Alaska optometrists can hand routine tasks to unlicensed staff starting Nov. 26

Alaska optometrists will be able to hand routine eye-care tasks to unlicensed staff starting Nov. 26, under rules the state filed Tuesday.

The Board of Examiners in Optometry adopted the rules Oct. 8. The board received no public comments on them, according to its adoption order.

A task qualifies as routine if it happens often, follows a standard procedure with predictable results and carries minimal risk to the patient. It must also be something the optometrist is licensed to do.

The staff member must be trained to do the task "safely and competently." The optometrist must supervise and remains responsible for the care.

Staff can't take on work that calls for professional medical judgment. That includes assessing a patient's condition, writing a care plan, counseling patients or their families, giving injections and managing medications that need ongoing dose changes. It also rules out anything involving pain management, opioids or addiction.

Optometrists who knowingly hand off a task reasonably likely to pose a substantial risk of harm to a patient will be committing unprofessional conduct under the rules.

Until 2024, state lawyers said, the board had no power to allow any of this. In September 2023, a state assistant attorney general concluded that state law gave the board no authority to let non-optometrists perform optometry tasks. The board had proposed having unlicensed "telehealth facilitators" conduct eye exams under the direction of an optometrist somewhere else.

The Legislature passed a bill granting that authority in 2024, and it became law without Gov. Mike Dunleavy's signature. Its sponsor, Rep. Justin Ruffridge, told a Senate committee that May that it was partly a cleanup bill because some of the practices were already happening, according to the committee minutes. A Fairbanks optometrist testified that she used optometric assistants every day and that they improved efficiency and helped contain costs.

The American Academy of Ophthalmology, which represents eye physicians and surgeons, urged lawmakers to reject the bill. Its March 2024 letter said the bill was unclear on who could take on delegated work, which services, how much supervision and what education would be required. It pointed to Alaska's dentistry law, which spells out what dentists may hand to assistants and requires coursework certificates for some tasks.

The final rules define routine services and list what can't be delegated. They require training and supervision but don't set a specific training program or level of supervision.

The 2024 law says unlicensed staff may do delegated work only if they meet "applicable standards established by the board." When the board proposed the rules in August, its explainer said the law "does not require a complex training program, and optometrists are not expected to develop one." It also said the law "does not expand the scope of practice for optometrists, nor does it authorize staff to act as optometrists."

The state Department of Law approved the rules Oct. 23.