RALEIGH, N.C. – A three-judge panel in North Carolina today intensely scrutinized a controversial state health law that limits certain eye care procedures, as a Craven County eye doctor argued it unconstitutionally restricts patients’ access to care in the field of ophthalmology.
- Craven County Optometrist Ignites Challenge Against Scope-of-Practice Restrictions
- Three-Judge Panel Delves into Core Constitutional Questions
- Ophthalmology vs. Optometry: Fueling National Debate on Eye Care Access
- Patient Stories Spotlight Urgency of Health Law Reform
- Ruling Could Reshape Eye Care Landscape and Beyond
The hearing, held at the North Carolina Court of Appeals, centered on a lawsuit filed by Dr. Emily Hargrove, a seasoned optometrist from New Bern in Craven County. Dr. Hargrove contends that the law, enacted in 2019, improperly scopes practice boundaries between optometrists and ophthalmologists, potentially delaying critical treatments and exacerbating eye health disparities in rural areas. Judges peppered attorneys with pointed questions about due process, equal protection, and the state’s compelling interest in regulating medical professions.
This case has drawn national attention from eye care advocacy groups, highlighting ongoing turf wars in North Carolina‘s healthcare landscape. With wait times for ophthalmologist appointments stretching up to six months in some regions, proponents argue the restrictions hinder timely access to care.
Craven County Optometrist Ignites Challenge Against Scope-of-Practice Restrictions
Dr. Emily Hargrove, who has practiced optometry in Craven County for over 15 years, filed the lawsuit in 2022 after repeated patient complaints about delayed referrals under the health law. The statute, part of the North Carolina Medical Practice Act amendments, prohibits optometrists from performing certain laser procedures and advanced diagnostic injections traditionally reserved for ophthalmologists – medical doctors with surgical training.
“Patients in eastern North Carolina shouldn’t have to drive hours to Raleigh or Wilmington for basic eye injections that could prevent vision loss,” Dr. Hargrove stated in court filings. Her practice, Eastern Eye Care Associates, serves a predominantly rural population where 22% live below the poverty line, according to U.S. Census data. In 2023 alone, she documented 47 cases where patients faced delays exceeding 90 days due to the law’s mandates.
The law stems from lobbying by the North Carolina Society of Eye Physicians and Surgeons, representing ophthalmologists, who argue that optometrists lack the requisite residency training – typically three to four years post-medical school – for invasive procedures. However, Dr. Hargrove’s legal team cites a 2021 study by the American Optometric Association showing optometrists perform 70% of primary eye exams nationwide with complication rates under 0.5% for approved procedures.
Craven County’s demographics amplify the stakes: The county’s 103,000 residents include high rates of diabetes, a leading cause of blindness. North Carolina ranks 38th nationally in optometrist-to-patient ratios, per the Health Resources and Services Administration (HRSA), making local access critical.
Three-Judge Panel Delves into Core Constitutional Questions
Presiding over the appeal were Judges Lucy Thurston, Richard Dietz, and Hunter Murphy, who heard oral arguments lasting over two hours. The panel focused on whether the health law violates the North Carolina Constitution’s guarantees of due process and equal protection under Article I, Sections 19 and 1.
“Is the state’s restriction narrowly tailored, or does it sweep too broadly into patient rights?” Judge Thurston asked plaintiff’s attorney, Sarah Kline. Kline responded by referencing a 2018 federal case in Tennessee, Maxwell v. State, where similar optometry restrictions were struck down for lacking evidence of public harm.
Defense attorney Mark Reilly, representing the North Carolina Board of Medical Examiners, countered: “Ophthalmology requires surgical precision; blurring lines endangers eyes.” He pointed to a 2022 incident in South Carolina where an optometrist’s procedure allegedly led to complications, though data from the National Eye Institute disputes systemic risks.
The judges also probed constitutionality through the lens of intermediate scrutiny, questioning if the law advances a substantial government interest without unduly burdening providers. No ruling was issued immediately, but observers noted Judge Dietz’s skepticism toward blanket prohibitions.
