TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF OPTOMETRY

Proposed Regulation

Title of Regulation: 18VAC105-20. Regulations Governing the Practice of Optometry (amending 18VAC105-20-5, 18VAC105-20-10, 18VAC105-20-20, 18VAC105-20-60; adding 18VAC105-20-80 through 18VAC105-20-110).

Statutory Authority: §§ 54.1-2400 and 54.1-3223 of the Code of Virginia.

Public Hearing Information:

August 28, 2024 - 9:05 a.m. - Department of Health Professions, 9960 Mayland Drive, Conference Center, Board Room 3, Henrico, VA 23233.

Public Comment Deadline: October 25, 2024.

Agency Contact: Kelli Moss, Executive Director, Board of Optometry, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 597-4077, FAX (804) 793-9145, or email kelli.moss@dhp.virginia.gov.

Basis: Regulations of the Board of Optometry are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which authorizes health regulatory boards to promulgate regulations that are reasonable and necessary to effectively administer the regulatory system. Chapters 16 and 17 of the 2022 Acts of Assembly require the board to promulgate regulations related to certification of optometrists to perform laser surgery.

Purpose: The agency is required by legislation to promulgate regulations. The legislation specifically states that the board "shall promulgate regulations establishing criteria for certification of an optometrist to perform certain procedures." The legislation requires provisions for (i) promotion of patient safety; (ii) identification and categorization of procedures for the purpose of issuing certificates; (iii) establishment of an application process for certification to perform such procedures; (iv) establishment of minimum education, training, and experience requirements for certification to perform such procedures; (v) development of protocols for proctoring and criteria for requiring such proctoring; and (vi) implementation of a quality assurance review process for such procedures performed by certificate holders.

Substance: The proposed amendments include (i) definitions specific to laser surgery; (ii) requirements to obtain a laser surgery certification, including fees, education, and clinical training, whether in a school setting or via proctored sessions; (iii) specific requirements for proctoring and proctors; (iv) reporting requirements, including reporting requirements to maintain a quality assurance review process; (v) fees related to certification; and (vi) renewal requirements.

Issues: The primary advantage to the public is that more practitioners will be available to perform laser surgery of the eye. There are no disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. As a result of a 2022 legislative mandate,² the Board of Optometry (board) seeks to establish a certification for optometrists to perform certain laser surgery procedures. The Board also proposes to standardize late renewal fees and remove outdated language.

Background. Chapter 16 of the 2022 Acts of Assembly directed the board to promulgate regulations establishing criteria for certification of an optometrist to perform three laser surgery procedures: peripheral iridotomy, selective laser trabeculoplasty, and YAG capsulotomy.³ In doing so, the board reports that the legislation expanded the scope of practice of optometry in the Commonwealth. The legislation also specified that the regulation must (i) establish the minimum education, training, and experience requirements for certification; (ii) develop protocols for proctoring and criteria for requiring such proctoring; and (iii) implement a quality assurance review process for such procedures performed by certificate holders.⁴ Accordingly, the board seeks to make the following amendments to the regulation:

18VAC105-20-5 (Definitions) would be amended to add definitions for "laser surgery certification," "LSPE," "proctored session," and "proctoring."

18VAC105-20-10 (Requirements for Licensure) would be amended so that from January 1, 2033, onward, all applicants for a license to practice optometry in the Commonwealth shall meet the requirements for laser surgery in 18VAC105-20-80, which would be newly created by this action. Although the date was chosen at the board discretion, the Department of Health Professions (DHP) reports that professional licenses are intended to cover the scope of practice of the profession. Thus, even though the certification may be used initially to indicate which licensees are qualified to perform the surgery, the delayed date was selected so that all applicants would have sufficient notice that they would eventually need to be qualified to practice laser surgery as part of the expanded scope of the profession.

18VAC105-20-20 (Fees) would be amended to add a $200 fee for applications for laser surgery certification, a $350 fee for initial applications for licensure with TPA certification and laser surgery certification, and a $250 fee for annual licensure renewal with TPA certification and laser surgery certification.

18VAC105-20-80 (Requirements for laser surgery certification) would be newly added. This section would require applicants to submit the application form, the prescribed fee, an educational attestation form covering specific subjects, and evidence of either passing the laser section of the LSPE (Laser and Surgical Procedures Examination) or proctored sessions as required by the newly created 18VAC105-20-90.

