Vermont’s ongoing battle over eye care access has landed squarely in the Senate Health and Welfare Committee, where a bill proposing to expand what optometrists can legally do in the state has sparked an unusually bitter dispute between two professions that, at least in theory, share the same mission.
S.64 would allow qualified optometrists to perform a defined set of advanced procedures currently limited to ophthalmologists. Those procedures include specific injections, certain laser treatments for glaucoma and cataracts, and minor surgeries to remove eyelid lesions or cysts. Supporters argue the bill addresses a genuine shortage of ophthalmologists in Vermont, particularly in rural communities where patients sometimes wait months for care that requires a surgical specialist.
The bill drew from a 2023 report by the Vermont Secretary of State’s Office of Professional Regulation, which found that optometrists could safely perform those procedures with appropriate training and oversight. That finding gave the legislation its foundation, but it has not quieted the opposition.
Committee Chair Sen. Ginny Lyons, D-Chittenden Southeast, delayed a Thursday vote, pushing deliberations to Friday, the first crossover deadline day. The extra time reflected the weight of the decision and, notably, the volume of pressure committee members had received from outside.
Lyons did not mince words about the tone of that pressure. “I’ve heard some pretty negative and uncomfortable and not nice emails,” she said, adding that she found the conduct “really inappropriate.” She drew a firm line between the professional question before the committee and what had apparently become a personal campaign by some stakeholders. “This isn’t a personal issue. This is a professional issue,” she said.
At the center of that professional debate sits a meaningful distinction in training. Ophthalmologists complete four years of medical school followed by four or more years of residency. That background gives them broad exposure to systemic medicine, and critics of S.64 argue that depth matters when procedures go wrong. A complication during an eye procedure might implicate cardiovascular health, blood pressure management, or other conditions that require a broader clinical lens.
Lyons raised that concern directly, asking how an optometrist would manage a post-procedure complication. Would a patient end up in the emergency room? How would referral coordination with an ophthalmologist actually work in practice?
Opponents of the bill have also raised concerns about repetition. Surgical competence typically builds through volume. Some ophthalmologists and their allies worry that optometrists, who would only perform these advanced procedures as a fraction of their general practice, may not perform them frequently enough to maintain the skill level the procedures require.
Dean Barcelow, a doctor of optometry and president of the Vermont Optometric Association, pushed back on the narrative that the two professions operate in silos. “In this moment for this committee, it sure seems like optometry and ophthalmology don’t get along,” he said, “but I have a dozen personal cell phones of ophthalmologists in my phone. I call them and I say, ‘Hey, I need this’ or ‘This patient might be a little tricky.’” His point was that informal coordination already happens constantly, and that the professional relationship on the ground looks different from the one playing out in committee hearings.
The broader context matters here. Vermont has fewer physicians per capita in rural areas than many other states, and access to specialty care like ophthalmology requires either travel or a long wait. Scope-of-practice expansions have become a recurring policy strategy for states trying to close that gap, not just for eye care but for nurse practitioners, pharmacists, and other providers. The logic is consistent: when specialists are scarce, training adjacent professionals to handle a defined subset of procedures can extend care to more patients.
Whether Vermont’s legislature accepts that logic for optometrists depends, at least in part, on what happens when the Senate Health and Welfare Committee reconvenes. The crossover deadline creates real pressure to act. Whatever the committee decides, the heated exchange of recent weeks signals that scope-of-practice questions carry stakes that go well beyond professional turf. For patients in underserved corners of Vermont, the outcome could determine whether they get timely care at all.
