By Clayton Tyler Boyd, OD, FAAOMS
When I perform a YAG laser procedure in my rural Oklahoma practice, I’m benefiting from a legacy that began decades before I was born. That 10-minute procedure—which keeps my patient from driving three hours to see a subspecialist—exists because the American Optometric Association fought a battle I never had to fight alone.
Every major advancement in optometry, from Medicare recognition to therapeutic authority to laser procedures, happened because AOA members collectively tackled challenges that would have been impossible for individual practitioners to overcome. As I reflect on my practice today, I realize how many daily benefits I take for granted were hard-won victories that required sustained, organized advocacy.
Here are six major pain points the AOA has solved—battles that shaped the profession we practice today.
The Medicare Miracle (1987): Foundation of Modern Optometry Perhaps no single victory better illustrates the AOA’s power than the 22-year fight for Medicare recognition. From 1965 to 1987, optometrists were completely excluded from Medicare reimbursement. Think about that: for over two decades, the largest healthcare program in America didn’t recognize optometry as a legitimate medical profession.
The AOA never gave up. Through sustained lobbying, grassroots advocacy, and strategic coalition-building, they finally achieved Medicare parity in the 1987 budget reconciliation bill. The AOA president called it “the greatest legislative achievement in the history of optometry”and for good reason. This victory opened optometric care to 30 million Americans and established the foundation for everything that followed.
Without this AOA victory, modern optometry simply wouldn’t exist. Every Medicare patient I see, every refractive surgery consultation, every diabetic eye exam, none of it would be possible without the AOA’s refusal to accept exclusion from America’s largest healthcare program.
From “Drugless” to Medical: The TPA Revolution (1976-1998)
When I graduated optometry school, I took for granted my ability to prescribe medications and treat eye diseases. But optometry was once legally defined as a “drugless profession.” Optometrists could only detect problems – not treat them.
The AOA launched a methodical, state-by-state campaign that spanned 22 years. West Virginia became the first state to grant therapeutic pharmaceutical authority in 1976, and the AOA supported affiliate organizations nationwide until every state and the District of Columbia had TPA laws by 1998.
The impact was profound: a 12% reduction in vision impairment nationwide, a 13% wage increase for employed optometrists, and the elimination of racial disparities in eye care access. When I treat a patient’s glaucoma or prescribe antibiotics for conjunctivitis, I’m exercising authority that exists because the AOA refused to accept artificial limitations on optometric practice.
Current Scope Expansion: Doubling the Pace of Progress
The AOA’s advocacy continues today through initiatives like the Future Practice Initiative, launched in 2018 to support state-level scope expansion efforts. The results speak for themselves: six additional states gained laser authority between 2019 and 2024, doubling the rate of expansion compared to the previous 20 years.
These aren’t abstract policy victories. I personally benefit from Oklahoma’s early laser authority, and I’ve seen patients drive from neighboring states like Texas and Kansas for procedures they can’t access locally. The AOA’s safety data—146,403 laser procedures with only 2 adverse outcomes, a 0.001% complication rate—provides the evidence state legislators need to expand access.
West Virginia just passed scope expansion in May 2025, and 13 states are currently pursuing similar legislation. This momentum exists because the AOA provides strategic funding, lobbying expertise, and coordinated messaging that individual state associations couldn’t achieve alone.
2025 Legislative Victories: Protecting Practice Viability
This year alone, the AOA delivered concrete financial benefits to every practicing optometrist. When Medicare cuts and expiring tax deductions threatened practice viability, the AOA’s intensive lobbying during H.R. 1 “One Big Beautiful Bill Act” negotiations secured critical wins:
● A 2.5% physician pay increase for 2026 (preventing planned cuts)
● Permanent extension of the 20% small business tax deduction
● Preservation of the SALT deduction for high-tax states
These victories saved thousands of dollars per practice annually. Without AOA advocacy, every optometrist would be facing Medicare cuts and significant tax increases in 2026.
Fighting Vision Benefit Manager Abuses
Perhaps no current issue better demonstrates the AOA’s value than the fight against Vision Benefit Manager abuses. VBMs have forced below-cost contracting, implemented anti-competitive practices, and undermined practice autonomy—issues individual doctors couldn’t combat alone.
The AOA’s response has been systematic and effective. They’ve launched three separate federal congressional investigations, sent cease-and-desist letters to abusive VBMs, and developed model state legislation. Texas passed HB 3211 as a model law, with Arkansas, Oklahoma, and Illinois following suit. The AOA organized 600+ doctors for Capitol Hill advocacy, creating bipartisan support for the DOC Access Act.
The results are tangible: VSP has reached multiple lawsuit settlements, and federal antitrust investigations are examining VBM market concentration. When House Republicans announced antitrust hearings into vision insurance markets in September 2025, it was the direct result of AOA advocacy efforts.
Contact Lens Safety: Eliminating Dangerous Loopholes
A more targeted but equally important victory involved contact lens prescription verification. The AOA discovered that 89% of optometrists were receiving invalid robocall verifications—54% for wrong prescriptions, 43% for non-patients. This wasn’t just an annoyance; it was a patient safety crisis.
The AOA-backed Contact Lens Prescription Verification Modernization Act gained 74 House cosponsors and bipartisan support. Their advocacy contributed to the largest Contact Lens Rule enforcement action in FTC history: a $3.5 million settlement with Hubble Contacts. The legislation eliminated robocall loopholes and required direct communication for prescription verification, protecting both patient safety and professional integrity.
The Power of Collective Action
These victories share a common theme: they required sustained, coordinated effort that individual practitioners couldn’t achieve alone. The AOA succeeded because it could maintain 22-year campaigns, coordinate across 50 states, and speak with the unified voice of America’s optometrists.
Today’s challenges—VBM accountability, scope expansion, Medicare advocacy—require the same collective approach. The AOA’s recent growth demonstrates that optometrists recognize this value: over 300 new doctors joined in the first six months of 2024 alone.
When I see the trust data showing that 75% of Americans trust AOA-member optometrists, I understand that this trust wasn’t built overnight. It was earned through decades of advocacy that prioritized patient care, professional excellence, and expanded access to eye health services.
Why Membership Matters Now
Every day, I practice with freedoms and opportunities that exist because previous generations of AOA members fought for them. The Medicare recognition that allows me to serve elderly patients, the therapeutic authority that lets me treat diseases, the laser certification that keeps patients close to home—none of these existed automatically.
They exist because the AOA never accepted limitations on what optometrists could do for patients. They understood that individual excellence wasn’t enough; the profession needed collective advocacy to achieve its potential.
As we face new challenges – artificial intelligence integration, telehealth regulation, continued scope expansion – the need for unified advocacy remains as critical as ever. The AOA has proven it can deliver results when optometrists stand together.
The question isn’t whether you can afford AOA membership. The question is whether you can afford to practice without the organization that has fought every major battle that made modern optometry possible.
Every YAG procedure, every glaucoma treatment, every Medicare patient—they all bear the fingerprints of AOA advocacy. That legacy continues today, but only if we support the organization that makes it possible.
