New legislation will allow Tennessee optometrists to include the use of medical lasers for specific eye care procedures.
Governor Bill Lee recently signed the new law which goes into effect in two years. Local Ophthalmologist Dr. Andrew Johnson said the new law allows licensed optometrists to perform three non-invasive office procedures. Johnson expressed the need for attention to patient safety.
“If a patient would go to someone who’s maybe only done two of these in their whole life, maybe it’s been even years since they were in optometry school and now they’re trying to do this unsupervised procedure, what could happen?” Johnson said. “That’s where I have concerns.”
Johnson said the high cost of laser equipment and decreasing Medicare reimbursement rates may prevent many local optometry clinics from offering these services immediately.
The authorized treatments include YAG capsulotomies to address scar tissue after cataract surgery and selective laser trabeculoplasty to manage eye pressure for glaucoma patients. Johnson called for standardization across the specialties, keeping operational protocols in mind.
“I think it is wonderful in thought, and it’s a good compromise with hopefully, lower risk procedures providing some access,” Johnson said. “There’s just some things I think that need ironed out to make it safe for everybody.”
The painless YAG laser travels through the cornea to remove scar tissue, while selective laser trabeculoplasty creates an inflammatory reaction that helps the eye recycle fluid more effectively.
“You have to be pretty precise with this because missing on the laser can cause pits to form on the intraocular lens that’s placed during cataract surgery,” Johnson said. “So this is something that you just have to be very careful to avoid, and it’s really easy, especially starting out, to put pits on the lens without proper supervision.”
Ophthalmologists undergo four years of surgical training after medical school to master these procedures. Johnson said he is concerned that the educational benchmarks for optometrists under the Board of Optometry guidelines may not match the rigorous standards required for medical doctors.
“Just by saying we’re increasing the scope and increasing access doesn’t necessarily mean we’re actually helping people, that can mean harm,” Johnson said. “So that’s just what, moving forward, I’d like to see equilibrated if you will.”
Patients in the Upper Cumberland already have access to these treatments through existing ophthalmology practices, Johnson stated.
“I would argue it’s worth driving 30 or 45 minutes to get to someone who’s done hundreds of these procedures, and already done a bunch that were supervised by ophthalmologists in training,” Johnson said.
The operational rules for the expanded scope of practice are scheduled to take effect January 1, 2028.