18VAC105-20-90 (Requirements for proctoring) would specify that applicants who have not provided the board with a passing score on the LSPE must submit a form providing evidence of at least two proctored sessions for each of the three procedures: peripheral iridotomy, selective laser trabeculoplasty, and YAG capsulotomy. This section would also specify who could proctor these sessions and what information must be provided on the form.

18VAC105-20-100 (Reporting requirements) would be newly added to require optometrists certified to perform laser surgery to provide quarterly reports to the board containing the number and type of laser surgeries performed, the conditions treated for each surgery, and any adverse treatment outcomes that required referral to an ophthalmologist for treatment. This requirement is identical to the fourth enacting clause of Chapter 16 of the 2022 Acts of Assembly and expires on July 1, 2025.

18VAC105-20-110 (Quality assurance review process) would also be newly added and would require optometrists certified to perform laser surgery to maintain documentation for at least three years of the number and type of laser surgeries performed and any adverse treatment outcomes that required referral to an ophthalmologist for treatment. This requirement would become effective on July 1, 2025, effectively replacing the reporting requirements in 18VAC105-20-100. This section would also specify that the board may conduct a random audit of licensees, which would require the licensee to provide this documentation within 30 days of notification of the audit.

In addition, the board plans to change the late renewal fees to $50 regardless of license type. Currently, the late renewal fees are $50 for a license without TPA certification, $65 for late renewal with TPA certification, and $35 for an inactive license.

Estimated Benefits and Costs. The proposed amendments would primarily benefit optometrists who have already received the training to perform these laser eye surgeries and licensed optometrists who want to obtain such training by creating a pathway for those optometrists to become certified to perform these procedures. As of December 31, 2023, there were 1,852 TPA-certified optometrists in the Commonwealth who would be able to seek certification to perform laser surgery.⁵

The board reports that optometry students who graduated since roughly 2015 have already received the education required in these amendments as part of the standard instruction at schools of optometry.⁶ Licensed optometrists who graduated prior to 2015 may need to obtain appropriate training and proctored testing to pursue certification. The board reports that these programs run regularly and cost approximately $1,200 according to the Oklahoma College of Optometry continuing education course offering.⁷

Representatives for the Virginia Optometric Association indicate that there are roughly 200 optometrists in Virginia who already meet the criteria for certification, and that the total number of providers of these laser procedures is likely to increase by up to 50% once this regulation becomes effective.⁸ These 200 candidates would be able to apply for certification as soon as it is available, either because they have received the required instruction as part of the standard curriculum or because they have completed separate training in other states that would meet the requirements in the proposed text. Representatives for the association also noted that equivalent certifications are not available in North Carolina, Maryland, West Virginia, or Washington, DC, which could lead some optometrists in those places to either relocate or obtain a Virginia license and practice in multiple jurisdictions depending on their location and proximity.

An increase in the supply of providers of these three laser surgery procedures would benefit patients who need any of these procedures by increasing the availability of appointments and lowering wait times. Patients may also face lower out-of-pocket costs to obtain treatment depending on their insurance coverage.

Lastly, suppliers of the laser equipment required to perform these procedures would benefit since optometrists who obtain the certification in Virginia would have to purchase this equipment. Optometrists who seek to provide these surgeries would have to incur costs to invest in such equipment. However, this investment is not expected to be so high that solo or group private practices would find it cost-prohibitive.

As mentioned previously, initial applicants for licensure with TPA certification and laser surgery certification would have to pay a $350 application fee, which is $100 greater than the initial application fee with TPA certification alone. The standalone laser surgery certification would require payment of a $200 fee. The annual license renewal fee with TPA and laser surgery certification would be $250, which is $50 greater than the annual license renewal fee with TPA certification. These fees are likely very small relative to the fixed cost of investing in the equipment and the expected revenue from payments for laser surgeries.

Businesses and Other Entities Affected. As described above, the proposed changes would benefit the TPA-certified optometrists who also become certified to provide these three laser eye surgery procedures as well individuals who need these treatments. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁹ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.¹⁰

Applicants for the optometry license after January 1, 2033, would be required to pay an additional $100 for the license fee for the laser surgery certification, since they would no longer have the option of applying for an initial license with just the TPA certification. They may also incur additional indirect costs through higher tuition for optometry programs with instruction in subjects that would be required for the laser surgery certification; however, to the extent that these subjects are already part of the standard optometry curriculum, any associated costs may already be incurred by optometry students. Similarly, the broader scope of practice may lead to higher costs for liability insurance coverage.

