March 27, 2026
Optometrists, otherwise known as eye-doctors, are primary healthcare providers who diagnose and treat common eye problems such as near-sightedness or astigmatism. They differ from other doctors due to their background education, because they attend a special type of medical school specifically for Optometrists. Using data from the Knee Regulatory Research Center’s 2025 Annual Licensing database, I’ll provide a rundown of what your eye doctor must do to legally practice in your state. This will include comparisons on things such as exam requirements, continuing education requirements, fees associated with licensing, and scope of practice.
Currently, all 50 states license the profession, with all of them requiring a Doctor of Optometry (O.D) to even be considered for licensure. Provided below is a summary statistics table with some basic computed statistics relating to licensing requirements. This table covers the renewal fees, initial fees, the number of exams required, and the continuing education requirements for renewal.
Table 1: Summary Statistics
| Mean | Standard Deviation | Minimum Value | Maximum Value | |
|---|---|---|---|---|
| Initial Licensing Fee | $357.30 | $221.20 | $25.00 | $1,300.00 |
|
License Renewal Fee
|
$414.10 | $255.10 | $26.00 | $1,000.00 |
| Number of Exams | 4.5 | 0.80 | 3.00 | 6.00 |
|
Continuing Education Requirement |
36.4 | 11.90 | 0.00 | 80.00 |
One very important difference between states is the number of exams that are required to become licensed. Every state requires prospective optometrists to take at least one part of the National Board of Examiners in Optometry (NBEO) exam, which consists of 3 separate parts with additional exams that cover specific optometry skills and procedures. All states require these three parts of the base exam; however, additional NBEO exams beyond the base three may be required depending on the state. Another common practice is for states to require a jurisprudence exam for licensure, which is an exam that tests an applicant on their knowledge of Optometry laws within the state. Provided below is a map that colors the exam requirements by state; most states require around 3 to 4 exams, although states like Alaska, Florida, North Carolina, and Kentucky differ from the usual number.
Figure 1: Exams Required by State
Like many other licensed occupations, there is an initial fee that is required to become licensed. This fee varies quite a bit from state to state, with Pennsylvania having the lowest initial fee at $25 dollars, and Alaska having the highest initial fee at $1300. This is a requirement that frequently changes on a yearly basis, as many states raise the initial fee to adjust for inflation. The map below displays a visual representation of the initial licensing fee across all 50 states, where Alaska is clearly an outlier.
Figure 2: Initial Licensing Fees by State
Similarly to the initial licensing fee, there is also a license renewal fee that licensed Optometrists must pay in every state to have their license renewed. This fee is administered either once a year or twice a year depending on the state, because some states grant Optometry licenses that are valid for two years rather than one. This fee also varies considerably by state, with Colorado having the lowest renewal fee at $26, and West Virginia and Oregon being tied for the highest renewal fee at $1000. This specific requirement is also raised frequently by states due to rising costs. The table below visually illustrates this range in renewal fees, and shows that states such as Maine, West Virginia, Nevada, and Oregon are outliers within the bunch.
Figure 3: Renewal Fee by State
Continuing education requirements outline the number of recurring educational or training hours outside of working that a professional needs to accrue to renew their license. Licensed Optometrists see a wide range of requirements, with Minnesota having the highest requirement at 80 hours, and New York having the lowest at 0 hours. It is important to note that some of these numbers may even differ within each state, because some states grant additional certificates to licensed Optometrists that grant additional privileges. For example, the number of continuing education requirements may be higher for Optometrists that are certified to prescribe pharmaceutical agents. Below is a table that shows this information on a map, with Minnesota being shown as a clear outlier compared to the rest of the states.
Figure 4: Continuing Education Requirement by State
As it stands, a debate also exists surrounding the expansion of Optometrist scope of practice, which is essentially a list of procedures and privileges that an Optometrist has. For example, delicate eye surgeries such as LASIKS would not fall under the scope of practice of Optometrists. Instead, this kind of procedure would fall under the scope of practice of an Ophthalmologist, which is an eye care provider with more training and the privilege to provide more advanced eye care.
Expanding Optometrist scope of practice would mean transferring some privileges and procedures normally granted to Ophthalmologist over to Optometrists. Given the shortage of physicians due to population growth and aging, this is seen as a solution because Ophthalmologists are especially hard to come by when compared to Optometrists. Prior research backs this claim up, as granting Optometrists the ability to diagnose eye diseases and prescribe Therapeutic Pharmaceutical Agents (TPA) was shown to reduce vision impairment by 12% on average across all states (Bae et al., 2025). This is of course just one of many expansions to Optometric scope of practice, as there are still things such as laser procedure privileges that are restricted in more than half of the states despite evidence pointing towards a net benefit for patients (Doctor of Optometry Have Safely Performed Thousands of Optometric Laser Procedures).
Altogether, licensing for Optometrists is uniform in the sense that the background education is the same regardless of state, however there are multiple small differences in fees, scope of practice, and exam requirements. With scope of practice in particular, reform and expansion can be utilized to expand access to eye care, especially for areas that are severely impacted by physician shortages.
Works Cited
Bae, K., Timmons, E. & Nandy, P. (2025) Seeing is believing: The effects of optometrist scope of practice expansion. Contemporary Economic Policy, 43(1), 135–160.
“Doctors of Optometry Have Safely Performed Thousands of Optometric Laser Procedures.” American Optometric Association (AOA), 4 Aug. 2024, www.aoa.org/news/clinical-eye-care/public-health/doctors-of-optometry-have-safely-performed-thousands-of-optometric-laser-procedures.
Norris, Conor, Kelley, Ethan, Carneal, Troy, and Timmons, Edward. (2025). “CSOR Licensing Database Annual Snapshot: 2025.” Knee Regulatory Research Center.