedures. And there are 21 states that authorize optometrists to inject lidocaine, local anesthetics, perform eyelid procedures, remove what we call lumps and bumps, lesions of the eyelids, etcetera. There's 21 states that currently authorize that. Going forward here, I'm really here to outline education and training. Obviously I work at a school, I'm the Dean of an optometry school and I can tell you about the training and education that currently happens in optometry schools. I will tell you that every optometry school across the nation, every single one of them trains their current optometry students on laser procedures, surgical procedures, these in office procedures that we are talking about. Training happens at multiple levels. Training happens in the classroom. You listen to lectures, multiple classes and go through all of the didactic and theory of how this works and how you should do that. That happens in the classroom, watching videos of procedures performed. But after you go from the classroom, you need to go into the laboratory. Laboratory workshop, hands on training, which all optometry schools again are in the classroom. All optometry schools are doing hands on laboratory training. You can see this photo here of optometry students getting trained on laser procedures. This procedure is called an SLT or a selective laser trabeculoplasty, which is a laser that Dean talked about that's done for glaucoma to help ease the burden on patients having to take eye drops, helps to lower their eye pressure. So laboratory hands on training on model eyes that are developed by ophthalmology, used by ophthalmology and used by optometry in every single optometry school now as well. So again, training starts in the classroom. It goes to the hands on laboratory training that you just saw, testing on both of those. Our students have written testing, they have laboratory testing where they basically have to walk into a room and there's a proctor there that goes, okay, demonstrate how you would do this procedure. What would you put in before the procedure? What drops would you put in after the procedure? Would you take me through the steps and perform the procedure on Model Ys? Again, every optometry school in the nation is doing number one, number two, and number three. And then in Oklahoma, we have a law that allows us to do number four, actually treat patients in the clinic. When I am done here with this testimony, I'm gonna walk down, I'm in clinic this morning. Somebody's covering my clinic right now I'm going to, for the rest of the morning, be performing laser procedures with our optometry students in clinic. You can see them performing actual procedures, whether it's an SLT, whether it's a YAG capsulotomy, a laser peripheral iridotomy, those are the laser procedures outlined in this bill. Again, they are performing these procedures on patients. We're doing this in Oklahoma, in Kentucky, in the states that allow us, because we have a lot to do that. So you can't penalize the New England College of Optometry, the Massachusetts College of Optometry, the State University of New York, they train in the classroom. They train in the lab, they test their students on that, but their law doesn't allow them to do these procedures. So when somebody tells you, perhaps an opponent tells you, well, don't have the proper training because they don't do live procedures. Well, the law doesn't allow them to do live procedures. And then you say, well, we can't change the law because they don't have the proper training, but they can't get the proper training because the law doesn't allow it. You see you're caught in a catch 22 there. Now, fortunately again, us in Oklahoma, we have a law that allows us to go to all four levels of this training. So in the classroom, in the laboratory, extensive testing, and then treating patients in clinic. Again, students are having this at all of the optometry schools to the highest level that the law allows them in each individual state. So the question then becomes, well what happens if a doctor graduated twenty five years ago or thirty five years ago? Education as Dean said, it continues beyond the day that you graduate. I graduated in 2009. If I practiced to 2009 knowledge, I'm guessing none of you would want to see me as an eye doctor. We continue to evolve and that's why we get continuing medical education every year. I'm fortunate that I lead what's called our laser and surgery course, our advanced procedures course, ophthalmic procedures course. Those are just different names for the same course. Have traveled and here's me preparing to do a laser procedure. I show this picture because this is very, very similar, the same skills as a slit lamp exam. Every single optometrist in the country, every single optometrist in Vermont has a slit lamp or multiple slit lamp. So you've probably had your eyes examined, put your chin in here and your forehead up against the forehead rest and they examine your eyes. These lasers, that's a laser right there. And it has very, very, very similar skills as doing a slit lamp. So education and training would certainly happen in Vermont when you guys pass this law and bill, but I can assure you after training optometrists in 49 of the 50 states that

[Dr. Dean Barcelow, OD (Immediate Past President, Vermont Optometric Association)]: much of