The board reports that the 2022 legislation expands the scope of practice of the profession to include these three laser eye surgeries. However, the legislation does not appear to directly stipulate that the board require all applicants for the optometry license be certified to perform laser eye surgeries, or to set a date for such a requirement to go into effect. Since these requirements are at least partly discretionary, an adverse impact is indicated for optometry license applicants on or after January 1, 2033.

Small Businesses¹¹ Affected.¹² The proposed amendments would not directly affect small businesses. However, roughly 60% of optometrists in Virginia work in a group or solo private practice; these would meet the definition of small businesses.¹³ These private practices would benefit to the extent that those practitioners seek to obtain laser certification and offer laser eye surgeries. The requirement that from 2033 onward, all applicants for licensure in optometry must meet the criteria for laser surgery certification, and the resulting increase in the cost of obtaining licensure, could impact the creation of new private practices. However, since these arise from individual ability to practice in the Commonwealth, they are discussed under the Projected Impact on Employment.

Localities¹⁴ Affected.¹⁵ The proposed amendments neither disproportionally affect any particular localities, nor affect costs for local governments.

Projected Impact on Employment. The proposed regulation does not appear to directly affect total employment. However, there may be a nominal increase in the employment of optometry support staff if, for example, some optometrists moved to Virginia from neighboring states or opened practices to provide laser eye surgeries once the certification becomes effective. The requirement that from 2033 onward, all applicants for licensure in optometry must meet the criteria for laser surgery certification, and the resulting increase in the cost of obtaining licensure, could discourage some individuals who would otherwise have studied to enter the optometry profession from doing so.

Further, individuals with out-of-state licenses are currently required to obtain a Virginia license to practice in the Commonwealth. Since many other states do not include any laser eye surgeries in the scope of practice for optometry in their state, starting in 2033, such applicants may need to pay for additional education or additional testing or proctoring to meet the requirements in the proposed 18VAC105-20-80. The extent to which such costs are incurred would depend on the number of out-of-state licensees seeking to work or establish a private practice in Virginia in/after 2033, when they received their optometry education, and whether the subject areas required by 18VAC105-20-80 were covered by their programs.

Effects on the Use and Value of Private Property. The value of some private optometry practices that invest in laser technology and certification and provide laser eye surgery could increase since it may increase their operating profits. The proposed amendments do not affect real estate development costs.

_____________________________

¹Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² See https://lis.virginia.gov/cgi-bin/legp604.exe?221+ful+CHAP0016.

³ "Peripheral iridotomy" is used to treat or prevent glaucoma or high eye pressure by creating a hole in the iris to free trapped fluid. See https://glaucoma.org/treatment/laser/lpi. SLT is used to treat glaucoma by applying laser energy to the drainage tissue in the eye to lower eye pressure. See https://glaucoma.org/articles/selective-laser-trabeculoplasty-10-commonly-asked-questions. "YAG capsulotomy" is used to remove scar tissue after lens replacement. See https://www.webmd.com/eye-health/cataracts/what-to-know-about-posterior-capsulotomy-yag-laser. "YAG" derives from the name of the laser, "Neodymium:yttrium-aluminum-garnet (Nd:YAG)," which contains the acronym, "YAG."

⁴ In addition, the legislation also required the board to promulgate regulations requiring all optometrists to register annually with the board and to report certain information as deemed appropriate by the Board, including certain mandatory reporting elements. The annual registration and reporting requirements are being implemented through a separate regulatory action. See https://townhall.virginia.gov/L/ViewStage.cfm?stageid=10029.

⁵ See https://www.dhp.virginia.gov/about/stats/2024Q2/04CurrentLicenseCountQ2FY2024.pdf. Section 54.1-3225 of the Code of Virginia specifies that only TPA-certified optometrists are eligible for laser surgery certification.

⁶ See Agency Background Document (ABD), page 5: https://townhall.virginia.gov/l/ GetFile.cfm?File=29\6072\10028\AgencyStatement_DHP_10028_v3.pdf

⁷ ABD, page 5.

⁸ This assumes that there are currently roughly 400 ophthalmologists who perform these surgeries.

⁹ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

¹⁰ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

¹¹ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

¹² If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

¹³ See https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/opt/0618Optometrists2023.pdf, page 14.

