S 64

No. 171  Page 1 of 13
2026
No. 171. An act relating to amendments to the scope of practice for
optometrists.
                                      (S.64)
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 26 V.S.A. § 1703 is amended to read:
§ 1703. DEFINITIONS
   As used in this chapter:
      (1) “Board” means the State Board of Optometry.
      (2)(A) The “practice of optometry” means any one or combination of
the following practices:
          (A)(i) Examining the human eyes and visual system for purposes of:
            (i)(I) diagnosing refractive and functional ability; or
            (ii)(II) diagnosing the presence of eye and adnexa disease or
injury, treating the disease or injury with the appropriate therapeutic
pharmaceutical agents and procedures in accordance with this chapter, and
making referrals to the appropriate health care provider when warranted.
          (B)(ii) Diagnosing and correcting anomalies of the refractive and
functional ability of the visual system and the enhancement of visual
performance including the following:
            (i)(I) prescribing and using ophthalmic lenses, prisms,
autorefractor or other automatic testing devices, frames, ophthalmic aids, and
prosthetic materials as consistent with the health of the eye;
            (ii)(II) prescribing and employing contact lenses; and
                                                                      VT LEG #390264 v.1
No. 171  Page 2 of 13
2026
            (iii)(III) administering visual training, vision therapy, orthoptics,
and pleoptics.
          (C)(iii) Prescribing and administering appropriate therapeutic
pharmaceutical agents, as defined in this section, for the diagnosis,
management, and treatment of the eye and adnexa.
          (D)(iv) Removing superficial foreign bodies from the eye and
adnexa; epilating the eyelashes, including by electrolysis; and punctal dilation,
lacrimal irrigation, and punctal plugs insertion.
          (E)(v) Managing the following types of glaucoma in patients who are
16 years of age or older:
            (i)(I) adult primary open angle glaucoma;
            (ii)(II) exfoliative glaucoma;
            (iii)(III) pigmentary glaucoma;
            (iv)(IV) low tension glaucoma;
            (v)(V) inflammatory (uveitic) glaucoma; and
            (vi)(VI) emergency treatment of angle closure glaucoma.
            (vi) For an optometrist holding an advanced therapeutic
procedures specialty issued pursuant to subchapter 5 of this chapter,
performing the following advanced therapeutic procedures:
                 (I) surgery to remove lesions from the eye and adnexa and the
accompanied restoration of tissue, including only the following:
                   (aa) excision and repair of nonrecurrent chalazia;
                                                                   VT LEG #390264 v.1
No. 171  Page 3 of 13
2026
                  (bb) excision and biopsy of nonrecurrent lesions of the
adnexa without characteristics or obvious signs of malignancy, excluding any
lesion involving the eyelid margin, involving the lacrimal supply or drainage
systems, deeper than the orbicularis muscle, or larger than five millimeters in
diameter;
                  (cc) closure of wounds resulting from removal of a lesion;
                  (dd) repair of an eyelid laceration not larger than 2.5
centimeters, not deeper than the orbicularis muscle and not involving the
eyelid margin or lacrimal drainage structures; and
                  (ee) corneal crosslinking;
               (II) the following laser procedures:
                  (aa) laser capsulotomy;
                  (bb) laser peripheral iridotomy; and
                  (cc) laser trabeculoplasty; and
               (III) the following injections:
                  (aa) injections of therapeutic pharmaceutical agents into the
eyelid or its adnexa, including into the subconjunctival space, and including
injections for the removal of chalazia and injections to administer local
anesthesia;
                  (bb) injections to perform fluorescein angiography;
                  (cc) injections of epinephrine for treatment of anaphylactic
shock; and
                                                                  VT LEG #390264 v.1
No. 171  Page 4 of 13
2026
                     (dd) if authorized by the Commissioner of Health during a
public health emergency, vaccinations for systemic health reasons.
          (B) The practice of optometry does not include performing any of the
practices set forth in section 1720 of this chapter.
                                       ***
      (6) “Adverse event” means any untoward incident, therapeutic
misadventure, iatrogenic injury, or other undesirable outcome directly
associated with care or services provided by a health care provider or a health
care facility, as those terms are defined in 18 V.S.A. § 9402.
      (7)(A) “Therapeutic pharmaceutical agent” means any prescription or
nonprescription drug used or prescribed for the diagnosis, prevention,
treatment, or mitigation of abnormal conditions and pathology of the human
eye or its adnexa.
          (B) “Therapeutic pharmaceutical agent” does not include:
            (i) any drug or other substance that must be administered by
intraocular injection or intraocular implementation, except as authorized by
subdivision (2)(A)(vi)(III) of this section for an optometrist holding an
advanced therapeutic procedures specialty issued pursuant to subchapter 5 of
this chapter; or
            (ii) any drug or other substance that is prohibited under subsection
1720(b) of this chapter.
                                                                  VT LEG #390264 v.1
No. 171  Page 5 of 13
2026
Sec. 1a. 26 V.S.A. § 1707 is amended to read:
§ 1707. QUALIFICATIONS; TERM OF OFFICE; REMOVAL
   (a) The State Board of Optometry is created.
