Optometric Scope Expansion Doesn’t Increase Malpractice Risk, Study Finds

An analysis of the National Practitioner Data Bank showed that compared to many other healthcare professions, malpractice payments made on behalf of optometrists were significantly less frequent—even in states where ODs have expanded prescribing and surgical authority. Considering this, the authors stated, “Despite frequent claims that expanding optometric privileges, particularly for laser procedures, poses safety concerns, our analysis yields no malpractice litigation evidence to suggest such expansions have compromised patient safety.” Photo: Getty Images. Click image to enlarge. Legal efforts are active in several states to modernize optometry laws, with two—Kansas and Tennessee—successfully expanding optometrists’ privileges so far this year. New research validating the safety of optometrist-performed procedures may bolster those efforts: a study recently published in Optometry and Vision Science found malpractice payments involving optometrists are infrequent and financially modest, with no evidence that allowing lasers, injections or oral medications has raised malpractice risk. The authors point to advances in education, technology and interprofessional collaboration as likely contributors to that stability—findings that could reassure lawmakers weighing similar scope of practice changes.Researchers performed a retrospective analysis of public National Practitioner Data Bank (NPDB) records to identify malpractice payments made on behalf of optometrists from 1996 through 2023, with the goal of determining whether state-level expansions of optometry’s practice scope are associated with increased liability risk. They considered multiple variables in their analysis, including number and value of payments (adjusted for inflation), provider age, patient demographics, geographic distribution and allegation category. Across the 28-year interval, the dataset contained 1,040 paid malpractice events (equating to an average of 38 to 39 payments per year, with an average payout of $220,918). Most claims were categorized as diagnostic failures, accounting for roughly 40% of allegations, rather than procedure-related complications. The majority of payments (56%) were received by patients older than age 50.The authors found malpractice payments on behalf of ODs to be uncommon and modest in magnitude relative to many other health professions, “which experience substantially higher rates of paid claims over time,” they wrote in their paper. To put this in perspective, in 2023 there were only 41 malpractice payments among 41,390 optometrists practicing in the US—an estimated annual risk of just 0.10% per OD. Meanwhile, that same year, among 770,850 active osteopathic and allopathic physicians there were 8,603 payments (1.12%), practicing dentists recorded 1,123 payments (0.81%) and 9,470 practicing podiatrists had 224 payments (2.58%).Perhaps most importantly, the data showed no significant difference between the number of malpractice payments in states with and without expanded optometric authority, Indiana being the only exception among the 11 expanded-scope states as of 2023. The authors noted that, overall, these states “mirrored national trends in both payment frequency and amount.” Moreover, there was no notable change in annual case numbers throughout the study period. “As the scope of optometric practice continues to expand, including authority for prescribing oral medications, administering injections and performing in-office laser procedures, there is no evidence to date that these expansions compromise patient safety or increase malpractice liability,” the authors summarized. “Instead,” they argued, “advances in education, adoption of sophisticated diagnostic technologies, stronger patient-provider communication and interprofessional collaboration all likely contribute to reducing risk and promoting high-quality care.” According to Eric Conley, OD, MJ, an optometrist at South Shore Eye Care in Wantagh, NY, who serves as an expert witness case reviewer, “it remains evident that optometric providers continue to demonstrate safe and efficacious care regardless of the allowable scope of practice as dictated by any legislature. In fact, the bulk of cases we continue to see remain consistent with that as presented in the NPDB study data, with failure to diagnose or improper management or referrals being paramount and not laser or minor surgical procedures related.” Dr. Conley adds that these cases remain very limited in number, despite the significant number of patient interactions seen annually with optometrists and their patients. “In an additional review of the NPDB databank, our group also highlighted that malpractice litigation experienced by optometrists and ophthalmologists nearly matched each other, by percentage of incident (not raw number), in every state,” he says, noting that “this is critically important as one group, ophthalmologists, practice without any licensure restrictions and the other has a quite variable scope as dictated by each individual legislature.” Legislators should feel reassured, Dr. Conley suggests, to continue pursuing scope of practice expansion for optometrists in their respective states “to benefit their constituents with improved care and the associated increased access to care that is needed and remains ever-growing."    Click here for the journal source. Duszak RS, Phan MS, Duszak R. Malpractice payments by optometrists in the United States: An analysis of the National Practitioner Data Bank from 1996 to 2023. Optom Vis Sci. 2026;103(4):e70049. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.