¹⁴ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹⁵ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The agency generally agrees with the economic impact analysis prepared by the Department of Planning and Budget. However, the agency would like to address two issues.

First, for clarification, the legislation that forms the basis of the current action changed the scope of practice of optometry in § 54.1-3201 of the Code of Virginia to include all actions previously within the scope of practice and additionally include the three laser surgeries at issue in the legislation. The legislation altered the scope of practice of optometry; therefore, it altered what a license from the Board of Optometry represents a bearer of the license as competent to perform according to the Commonwealth of Virginia. A license held by a physician in the Commonwealth, for example, demonstrates that the holder can perform medicine and surgery as that is the scope of practice included for physicians pursuant to § 54.1-2900 of the Code of Virginia. Physicians do not obtain a separate certification for surgery. Recognizing that this is an expansion of scope for optometrists, certifications must be initially offered separate from initial licensure and for any existing licensees. In fact, after January 1, 2033, existing licensees will still be able to obtain a certification to practice laser surgery separate from their existing license. New license applicants - those that have never held a license in Virginia - will need to obtain a license that incorporates the requirements for laser surgery after January 1, 2033.

Additionally, the agency disagrees with the following statement: "The requirement that from 2033 onward, all applicants for licensure in optometry must meet the criteria for laser surgery certification, and the resulting increase in the cost of obtaining licensure, could discourage some individuals who would otherwise have studied to enter the optometry profession from doing so." The current cost of tuition at optometric schools in the United States covers the study of these three laser procedures, which has been part of curricula covered prior to graduation since approximately the class of 2015. The cost of tuition far exceeds the comparatively minimal cost of obtaining licensure, even after 2033, when the cost of a new license to practice would include the cost of laser certification. The cost of optometry school may deter potential optometrists, but it is extremely unlikely that the cost of licensure would lead a potential optometrist to forgo attending optometry school, particularly given the cost of school and the number of optometrists carrying student loan debt. As noted in the Health Workforce Data Center 2023 Report on the Profession of Optometry: "More than two out of every five optometrists currently have education debt, including 75% of those who are under the age of 40. For those optometrists with education debt, the median debt amount is between $120,000 and $140,000" (https://www.dhp.virginia.gov/media/dhpweb/docs/hwdc/opt/0618Optometrists2023.pdf).

Summary:

Pursuant to Chapters 16 and 17 of the 2022 Acts of Assembly, the proposed amendments establish criteria for certification of optometrists to provide certain laser surgeries, including (i) adding definitions specific to laser surgery; (ii) requiring a laser surgery certification, including provisions for fees, education, and clinical training, whether in a school setting or via proctored sessions; (iii) specifying requirements for proctoring and proctors; (iv) adding reporting requirements, including reporting requirements to maintain a quality assurance review process; (v) establishing fees related to certification; and (vi) providing renewal requirements

18VAC105-20-5. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Acute pain" means pain that occurs within the normal course of a disease or condition for which controlled substances may be prescribed for no more than three months.

"Active clinical practice" means an average of 20 hours per week or 640 hours per year of providing patient care.

"Adnexa" is defined as the conjoined, subordinate, or immediately associated anatomic parts of the human eye, including eyelids and eyebrows.

"Board" means the Virginia Board of Optometry.

"Chronic pain" means nonmalignant pain that goes beyond the normal course of a disease or condition for which controlled substances may be prescribed for a period greater than three months.

"Controlled substance" means drugs listed in the Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia) in Schedules II through V.

"Laser surgery certification" means a certification issued by the board to a Virginia-licensed TPA-certified optometrist who has demonstrated compliance with the board's criteria for performance of peripheral iridotomy, selective laser trabeculoplasty, and YAG capsulotomy.

"LSPE" means the Laser and Surgical Procedures Examination administered by the NBEO.

"MME" means morphine milligram equivalent.

"NBEO" means the National Board of Examiners in Optometry.

"Prescription Monitoring Program" means the electronic system within the Department of Health Professions that monitors the dispensing of certain controlled substances.

"Proctored session" means any surgery on a live patient or procedure performed on a model eye that is observed and evaluated by a proctor for the purpose of obtaining laser surgery certification pursuant to 18VAC105-20-80 4 b.

"Proctoring" means an objective evaluation of an optometrist's clinical competence to perform laser surgery pursuant to § 54.1-3225 of the Code of Virginia.

"TMOD" means the treatment and management of ocular disease portion of the NBEO examination.