   (b)(1) The Board shall consist of five seven members, three four of whom
shall be residents of the State who have had at least five years’ experience in
the practice of optometry in the State and are in the active practice of
optometry at the time of their appointment; one member who shall be a
resident of the State who has at least five years’ experience in the practice of
ophthalmology and is in the active practice of ophthalmology at the time of
appointment; and two members who shall be representatives of the public, who
shall be residents of the State for five years, and who shall have no financial
interest in the profession other than as a consumer or potential consumer of its
services.
      (2) Beginning on January 1, 2031, at least one of the optometrist
members of the Board shall hold an advanced therapeutic procedures specialty
issued pursuant to subchapter 5 of this chapter.
                                      ***
Sec. 2. 26 V.S.A. § 1716a is amended to read:
§ 1716a. RENEWAL
   (a) Licenses shall be renewed every two years upon payment of the
required fee, provided that the person applying for renewal completes at least
40 hours of continuing education, approved by the Board, during the preceding
                                                                   VT LEG #390264 v.1
No. 171  Page 6 of 13
2026
two-year period and holds a current cardiopulmonary resuscitation
certification.
   (b) Licensees holding an advanced therapeutic procedures specialty
pursuant to subchapter 5 of this chapter shall, during each two-year licensure
period, complete an additional five hours of continuing education, approved by
the Board, in the advanced procedures.
Sec. 3. 26 V.S.A. § 1720 is added to read:
§ 1720. PROHIBITED PRACTICES
   (a) An optometrist shall not perform any ophthalmic surgeries, with or
without the use of lasers, or injection procedures, other than those set forth in
subdivision 1703(2)(A)(vi) of this chapter. This prohibition includes the
following procedures, which an optometrist is prohibited from performing:
      (1) retinal laser procedures, laser-assisted in situ keratomileusis
(LASIK), photorefractive keratectomy, laser epithelial keratomileusis, or any
forms of refractive surgery;
      (2) penetrating keratoplasty, corneal transplant, or lamellar keratoplasty;
      (3) the administration of general anesthesia;
      (4) surgery done with general anesthesia;
      (5) laser or nonlaser injection in the posterior or vitreous chamber of the
eye to treat any macular or retinal disease;
      (6) surgery related to removal of the eye or adnexa, including the
eyeball, from a living human being;
                                                                    VT LEG #390264 v.1
No. 171  Page 7 of 13
2026
      (7) surgery requiring full-thickness incision or excision of the cornea or
sclera other than paracentesis in an emergency situation requiring immediate
reduction of the pressure inside the eye;
      (8) surgery requiring incision of the iris and ciliary body, including iris
diathermy or cryotherapy;
      (9) surgery requiring the incision or removal of the vitreous;
      (10) surgery requiring incision of the retina;
      (11) surgical extraction of the crystalline lens;
      (12) surgical intraocular lens implants;
      (13) incisional or excisional surgery of the extraocular muscles;
      (14) surgery of the eyelid for suspected malignancies, for cosmetic
purposes, or for cosmetic or mechanical repair of blepharochalasis, ptosis, and
tarsorrhaphy;
      (15) surgery for the removal of lesions involving the eyelid margin,
lacrimal supply, or drainage systems;
      (16) repair of an eyelid laceration larger than 2.5 centimeters, deeper
than the orbicularis muscle, or involving the eyelid margin or lacrimal drainage
structures;
      (17) surgery of the bony orbit, including orbital implants;
      (18) incisional or excisional surgery of the lacrimal system other than
probing or related procedures;
                                                                    VT LEG #390264 v.1
No. 171  Page 8 of 13
2026
        (19) surgery requiring full-thickness conjunctivoplasty with graft or
flap;
        (20) pterygium surgery;
        (21) ionizing radiation;
        (22) intraocular injections penetrating the globe; and
        (23) retrobulbar or intraorbital injections.
   (b)(1) An optometrist shall not prescribe or administer a drug or other
substance that is listed as a Schedule I or II controlled substance pursuant to
the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., as amended,
except as set forth in subdivision (2) of this subsection.
        (2) Notwithstanding subdivision (1) of this subsection, an optometrist
may prescribe or administer hydrocodone in combination with analgesics,
provided that an optometrist shall not prescribe more than a 72-hour supply of
hydrocodone and shall not provide any refills of the prescription.
Sec. 4. 26 V.S.A. chapter 30, subchapter 5 is amended to read:
   Subchapter 5. Diagnostic Pharmaceutical Agents Advanced Therapeutic
                                Procedures Specialty
§ 1723. ADVANCED THERAPEUTIC PROCEDURES SPECIALTY
   An optometrist who is licensed pursuant to subchapter 3 of this chapter may
apply for an advanced therapeutic procedures specialty that authorizes the
optometrist to perform the advanced therapeutic procedures set forth in
subdivision 1703(2)(A)(vi) of this chapter.
