What question did this study set out to answer?

To analyze trends in malpractice payments by U.S. optometrists and assess the relationship with state-level scope-of-practice expansions.

April 29, 2026

Malpractice payments by optometrists in the United States: An analysis of the National Practitioner Data Bank from 1996 to 2023

Key Points

To analyze trends in malpractice payments by U.S. optometrists and assess the relationship with state-level scope-of-practice expansions.
Reviewed NPDB data from 1996 to 2023 for optometrist malpractice payments.
Analyzed nationwide trends using the Mann–Kendall test; evaluated state comparisons post-scope expansions with the Mann–Whitney rank-sum test.
Adjusted all monetary values for inflation to 2023 U.S. dollars.
Total of 1040 malpractice payments recorded, with a mean payment of $220,918.
Significant upward trend in inflation-adjusted payments (p=0.008); became nonsignificant after excluding 2021-2023 (p=0.15).
No significant increase in malpractice cases post-scope expansion in 10 states, except Indiana (p=0.049).

Abstract

ABSTRACT Purpose To analyze trends in malpractice payments made on behalf of U. S. optometrists from 1996 to 2023 using National Practitioner Data Bank (NPDB) data, and to assess whether state‐level scope‐of‐practice expansions are associated with increased liability risk. Methods Publicly available NPDB data were reviewed for malpractice payments involving optometrists between 1996 and 2023. Variables included number and value of payments, provider age, patient demographics, geographic distribution, and allegation category. Nationwide trends were analyzed using the Mann–Kendall test; pre‐ and post‐scope expansion comparisons in 11 states were evaluated using the Mann–Whitney rank‐sum test. All monetary values were inflation adjusted to 2023 U. S. dollars. Results A total of 1040 malpractice payments were recorded (mean 38. 5 cases/year). Mean payment was 220, 918 (SD 311, 395; range 300–2. 95 million). The average provider age was 43 years; 56% of patients were >50 years old. ‘Failure to diagnose’ accounted for 40% of primary allegations. Inflation‐adjusted total payments demonstrated a significant upward trend (p = 0. 008) that became nonsignificant after excluding 2021–2023 (p = 0. 15). No significant change in annual case numbers was observed (p = 0. 28). Among 11 states with expanded optometric authority, no statistically significant increase in malpractice cases occurred post‐expansion except in Indiana (p = 0. 049). Expanded‐scope states mirrored national trends in both payment frequency and amount. Conclusions Malpractice payments involving optometrists remain infrequent and financially modest compared with other health professions, with most claims arising from diagnostic rather than procedural issues. There is no evidence that expanding optometric privileges, including lasers, injections, or oral medications, has increased malpractice risk. Advances in education, technology, and interprofessional collaboration likely underpin this stability. Ongoing monitoring of NPDB data will help ensure that optometry's growing clinical role continues to align with patient safety and professional accountability.

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