"TPA" means therapeutic pharmaceutical agents.

"TPA certification" means authorization by the Virginia Board of Optometry for an optometrist to treat diseases and abnormal conditions of the human eye and its adnexa and to prescribe and administer certain therapeutic pharmaceutical agents.

18VAC105-20-10. Requirements for licensure.

A. The applicant, in order to be eligible for licensure to practice optometry in the Commonwealth, shall meet the requirements for TPA certification in 18VAC105-20-16 and shall:

1. Be a graduate of a school of optometry accredited by the Accreditation Council on Optometric Education or other accrediting body deemed by the board to be substantially equivalent; and have an official transcript verifying graduation sent to the board;

2. Request submission of an official report from the NBEO of a score received on each required part of the NBEO examination or other board-approved examination;

3. Submit a completed application and the prescribed fee; and

4. Sign a statement attesting that the applicant has read, understands, and will comply with the statutes and regulations governing the practice of optometry in Virginia.

B. On or after January 1, 2033, all applicants to practice optometry in the Commonwealth shall meet the requirements for laser surgery in 18VAC105-20-80.

C. The board may waive the requirement of graduation from an accredited school of optometry for an applicant who holds a current, unrestricted license in another United States jurisdiction and has been engaged in active clinical practice for 36 out of the 60 months immediately preceding application for licensure in Virginia.

C. D. Required examinations. For the purpose of § 54.1-3211 of the Code of Virginia, the board adopts all parts of the NBEO examination as its written examination for licensure. After July 1, 1997, the board shall require passage as determined by the board of Parts I, II, and III of the NBEO examination, including passage of TMOD.

D. E. If an applicant has been licensed in another jurisdiction, the following requirements shall also apply:

1. The applicant shall attest that the applicant is not a respondent in a pending or unresolved malpractice claim.

2. Each jurisdiction in which the applicant is or has been licensed shall verify that:

a. The license is current and unrestricted, or if the license has lapsed, it is eligible for reinstatement;

b. All continuing education requirements have been completed, if applicable;

c. The applicant is not a respondent in any pending or unresolved board action; and

d. The applicant has not committed any act that would constitute a violation of § 54.1-3204 or 54.1-3215 of the Code of Virginia.

3. An applicant licensed in another jurisdiction who has not been engaged in active practice within the 12 months immediately preceding application for licensure in Virginia shall be required to complete 20 hours of continuing education as specified in 18VAC105-20-70.

4. In the case of a federal service optometrist, the commanding officer shall also verify that the applicant is in good standing.

18VAC105-20-20. Fees.

A. Required fees.

Initial application and licensure (including with TPA certification)	$250
Initial application for licensure with TPA certification and laser surgery certification	$350
Application for laser surgery certification	$200
Annual licensure renewal without TPA certification	$150
Annual licensure renewal with TPA certification	$200
Annual licensure renewal with TPA certification and laser surgery certification	$250
Annual renewal of inactive license	$100
Late renewal without TPA certification of any license	$50
Late renewal with TPA certification	$65
Late renewal of inactive license	$35
Handling fee for returned check or dishonored credit card or debit card	$50
Reinstatement application fee (including renewal and late fees)	$400
Reinstatement application after disciplinary action	$500
Duplicate wall certificate	$25
Duplicate license	$10
Licensure verification	$10

B. Unless otherwise specified, all fees are nonrefundable.

C. From October 31, 2018, to December 31, 2018, the following fees shall be in effect:

Annual licensure renewal without TPA certification	$75
Annual licensure renewal with TPA certification	$100
Annual professional designation renewal (per location)	$25

18VAC105-20-60. Renewal of licensure; reinstatement; renewal fees.

A. Every person authorized by the board to practice optometry shall, on or before December 31 of 2018 March 31 of each year, submit a completed renewal form and pay the prescribed annual licensure fee. Beginning with calendar year 2020, the renewal of licensure deadline shall be March 31 of each year. For calendar year 2019, no renewal is required.

B. It shall be the duty and responsibility of each licensee to assure ensure that the board has the licensee's current address of record and the public address, if different from the address of record. All changes of address or name shall be furnished to the board within 30 days after the change occurs. All notices required by law or by these rules and regulations are to be deemed to be validly tendered when mailed to the address of record given and shall not relieve the licensee of the obligation to comply.