                                                                   VT LEG #390264 v.1
No. 171  Page 9 of 13
2026
§ 1724. QUALIFICATIONS FOR ADVANCED THERAPEUTIC
          PROCEDURES SPECIALTY
   (a) Generally. An optometrist shall obtain an advanced therapeutic
procedures specialty in order to perform the advanced therapeutic procedures
set forth in subdivision 1703(2)(A)(vi) of this chapter. The Board may grant
an advanced therapeutic procedures specialty to an applicant who:
      (1) is licensed as an optometrist pursuant to subchapter 3 of this chapter;
      (2) meets the applicable requirements for education and demonstrated
competency set forth in subsections (b) and (c) of this section; and
      (3) has completed the examination requirements set forth in subsection
(d) of this section.
   (b) Educational requirements.
      (1) In order to obtain an advanced therapeutic procedures specialty, an
optometrist who graduated from an optometric school or college prior to 2019
shall have completed a postgraduate course sponsored by an organization
approved by the Board of Optometry that had a minimum duration of 32 hours
and included the following didactic classroom instruction:
          (A) laser physics, hazards, and safety;
          (B) biophysics of lasers;
          (C) laser application in clinical optometry;
          (D) laser-tissue interactions;
          (E) laser indications, contraindications, and potential complications;
                                                                  VT LEG #390264 v.1
No. 171  Page 10 of 13
2026
           (F) gonioscopy;
           (G) laser therapy for open-angle glaucoma;
           (H) laser therapy for angle closure glaucoma;
           (I) posterior capsulotomy;
           (J) common complications involving lids, lashes, and the lacrimal
system;
           (K) medicolegal aspects of anterior segment procedures;
           (L) peripheral iridotomy;
           (M) laser trabeculoplasty;
           (N) minor surgical procedures;
           (O) overview of surgical instruments, asepsis, and occupational
safety and health considerations;
           (P) surgical anatomy of the eyelids;
           (Q) emergency surgical procedures;
           (R) chalazion management;
           (S) techniques for and complications with local anesthesia;
           (T) anaphylaxis and other emergencies that may occur in an office
setting;
           (U) radiofrequency surgery;
           (V) postoperative wound care; and
           (W) clinical or laboratory experience that includes both video
demonstration and in vitro observation or participation.
                                                                  VT LEG #390264 v.1
No. 171  Page 11 of 13
2026
      (2) An optometrist who graduated from an optometric school or college
in 2019 or later shall not be required to complete additional postgraduate
coursework in order to obtain an advanced therapeutic procedures specialty.
   (c) Preceptorship requirements; competency demonstration.
      (1) In order to demonstrate competency for an advanced therapeutic
procedures specialty, an optometrist shall complete a preceptorship during
which the optometrist gains at least eight hours of clinical training that is
supervised by a preceptor and demonstrates clinical proficiency with hands-on
experience performing the following procedures on live, human patients:
          (A) at least two laser trabeculoplasties;
          (B) at least two posterior capsulotomies;
          (C) at least two laser peripheral iridotomies;
          (D) at least two chalazion excisions;
          (E) at least two chalazion intralesional injections; and
          (F) at least two excisions or drainages of an authorized lesion of two
millimeters or greater in size.
      (2) The preceptor shall be either:
          (A) an optometrist with a substantially similar scope of practice who
has been licensed in Vermont or any other U.S. jurisdiction to provide the
advanced procedures set forth in subdivision 1703(2)(A)(vi) of this chapter for
at least three years; or
          (B) an ophthalmologist.
                                                                     VT LEG #390264 v.1
No. 171  Page 12 of 13
2026
      (3) The preceptorship shall involve direct and in-person supervision of
the optometrist by the preceptor.
      (4) The preceptorship shall take place in a state in which the preceptor is
licensed and authorized to perform the advanced procedures.
      (5) The preceptor shall certify that the optometrist has competently
completed the required procedures and provide a log of the completed
procedures to the Board.
   (d) Examination requirements. The applicant shall successfully pass
written and clinical examinations administered by the National Board of
Examiners in Optometry (NBEO), including the NBEO Injections Skill
Examination (ISE), the NBEO Laser and Surgical Procedures Examination
(LSPE), and any other examination required by the Board by rule.
   (e) Advanced therapeutic procedures specialty by endorsement.
      (1) The Board may issue an advanced therapeutic procedures specialty
to an applicant who is licensed and in good standing in another U.S.
jurisdiction and who:
          (A) has an expanded scope of practice that is substantially equivalent
to or broader than the expanded scope of practice permitted by this subchapter;
and
          (B) has been in good standing in the expanded scope of practice in
the other jurisdiction for at least three years.
                                                                  VT LEG #390264 v.1
No. 171  Page 13 of 13
2026
      (2) An optometrist whose advanced therapeutic procedures specialty
was issued by endorsement pursuant to this subsection may serve as a
preceptor in this State.
§ 1725. REPORTING REQUIREMENTS
   An optometrist shall report any adverse event related to an advanced
procedure within 30 days following the event.
Sec. 5. 26 V.S.A. § 1727 is redesignated to read:
§ 1727 1705. EXPIRATION DATE
Sec. 6. EFFECTIVE DATE
   This act shall take effect on July 1, 2028.
Date Governor signed bill: June 18, 2026
                                                                VT LEG #390264 v.1