Regulations, Insurance and Advocacy

ASOPRS Position Statements
Approved by ASOPRS Board of Directors 10.15.25 

Optometry Scope of Practice

Legislative proposals expanding surgical scope of practice must be evaluated through the lens of patient safety. Eyelid, lacrimal (tear duct), orbital and facial procedures are among the most delicate in medicine. Errors can result in blindness, disfigurement, or even death. These procedures should only be performed by physicians with the extensive training to make surgical decisions, execute technique safely, and manage complications.

The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) is the educational body for oculofacial plastic surgery in the United States and Canada. ASOPRS Fellow Members are board-certified ophthalmologists, certified by the American Board of Ophthalmology (ABO), the American Osteopathic Association (AOA), or the Royal College of Physicians and Surgeons of Canada (RCPSC), with advanced training and expertise in oculofacial plastic surgery.

ASOPRS opposes legislation expanding the scope of optometry to include surgery. The American Medical Association  and the American College of Surgeons define surgery broadly, including procedures involving lasers, scalpels, or injections that alter human tissue. More specifically, AMA H-475.983 Definition of Surgery.

Our AMA adopts the following definition of “surgery” from American College of Surgeons Statement ST-11: Surgery is performed for the purpose of structurally altering the human body by the incision or destruction of tissues and is part of the practice of medicine. Surgery also is the diagnostic or therapeutic treatment of conditions or disease processes by any instruments causing localized alteration or transposition of live human tissue which include lasers, ultrasound, ionizing radiation, scalpels, probes, and needles. The tissue can be cut, burned, vaporized, frozen, sutured, probed, or manipulated by closed reductions for major dislocations or fractures, or otherwise altered by mechanical, thermal, light-based, electromagnetic, or chemical means. Injection of diagnostic or therapeutic substances into body cavities, internal organs, joints, sensory organs, and the central nervous system also is considered to be surgery (this does not include the administration by nursing personnel of some injections, subcutaneous, intramuscular, and intravenous, when ordered by a physician). All of these surgical procedures are invasive, including those that are performed with lasers, and the risks of any surgical procedure are not eliminated by using a light knife or laser in place of a metal knife, or scalpel. Patient safety and quality of care are paramount and, therefore, patients should be assured that individuals who perform these types of surgery are licensed physicians (defined as doctors of medicine or osteopathy) who meet appropriate professional standards. (Res. 212; A-07).

Optometrists play a vital role in vision care but do not receive the medical or surgical training required for safe performance of surgery. To protect patients, surgical procedures must remain within the scope of appropriately trained physician surgeons.

Dental Hygienist Use of Neurotoxins and Fillers

Legislative proposals expanding scope of practice must be evaluated through the lens of patient safety. Neurotoxin and filler injections carry the potential for significant risks, including vascular occlusion, necrosis, vision loss, and stroke. These procedures should only be performed by physicians with the training to recognize anatomy, manage complications, and provide comprehensive care.

The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) is the educational body for oculofacial plastic surgery in the United States and Canada. ASOPRS Fellow Members are board-certified ophthalmologists, certified by the American Board of Ophthalmology (ABO), the American Osteopathic Association (AOA), or the Royal College of Physicians and Surgeons of Canada (RCPSC), with advanced training and expertise in oculofacial plastic surgery.

ASOPRS opposes the administration of botulinum toxins and dermal fillers by dental hygienists. The American College of Surgeons (ACS) and the American Medical Association (AMA) define surgery as procedures that alter living tissue, including injections, and affirm that such procedures constitute the practice of medicine. Safe performance requires years of medical education and surgical training — education not provided in dental hygiene programs.

While dental hygienists provide essential oral health care, their training does not extend to facial anatomy, performance of surgery or the management of complications such as vascular occlusion, tissue necrosis, vision loss, or stroke. For patient safety, these procedures must remain within the scope of appropriately trained physician surgeons.

Dentist Use of Neurotoxins and Fillers

The use of neurotoxins and fillers must always be evaluated with patient safety in mind. These procedures carry risks such as intravascular injection, necrosis, and vision loss. Safe use requires detailed knowledge of anatomy, mastery of injection technique, and the ability to manage complications promptly and effectively.

The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) is the educational body for oculofacial plastic surgery in the United States and Canada. ASOPRS Fellow Members are board-certified ophthalmologists, certified by the American Board of Ophthalmology (ABO), the American Osteopathic Association (AOA), or the Royal College of Physicians and Surgeons of Canada (RCPSC), with advanced training and expertise in oculofacial plastic surgery.

ASOPRS recognizes that dentists and oral & maxillofacial surgeons have historically used botulinum toxin and fillers for therapeutic purposes, including the treatment of temporomandibular joint (TMJ) dysfunction and related conditions. These uses are supported by training within their professional domain and have contributed meaningfully to medical literature.

ASOPRS takes a neutral stance on the use of botulinum toxin and fillers by dentists and oral & maxillofacial surgeons when such procedures are consistent with their professional training and scope of practice.