Key takeaways:
- Out of 11 states that expanded the scope of optometry, only one had a significant increase in malpractice payouts post-expansion.
- The main malpractice allegation was “failure to diagnose.”
Optometrists had some of the lowest rates of malpractice payouts of all health professions, including after states allowed them to perform certain injections and laser surgeries, according to a study.
“Optometry’s scope of practice has expanded substantially over the past several decades, including increased authority to prescribe oral medications, administer injections and perform in-office laser procedures,” study author Robert S. Duszak, OD, FAAO, of Wilmington Veterans Affairs Medical Center, Delaware, told Healio. “Despite these changes, there has been limited contemporary data on whether these expanded responsibilities have influenced malpractice risk.”
Duszak and colleagues used the National Practitioner Data Bank to review malpractice payments spanning from 1996 to 2023. The results were published in Optometry and Vision Science.
The study analyzed malpractice payments in 11 states that expanded optometrists’ scope of practice to include procedures such as injections and laser surgery, Duszak said.
According to the results, malpractice payments by optometrists were “extremely rare,” Duszak said. There was a total of 1,040 malpractice payments from 1996 to 2023, averaging 38.5 cases per year and $220,918 per payment.
The most common types of malpractice allegations were “failure to diagnose” (40%) and “delay in diagnosis” (6.4%). “Failure/delay in referral,” “improper performance” and “improper management” made up 5.5%, 5.2% and 4.4% of allegations, respectively.
Among states that expanded scope of practice, Indiana was the only one with a statistically significant post-expansion increase in malpractice cases (P = .049). There was no significant increase in the other 10 states: Alaska, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Oklahoma, Virginia, Wisconsin and Wyoming.
“States with expanded privileges mirror national trends, suggesting that training, credentialing and modern technology are effectively supporting safe practice,” Duszak said.
The number of malpractice payments per year “increased slightly” from 1996 to 2023, but payments were still rare compared with other specialties, the researchers wrote.
“Optometry’s liability profile continues to compare favorably to other health professions, and the stability of malpractice payments over nearly 3 decades speaks to the profession’s strong emphasis on education, evidence-based care and patient communication,” Duszak said. “As scope continues to expand, ongoing monitoring is essential, but current data offer reassuring evidence that optometrists are delivering high-quality care even as their clinical responsibilities grow.”
For more information:
Robert S. Duszak, OD, FAAO, can be reached at robert.duszak@va.gov.
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