C. The license of every any person who does not complete the renewal form and submit the renewal fee each year for a licensure period may be renewed for up to one year by paying the prescribed renewal fee and late fee, provided the requirements of 18VAC105-20-70 have been met. After the renewal deadline, a license that has not been renewed is lapsed. Practicing optometry in Virginia with a lapsed license may subject the licensee to disciplinary action.

D. An optometrist whose license has been lapsed for more than one year and who wishes to resume practice in Virginia shall apply for reinstatement. The executive director may grant reinstatement, provided that:

1. a. The applicant has a current, unrestricted license in another United States jurisdiction and has been engaged in active clinical practice within the 12 months immediately preceding application for reinstatement; or

2. b. The applicant has satisfied current requirements for continuing education as specified in 18VAC105-20-70 for the period in which the license has been lapsed, not to exceed two years; and

3. 2. The applicant has paid the prescribed reinstatement application fee.

18VAC105-20-80. Requirements for laser surgery certification.

An applicant for laser surgery certification shall submit to the board:

1. A completed application for laser surgery certification;

2. The prescribed fee;

3. An educational attestation from a dean or designee of a school of optometry or an instructor of a laser surgery certification course approved by the board that verifies that the applicant received didactic and clinical laser surgery training in the following subjects:

a. Laser physics, hazards, and safety;

b. Biophysics of laser;

c. Laser application in clinical optometry;

d. Laser tissue interactions;

e. Laser indications, contraindications, and potential complications;

f. Gonioscopy;

g. Laser therapy for open-angle glaucoma;

h. Posterior capsulotomy;

i. Common complications, lids, lashes, and lacrimal;

j. Medicolegal aspects of anterior segment procedures;

k. Peripheral iridotomy; and

l. Laser trabeculoplasty.

The required attestation from the dean or designee of a school of optometry or an instructor of a laser surgery certification course approved by the board shall be submitted on a form prescribed by the board; and

4. Evidence of one of the following:

a. Passage of the Laser Section of the LSPE, for which the applicant must request submission of an official report from the NBEO of the score received on the Laser Section of the LSPE; or

b. Proctored sessions in compliance with 18VAC105-20-90, which may be obtained during education training described in subdivision 3 of this section.

18VAC105-20-90. Requirements for proctoring.

A. Applicants for laser surgery certification who have not provided the board with a passing score on the Laser Section of the LSPE must submit evidence on a form provided by the board of at least two proctored sessions for each of the following laser procedures:

1. Peripheral iridotomy;

2. Selective laser trabeculoplasty; and

3. YAG capsulotomy.

B. Proctors.

1. Pursuant to § 54.1-2400.01:1 of the Code of Virginia, a proctored session performed within the Commonwealth to qualify a TPA-certified optometrist for a laser surgery certification that consists of surgery on a live patient must be proctored by a licensed doctor of medicine or osteopathy who specializes in ophthalmology.

2. A proctored session performed within the Commonwealth to qualify a TPA-certified optometrist for a laser surgery certification that is performed on a model eye may be proctored by an individual holding a license in the Commonwealth or another jurisdiction who is authorized or certified to perform laser surgery on the eye and who does so as part of a regular course of practice.

3. The proctor must be in attendance in the room while the proctored session is performed, regardless of the jurisdiction in which the proctoring occurs.

4. Evidence of proctored sessions shall include a report by the proctor on a form provided by the board that:

a. Evaluates the clinical competency of the individual being proctored;

b. Describes the number and type of cases proctored; and

c. Includes the proctor's name, license type, license number, and state of licensure.

18VAC105-20-100. Reporting requirements.

A. An optometrist certified to perform laser surgery by the board shall report the following information to the board on a quarterly basis:

1. The number and type of laser surgeries performed by the optometrist;

2. The conditions treated for each laser surgery performed; and

3. Any adverse treatment outcomes associated with such procedures that required a referral to an ophthalmologist for treatment.

B. The requirements of subsection A shall expire on July 1, 2025.

18VAC105-20-110. Quality assurance review process.

A. Effective July 1, 2025, an optometrist certified to perform laser surgery by the board shall maintain documentation of the following for not less than three years:

1. The number and type of laser surgeries performed by the optometrist; and

2. Any adverse treatment outcomes associated with such procedures that required referral to an ophthalmologist for treatment.

B. The board may conduct a random audit of licensees requiring a subject licensee to provide documentation required in subsection A to the board within 30 days of notification of the audit.