Legislation would enhance vision and medical eye care in Maine

By Dr. David Douglass

I’ve been a practicing optometrist in Bangor for 36 years. During that time, I’ve witnessed many changes in state laws, which have allowed optometrists to better serve our patients. Almost four years ago, my daughter, Dr. Chloe Douglass, joined my practice, which has allowed us to increase the number of patients who receive care. This is especially important as the demand for vision and medical eye care is increasing as Maine’s population ages.

Yet, even with two optometrists, we aren’t able to provide all the care our patients need. This is not because we don’t have the ability or availability. Rather, it’s because Maine’s laws don’t authorize optometrists to perform certain in-office, noninvasive minor procedures that many of our patients need. That means if one of our patients requires one of these procedures, we must refer them to an ophthalmologist. 

Optometrists practice in 15 of Maine’s 16 counties and provide eye care access to 92 percent of our state’s residents. Three counties don’t have any ophthalmologists, and two counties have only one. Although Bangor is the third largest city in Maine, there are only a few ophthalmologists in our area. 

My patients often have to travel an hour to Waterville, Portland or beyond for a procedure that could be performed in my office. Other patients have reported waiting four to six months and traveling one hour for a cataract evaluation with an ophthalmologist.

This year, legislators are considering LD 1803, which authorizes optometrists to perform minor, noninvasive laser eye procedures to treat glaucoma and after-cataract surgery care and minor eye care procedures to remove styes and skin tags. These in-office laser procedures can safely and comfortably be performed using only local or topical anesthesia and have been performed more than 140,000 times since 1998 by optometrists in other states. They are also approved to be performed under the U.S. Department of Veterans Affairs’ Community Care Program in states that allow full-scope practice. Legislation will also expand existing vaccination and prescriptive authority for optometrists.

As an optometrist and business owner, I am continually looking for ways to enhance the care I provide for my patients, including hiring highly skilled optometrists. I have been trying to hire a new optometrist for the last two years, but many qualified candidates have chosen to move to states that allow optometrists to practice to the full extent of their education and training. 

It is difficult to attract skilled health care providers, including eye care specialists, to Maine. A recent article in the Journal of the American Medical Association examined the geographic distribution of ophthalmic surgeons and evaluated factors associated with practicing in rural areas. The study “suggests a concerning geographic disparity in rural ophthalmic surgeons available to serve the needs of rural patients.” It went on to state, “It has been established that limited access to ophthalmic care generates negative outcomes among rural or patients in underserved communities, including increased prevalence of visual impairment, diabetic retinopathy, and macular degeneration.”

Since I began practicing in 1989, optometric scope of practice has expanded to include topical and oral medications to treat a multitude of eye diseases including glaucoma. There was even a time before I began practicing when optometrists were prohibited from dilating pupils during an eye exam, fitting contact lenses and prescribing eye drops for pink eye and glaucoma. Can you imagine not being able to visit your optometrist for this care today?

None of the states that allow optometrists to perform the procedures included in this legislation have ever reversed a scope expansion, and there has been no increase in malpractice rates in those states. Maine’s optometric scope of practice laws have not been significantly changed in more than 15 years. It’s time to modernize optometric care in Maine. Please ask your representatives for their support.

Dr. Douglass is an optometrist and owner of Eye Center Northeast in Bangor.