As a physician, state lawmaker, and former Air Force fighter pilot, I’m incredibly concerned about dangerous policies under consideration in recent years throughout dozens of statehouses and within the U.S. Department of Veterans Affairs (VA) that threaten Americans’ eyesight.
If implemented, these policies would lower standards for surgical eye care by allowing people who have never been to medical school to perform delicate eye surgery with lasers, scalpels, or needles. To everyone but the bill supporters, it’s clear that this change jeopardizes patient safety and ignores decades of established medical guidelines.
In 2024, at least 13 states, including my own state of Kansas, introduced legislation that would have drastically threatened the standards for safe surgical eye care. Unfortunately, South Dakota’s recent enactment of House Bill 1099 is emblematic of that threat. This new law allows optometrists—who are not medical doctors or trained surgeons and are primarily trained in routine vision care—to perform delicate surgeries on and around the eye. The South Dakota legislature’s support of watering down patient safety protocols marks a concerning shift away from expertise and safety guardrails in healthcare. This vast scope expansion passed despite strong opposition from patients, health policy experts, and medical experts, including those who know the risks of ocular surgery best: ophthalmologists.
Ophthalmologists are medical doctors and trained eye surgeons. They amass thousands of hours of training through medical school, internships, residencies, and fellowships to master the intricacies of ocular surgery. An optometry school curriculum is not comparable by any objective measure. But bills across the country suggest that a 32-hour training course would equip optometrists to use lasers and scalpels like ophthalmologists. Optometrists play an important, trusted role on the eye care team servicing Americans’ needs for annual vision exams and fittings for corrective lenses. However, optometrists incorrectly believe that they are adequately trained to determine who requires surgery—and to perform it themselves.
More concerning is that optometrists are willing to test their skills on patients despite only training with videos, lectures, and practice on models and props, not live patients under supervision of surgical experts. In fact, of the nation’s 24 optometry schools, only two are in states that even allow optometrists to perform laser surgery, meaning that for roughly 95% of optometry students nationwide, it is unfathomable to undergo the necessary training, which includes performing actual surgeries on real patients under direct supervision by an attending surgeon, as is required for ophthalmologists.
As a practicing medical doctor and surgeon long before being elected to public office, I deeply respect the strenuous requirements physicians must meet before obtaining the privilege to perform surgery. These requirements are in place to ensure that surgeons are fully capable of handling the procedure and any complications that may arise. Furthermore, it instills the expertise to determine whether surgery is even the proper course of treatment. Ophthalmologists often get referrals from optometrists who say the patient requires a specific surgery when, after further evaluation, it’s either an incorrect surgery that was recommended, or sometimes no surgery is required after all. Think what would happen if the referring optometrist took it upon themselves to perform that surgery on their own.
Patient care and safety are foundational in modern medicine, and this cannot be changed. Operating on someone’s eyes safely requires intense education and training to prevent serious or irreversible vision-damage. When it comes to surgical care, optometry’s standards fall short of accepted medical ones, which makes it so concerning that they are pushing legislation to gain surgical authority that they are not prepared to have.
Just ask the affected patients who sought treatment in Louisiana or Oklahoma about the permanent vision damage they have suffered after an optometrist performed laser eye surgery on them and it becomes obvious that letting unqualified individuals operate on patients’ eyes is dangerous. Sadly, organized optometry often trivializes opposition to this misguided policy as mere “scare tactics” and “fear mongering.” But those aforementioned patients and others like them are real victims whose lives have been turned upside down due in part to ill-advised legislation that allowed non-medical providers to perform surgeries for which they are significantly undertrained. The stories of these patients are anything but fearmongering.
Adding to the concerning state-level trend, the VA could soon put veterans like me at risk. The VA has already removed requirements that only ophthalmologists can perform surgery from its Community Care guidelines for eye care. The VA is now considering allowing optometrists to perform eye surgery at its facilities and through the VA's Community Care Program nationwide. Safe surgery has no shortcuts, and America’s veterans deserve the highest quality of care. If implemented, this VA policy could put veterans who risked their lives for our country at risk from being harmed by someone woefully underqualified to operate on their eyes.
I urge policymakers at the VA and my colleagues in statehouses nationwide to oppose any bill or policy that dilutes the qualifications required to perform eye surgery safely. High standards for such sensitive and potentially life-altering procedures are critical to prevent irreversible harm to patients. Fortunately, most state legislatures this year rejected these dangerous bills, including Kansas, where I proudly serve in the statehouse. But troubling legislation is still under consideration in New Jersey and Ohio.
The integrity of eye care is at risk from misguided efforts to broaden optometrists’ scope of practice. Maintaining rigorous medical standards that ensure the safety of eye surgeries is critical to ensuring that all patients—especially U.S. veterans—receive the high-quality care they deserve to protect their eyesight.
The Honorable William Clifford, M.D., MBA, is a practicing ophthalmologist in Garden City, KS and currently serves as Republican member of the Kansas House of Representatives. He is an Air Force veteran and graduate of the United States Air Force Academy.
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