- Key Judicial Queries:
- Evidence linking optometrist procedures to higher malpractice rates?
- Impact on underserved areas like Craven County?
- Comparisons to other states allowing expanded optometric scopes?
This isn’t the first time North Carolina courts have tackled such disputes. A 2015 superior court ruling upheld minor expansions for optometrists, but the 2019 law rolled back gains amid ophthalmology pushback.
Ophthalmology vs. Optometry: Fueling National Debate on Eye Care Access
The case underscores a broader schism in ophthalmology and optometry. Ophthalmologists, who complete medical school plus specialized residency, perform surgeries like cataract removals – over 3.7 million annually nationwide, per the American Academy of Ophthalmology (AAO). Optometrists, with four-year doctoral programs, handle routine care, prescribing 80% of eyeglasses and detecting 44% of glaucoma cases early, according to AAO data.
In North Carolina, the divide affects 10.5 million residents, where 1.2 million have diabetes risking retinopathy. A 2023 Duke University study found rural patients wait 45% longer for specialist care, correlating with 15% higher blindness rates in eastern counties like Craven.
Advocates for expanded access to care include the North Carolina Optometric Society, which submitted an amicus brief citing 28 states permitting optometrists to perform the procedures at issue. “This law creates artificial shortages,” said society president Dr. Alan Chen. Conversely, the AAO warns of “diluting expertise,” referencing a hypothetical 5-10% rise in adverse events.
Economically, the restrictions cost patients: A routine ophthalmologist visit averages $250 versus $150 for optometry, per Healthcare Bluebook. In Craven County, where median income is $52,000, such disparities hit hard. Nationally, scope-of-practice expansions have boosted eye exam rates by 12%, a Rand Corporation analysis shows.
Patient Stories Spotlight Urgency of Health Law Reform
Real-world impacts emerged through affidavits. Take 62-year-old retiree James Whitaker of New Bern, who waited four months for a steroid injection after macular edema diagnosis. “By the time I saw the ophthalmologist, my vision dropped two lines on the eye chart,” he testified. Similar tales from 30+ patients underscore delays in treating conditions like wet AMD, affecting 2 million Americans.
Public health experts weigh in too. Dr. Maria Lopez, a UNC Chapel Hill epidemiologist, noted in a brief: “North Carolina’s glaucoma prevalence is 3.5%, above the national 3%. Restrictions exacerbate untreated cases, projecting $500 million in future Medicare costs by 2030.”
The health law‘s defenders highlight training gaps: Optometry programs average 1,200 clinical hours versus ophthalmology’s 12,000+. Yet, a Federation of State Medical Boards report finds no disparity in outcomes for non-surgical interventions.
- Training Comparison: Optometry: 4 years post-baccalaureate; Ophthalmology: 4 years med school + 3-4 years residency.
- Procedure Volume: Optometrists handle 39 million visits yearly; ophthalmologists 28 million surgeries.
- NC Shortages: 15 counties are eye care Health Professional Shortage Areas (HPSAs).
Ruling Could Reshape Eye Care Landscape and Beyond
A decision, expected within 90 days, could invalidate parts of the health law, paving the way for legislative tweaks or broader scope reforms. If upheld, it might embolden similar restrictions elsewhere, per legal analysts.
For patients, victory means faster access to care; loss prolongs waits. Nationally, it influences 15 pending bills in states like Virginia and Georgia. The U.S. Department of Health and Human Services has flagged scope laws as barriers to rural care, potentially tying federal funding.
Dr. Hargrove remains optimistic: “This is about eyes saved, not egos.” Ophthalmologists counter with patient safety paramount. As North Carolina navigates this, the ruling may set precedents for other fields like dentistry and podiatry, where professional silos clash with public needs.
Stakeholders await anxiously, with rallies planned in Raleigh. The interplay of constitutionality, economics, and health equity positions this as a bellwether for modern medicine.
