Final Reading: Two Vermont eye-care professions are at odds

A pair of golden eyes from "The Great Gatsby" book cover with a pair of spectacles over them. — It’s unclear whether Dr. T.J. Eckleburg from “The Great Gatsby” was an optometrist or an ophthalmologist. Either way, his billboard would not be allowed in Vermont. Photo illustration by Natalie Williams and Peter D’Auria. Images via Wikimedia Commons and Adobe Stock

For years, Vermont’s optometrists and ophthalmologists have had differing views of the responsibilities given to their two professions.

Many people may not even know the difference between the two eye-focused practitioners. (I personally for sure knew and definitely did not have to Google it ahead of time.)

But in Vermont, the distinction is a substantial one — and a source of ongoing discord.

Optometrists generally focus on primary eye care, like vision exams, diagnosing eye conditions, and prescribing glasses or contact lenses. They complete at least a four-year postgraduate program, a doctor of optometry, with the option of more training.

Ophthalmologists, meanwhile, are medical doctors. They go to medical school and then complete an internship and residency afterward, and are allowed to perform eye surgeries and more complex procedures.

In Vermont, the two groups have spent years at odds over the procedures that optometrists are allowed to perform.

Optometrists have long sought permission to do some surgical procedures currently reserved for ophthalmologists, such as removing lesions or using lasers to treat glaucoma. A number of other states allow optometrists to do so.

Ophthalmologists, however, have argued that optometrists don’t have sufficient training to do those procedures, and that allowing them could put patients at risk.

Two years ago, the Senate Committee on Government Operations directed the Secretary of State’s Office of Professional Regulation to find ways to expand optometrists’ scope of practice — meaning, allow them to perform some of those ophthalmologist-only procedures.

Last fall, the OPR issued a report recommending the creation of a new specialty endorsement license for Vermont optometrists that would allow them to perform a specific list of operations. The list is worth reading if you are training for a spelling bee and want to learn words like “chalazia” and “trabeculoplasty.”

Now, lawmakers on the House Committee on Government Operations & Military Affairs are considering whether to write those recommendations into legislation — a discussion that set off the latest salvo in the face-off between optometrists and ophthalmologists.

On Thursday, representatives from the Vermont Ophthalmological Society and the Vermont Optometric Association offered dueling testimony to the committee.

Jessica McNally, the president of the Vermont Ophthalmological Society, urged lawmakers to keep those procedures in the purview of ophthalmologists.

“We understand much better than the average person what the difference is between an optometrist and ophthalmologist,” McNally told the committee, adding, “Why would you take the risk in any kind of eye health by allowing people who are not trained to provide and perform surgeries to do so?”

But Dean Barcelow, the president of the Vermont Optometric Association, said that his fellow optometrists were perfectly capable of doing those procedures — and have been doing them for years in other states. The proposed regulations in Vermont, he said, would be the most stringent in the country.

“The bottom line is, despite attempts to imply the contrary, optometry has a sound track record in performing these procedures, and it spans decades,” Barcelow said. “The language before you would create the most robust endorsement system in the country by an order of magnitude.”

Ultimately, the committee adjourned the hearing without coming to any conclusion on the matter.

“This is an incredibly political discussion,” noted Rep. Jay Hooper, D-Randolph. “I don’t think you even have to have subpar eyesight to see that.”

— Peter D’Auria

As Vermont grapples with an ongoing housing crisis, advocates want to improve access for one group of people who have “a woefully low inventory” to choose from: people with disabilities.

The House Committee on General and Housing on Thursday morning took up H.137, that would make home accessibility modifications eligible for the Vermont Housing Improvement Program.

Susan Aranoff, senior planner and policy advisor for the Vermont Developmental Disabilities Council, said Vermont needs 604 units of housing that comes with services, according to a recent housing report commissioned as a result of Act 186.

“So these are people who have disabilities and in order to live independently… they need a certain level of support,” she said urging the committee to make it easier for families and landlords to make units more accessible for all.

“A rising tide lifts all boats,” she said. “Anybody could live in that unit. It doesn’t have to be a person with a disability. It can be just a unit that is available to more people and you can get in with your arms full.”

— Auditi Guha

On the move

Gov. Phil Scott on Thursday signed into law H.850, a bill that repeals a controversial property tax cap and allows school boards to push back budget votes in an attempt to lower education spending and, in turn, property taxes.

“The changes made in this bill are a necessary step as Vermonters face a projected 20% increase in property tax bills, and in some communities, it could be even higher,” Scott wrote in a letter to lawmakers.

A man in a suit and tie stands at a podium. — Gov. Phil Scott speaks during a press conference at the Statehouse on Jan. 10. Photo by Natalie Williams/VTDigger

“But to be clear, this bill does not solve our property tax problem,” he went on. “These changes will only reduce rates if school boards adjust their budgets accordingly and local voters support those changes.”

In his letter, the governor harkened back to 2017 and 2018 proposals that he said “would have put us on a better path to a sustainable public education system.”

Scott’s finger-pointing at lawmakers has become a repeated refrain as Vermonters face a projected average property tax increase of 20%, driven by a predicted 15% increase in education spending.

H.850 will repeal the 5% homestead tax rate increase cap created by Act 127 — Vermont’s most recent education funding law — and replace it with a tax discount system limited to districts that lost taxing capacity under the new pupil weighting system.

Data dispatch

Rural areas of the state, such as the Northeast Kingdom, stand to gain the most from a law that changed the way students are counted for the statewide education fund, according to new Agency of Education data presented to lawmakers earlier this month.

For school districts and homestead property tax payers, Act 127 goes into effect for the first time this coming fiscal year. The law, passed in 2022, is intended to even the playing field between districts by giving more weight to low-income students, English language learners and students at rural schools, on the understanding that these groups are more expensive to educate.

Go to our interactive map and table to see how your local school district is affected.