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: the skills are already there. They will build upon the skills that they have learned through four years of optometry school and all of their clinical practice and build on this to add a new skill. But the foundational skills are slit lamp and putting a lens on the eye when you're performing these laser procedures. Again, continues after your schooling ends, after your formal education ends, this is our advanced procedures course, our laser and surgery course, our ophthalmic procedures course. Again, mentioned three different names for it. This is a thirty two hour intensive four day course that we have put on in 37 of the 50 states. Every single state that has authorized these procedures, the 14 laser procedures, the 20 plus states that have injections have required that thirty two hour course. If you look into your laws, you guys were reviewing that law, that thirty two hour course for doctors that graduated 2019 and before it's modeled exactly after this course. I've headed this course for the last fifteen years and I'm happy to answer any questions on this. We've actually had numerous ophthalmologists involved in this. We did this course in The UK and The United Kingdom as they have expanded and are doing laser procedures in The United Kingdom. And there was an ophthalmologist involved in this course that provided a laser and you can see his quote at the bottom. He said, Boy, I wish we had training this good when I started performing laser procedures. I was basically shown the laser and said, just go ahead and start doing it. He goes, I wish we had training like this. So training that, I guess to sum up training not only happens currently in optometry school in 2026, but world class education and training happens for doctors that graduated prior to 2026 and prior to 2020 as well with post graduate secondary training, doctoral training, as you can see with this course here. I'm gonna, in my last few minutes here, I wanna mention a couple of different procedures. SLT, this is a laser procedure done in the office for glaucoma. And this has now become first line therapy for patients. When patients come in and they are diagnosed with glaucoma, historically they were often put on drops. It was Mrs. Jones, Mr. Jones, we have got to take a drop or two drops or three drops. And that is a burden on patients. The literature has been very, very clear now that SLT, this laser that Vermont optometrists are asking for, that 14 other states authorized optometrists to do, it is a first line therapy, meaning it should be done first line and helps to ease the burden on patients. And there's huge studies out there, this is the LIGHT trial. Every optometrist and every ophthalmologist across the country has heard of the LIGHT trial. This was released in 2019. And it said, you can see the conclusion, the yellow arrow, SLT not could be, it should be offered as a first line treatment. Meaning let's not go to drops first every time. It's not drops and drops and drops that they have to take every single day. We have a laser that we can do in the office that helps to lessen or eliminate their need for drops for periods of time. This should be offered as first line therapy supporting a change in clinical practice. If I ask Dean, I said Dean, who treats glaucoma first line in the state of Vermont? And Dean's answer would be who? Who treats glaucoma first line?

[Sen. John Benson (Member)]: Always optometrists.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: Optometrists do. We have wonderful glaucoma specialists, they are reserved for moderate to severe glaucoma. When they need surgical procedures, optometrists treats glaucoma first line. And we have two wonderful first line treatment options in glaucoma. We've got some wonderful eye drops and we have a wonderful laser as well. And the first line glaucoma eye providers in Vermont optometrists should be able to make the determination along with their patient, what is better for Mrs. Jones or Mrs. Jones? Is it a drop in this instance or is it a laser as well? So it'd be a huge public health win in my opinion for the citizens of Vermont if optometrists were allowed to use SLT because they are the first line providers and go back here. Huge public health win.

[Sen. John Benson (Member)]: Okay,

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: I do wanna in my last couple of minutes outline, there was a couple of questions. Are there studies out there? Can you guys see this study, this original investigation, YAG laser capsulotomy?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Okay.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: This is published research, peer reviewed published research of one of the laser procedures, YAG laser capsulotomy. Efficacy and outcomes performed by optometrists, ninety nine percent of patients in this study reported a visual improvement, ninety nine percent. And you can see the conclusion based on the outcomes of this study, YAG capsulotomies are effective treatments to improve patient vision that can be safely and effectively performed by optometrists. There were no complications in this study. This was a study that did compare data of optometry to the ophthalmology published literature. That's what this table is looking at. Of these 20 published studies, this study that was published by optometry was the fifth largest. So it's not like we did a small study and the rest of them were big studies. It was the fifth largest study. It found the exact same starting visual acuities and the exact same ending visual acuities as the ophthalmology studies. Meaning patients started twentyforty with three lines reduced vision and improved to twentytwenty after this procedure there with no complications with this. So yes, there is published literature out there on these exact procedures that they are talking about in Vermont. This was another one that was referenced, establishment and review of educational programs to train optometrists in laser procedures and injections. We looked at and contacted every single state board that has already authorized these procedures. Excuse

