New Hampshire Gov. Kelly Ayotte on March 27 vetoed House Bill 349, which would have expanded the scope of practice for optometrists in the state, allowing them to perform selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), and YAG capsulotomy.

The bill would have made New Hampshire the 16th US state to allow ODs to perform the office-based laser procedures. Kansas became the latest state to add lasers to ODs’ scope with a new law signed in March 2026.

Ayotte, in a news release announcing her veto, said: “Laser eye surgeries are not minor procedures. Complications or failure of such procedures can lead to permanent vision loss. Even if most of these procedures go as planned, complications can require the full spectrum of surgical skills and training that only ophthalmologists as physicians possess.”

An Ongoing Conflict

Ophthalmologists and optometrists have long been locked in conflict over scope of practice. Ophthalmologists earn licenses to practice medicine and surgery. Optometrists’ practice scope varies by state but generally involves eye examination and care of less severe eye conditions not requiring systemic therapy or surgery.

Societies such as the American Academy of Ophthalmology (AAO) characterize their objection to optometric expanded scope of practice as one of patient safety and quality of care, citing the extended years of medical training that ophthalmologists receive.

Optometrists say the issue is partly a matter of patient access. Proponents of expanded scope say ophthalmologists—especially in rural areas—will be unable to meet the increasing demand for age-related eye care in the years ahead. They also cite the track record of safety in states where laser procedures for ODs have already been approved.

Closing the Treatment Gap

The website Trusted Eye Care New Hampshire, which advocated for HB 349, says there are two New Hampshire counties without a single ophthalmologist in practice, and two counties have only one. All 10 counties have ODs in practice, the website says.

Ayotte cited an initiative in Berlin, New Hampshire, as one of the state’s successes in increasing access to care in rural areas.

North Country Ophthalmology, as of January 2026, offers biweekly appointments at Androscoggin Valley Hospital in Berlin, in the northern part of the state. Laser procedures for diabetic retinopathy, glaucoma, and retinal tears are available on-site, with expansion to cataract surgery planned for May 2026.

Berlin is a town of just over 9 thousand people, about an hour south of the Canadian border.

The Berlin Sun newspaper said the North Country Ophthalmology initiative was the first of its kind in the area, closing a long-standing gap in specialty surgical care. The newspaper said that patients previously had to travel hours for advanced eye treatment and surgery.

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