Alaska optometry board proposes letting unlicensed staff do routine eye work

Unlicensed staff in Alaska eye clinics could soon perform routine eye-care duties under what the state describes as Alaska's first written rules for handing eye-care work to someone who holds no license, with no board-set training credential behind it. The Alaska Board of Examiners in Optometry published the proposal Wednesday. Written comments are due by 4:30 p.m. on September 21.

An optometrist may delegate a routine service if it falls within the optometrist's own scope of practice, the agent has received necessary training to perform it safely and competently, and the optometrist supervises the agent and remains responsible for the quality of the service. The 2024 law behind the rules also removed the unlicensed-practice violation that used to cover this ground, creating an exception for properly delegated routine services.

A routine service is defined by resemblance rather than by name: one that occurs frequently, has a standard procedure and predictable results, and presents minimal risk. The proposal lists none, but bars several categories, most notably anything related to pain management, opioid use or addiction, along with assessing a patient's condition, forming a care plan, counseling patients, and administering injectable medication. A companion section would spell out when delegating crosses into unprofessional conduct.

That law, AS 08.72.050(7), directs the board to authorize delegation but requires that an unlicensed agent perform delegated duties "only if the agent meets applicable standards established by the board." Its FAQ document says it does not intend to set a fixed training standard. "These changes provide flexibility to the optometrist to decide how to train and supervise based on the optometrist's and practice's needs," it says.

A Department of Law memorandum from September 22, 2023 reviewed a different proposal, on remote telehealth eye exams. "No, state law does not grant the board legal authority to adopt regulations concerning delegation of optometry tasks to a non-optometrist," Assistant Attorney General Brad Sharp wrote. The Legislature then passed House Bill 309, and the board now cites five statutes as its authority, among them the section Sharp examined. The memo's other finding stands: it called the board an outlier, noting other Title 8 boards hold delegation authority, including the Board of Veterinary Examiners, which must set training requirements before duties pass to veterinary technicians.

The American Academy of Ophthalmology asked legislators to reject the bill. "This bill jeopardizes patient safety by authorizing optometrists to delegate the care of patients without sufficient guardrails," wrote Stephen D. McLeod, the academy's chief executive officer, and Jane C. Edmond, its president, on March 25, 2024. Its sponsors, Representatives Ruffridge and Saddler and Senators Giessel and Bjorkman, argued that without delegation some Alaska practices could close, hurting regions with few optometrists.

Comments go to regulations specialist Stefanie Davis at [email protected] by September 21. The board may then adopt the changes without further notice. If it does, the Department of Law reviews them, the lieutenant governor files them, and they take effect 30 days later. No one has commented on the record yet: the opposition quoted here was written against the bill, and the legal doubt before it passed.