What’s the news: New Hampshire Gov. Kelly Ayotte has vetoed legislation that would have permitted optometrists to perform complex eye surgeries in the Granite State. In a strong and principled statement, Ayotte reaffirmed the importance of patient safety and high-quality care, emphasizing that eye surgery must be performed by physicians with extensive clinical and surgical training.
The legislation at issue, New Hampshire House Bill (HB) 349, raised serious concerns, as it would have authorized optometrists to perform intricate surgical procedures on and around the eye.
Ayotte’s veto statement highlights her commitment to both accessible and safe care, noting that New Hampshire has expanded eye care access in rural areas through innovative market-based solutions without compromising patient safety.
She explained that laser eye surgeries are not minor procedures and that complications 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,” Ayotte’s veto statement says.
Learn more with the AMA about the difference between ophthalmologists and optometrists.
Why it’s important: As AMA CEO and Executive Vice President John Whyte, MD, MPH, noted in his letter (PDF) to Ayotte urging the veto, optometrists are essential health professionals in the delivery of routine vision care. However, only ophthalmologists—who complete four years of medical school followed by four to six years of residency and fellowship training—are qualified to manage and safely perform surgery on and around the eye.
“This training and hands-on surgical experience is necessary to ensure the safest outcomes for eye patients, particularly for procedures where complications can result in permanent vision loss,” Dr. Whyte noted in a follow-up thank-you letter (PDF) to the governor. “Your veto was not a reflection on the dedication of optometrists, who remain essential in providing routine vision care and non-surgical medical treatments. Instead, your decision recognized that surgical procedures require the expertise that only physicians possess.”
In her veto statement, Ayotte respectfully acknowledged the important contributions of optometrists to vision health, while underlining the vital distinction between surgical and nonsurgical eye care. The AMA commended Ayotte for her leadership and steadfast commitment to patients in New Hampshire ensuring that eye surgery remains the domain of fully trained physicians.
The New Hampshire Medical Society and the American Academy of Ophthalmology were tireless in their advocacy efforts, which were instrumental in securing this important veto. The AMA supported the New Hampshire Medical Society’s advocacy efforts through a Scope of Practice Partnership grant.
Learn more: In 2025, New Mexico Gov. Michelle Lujan Grisham safeguarded the vision of patients by vetoing similar legislation that would have allowed optometrists to perform a wide range of complex surgical procedures.
As part of its long-running efforts to fight scope creep, the AMA defends the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care. This year, the AMA has worked with more than 40 state medical associations and national specialty societies to defeat scope of practice legislation, and the AMA Scope of Practice Partnership has provided 14 grants to help state advocacy efforts on this issue in 2026. [KH1]
The partnership has handed out $5.7 million in grants since its inception, and that effort has been stepped up, with AMA Board Chair David H. Aizuss, MD, announcing in January that the AMA will commit $1 million annually to the Scope of Practice Partnership.
Read more from the AMA about the risks of letting optometrists do eyelid surgery.