[Sen. Virginia "Ginny" Lyons (Chair)]: me, you need to exchange seats with our VPS. Thank you. Thank you, Rachel. Sorry for the interruption, please keep going.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: No problem. We contacted every single state board that has previously authorized optometrists to perform laser procedures. That would be Oklahoma and Kentucky and Louisiana and Indiana and Mississippi, etcetera, etcetera, etcetera. And said, how many complaints have been filed? How many lawsuits have filed to the board of examiners, to health institutions like OPW. And we published this study. This was electronically published in the 2024, published in print early in 2025. And you can see as of 2024, if you guys can see the highlighting here, the outcomes of over 146,000 laser procedures have been reported by optometrists to the various state boards with two negative outcomes, two complaints, two lawsuits at this point. That is two out of 146,000 procedures. As you all know, certainly in medicine, things can go wrong. Have I had a complication of laser procedures? Absolutely, I've had one of those before in the thousands and thousands and thousands that I've done. And I contacted one of the ophthalmologists in 2011 when I had that first complication And he said, Nate, the only way you're never gonna have a complication is what? To not do the procedures. So if you do procedures, you're going to have complications. Fortunately, they are very, very, very rare. Two out of one hundred and forty six thousand in the published literature proving a very, very strong safety track record in the 14 states that authorized this. With that, I think I have covered everything. Questions for me?

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. That was really very well done. We appreciate it. And if you could please send us your testimony slides so we'll have it for the record, that would be very helpful. I do have two questions for you from your perspective. Obviously you're in a different situation from the local optometrist at Northeastern Oklahoma. Have two questions. One, patients with complex, and this is a question that will probably come up ongoing with folks, whether they're optometrists or ophthalmologists, which is how you deal with patients with complex diagnoses. You know, so someone who's got cancer, has had a stroke, has high blood pressure, has glaucoma- not an unusual thing as folks get older. Sure. And the training that you have there and what I would ask is, I'm asking this kinda generally, think, for anyone who's going to be testifying. Well, thoughts there briefly.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: That's part of all the education and training that optometrists have that our students have. Not only are they trained in laser procedures and injections, we are trained in systemic disease and every systemic disease that can affect the eyes. You wouldn't believe the amount of patients that we have that have high blood pressure and high cholesterol and uncontrolled diabetes and strokes of the eyes. And our students are incredibly well trained on this. Not only do they have, I'm going to go down to laser clinic here in just a little bit, they have diabetic eye clinic and glaucoma clinic and ocular disease clinic and acute care walk in clinic where anything walks in from the piece of metal in the eye that we have to remove to somebody that just had a stroke and can't see in part of their vision. And they are trained to handle all of that, To handle all of these medical complications that go with this. Yeah, it's unusual to see a patient that needs a YAG laser capsulotomy to clear that cloudy membrane. They're usually what age? In their 60s, 70s, 80s. They've got high blood pressure and they have high cholesterol. You evaluate all of that as part of your general medical eye exam, looking at the front of the eye, the back of the eye, and making sure that the benefits of a procedure outweigh the risks of a procedure. For example, if I have a patient that has extensive diabetic macular edema, they have diabetes and they have swelling in the back of their eye. I'm going to postpone that yag laser capsulotomy until the macula is taken care of by a retina specialist to take care of that diabetic macular edema. Does that make sense? So you look at all these different things and evaluate their medical history and make a decision as the doctor when you include all of the totality of all those things. So yeah, they're incredibly well trained on all of these complex systemic conditions and how they affect the eyes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. I have one last question if you could answer very shortly for me. One of the things that you said was that the laser surgery would preclude the need for drops and that so you would go right to the laser surgery rather than have the drop. You said that. So on principle, do you work from the least invasive treatment first or not? So that's just a yes or no really, but we can get into that another time I think with folks who come in.

[Dr. Nate Lighthizer, OD (Dean, NSU Oklahoma College of Optometry)]: We offer the two scientifically proven first line therapies, which is drops or lasers. We offer both of them to them and explain the pros and cons of both. The laser certainly is more invasive because you have laser energy going into the eye but the way it works, it is incredibly, incredibly gentle. You can't even tell you've had the laser procedure done. And the offset of maybe it's more invasive is the benefit of having a laser once a year, once every other year, once every three years versus taking drops every single day. So we make those decisions together with the patient. Okay,

[Sen. Virginia "Ginny" Lyons (Chair)]: thank you for that. All right, good. Thank you all for today. This is the beginning of S64. We have more testimonials scheduled beginning with some ophthalmologists next week, and we'll continue to look at the bill together so we can fully understand what the procedures are and what the the other provisions of the bill are. So we're gonna move on right now. Thank you, officer. So let's change the room because we're moving to. That's