Artificial eye-making has been practiced since ancient times. While ancient Rome and Egypt relied on priests to craft and fit prosthetic eyes, today we call these professionals ocularists. Ocularists fabricate and fit artificial eyes for patients, provide follow-up care including cleaning and maintenance, and work in tandem with ophthalmologists and optometrists and patients themselves. It is a deeply specialized profession and one of the most niche in all of eye care, with only 165 board-certified ocularists in the US according to the American Society of Ocularists’ registry.
The most prominent US entity for licensing ocularists comes at the national level: the National Examining Board of Ocularists (NEBO). There are two pathways to becoming a board-certified ocularist: completing a NEBO-approved education program plus completing 10,000 hours of experience or logging 14,000 hours of experience and obtaining references from two board certified ocularists and surgeons. Either way, you’re looking at a minimum of five years of training — followed by a two-part examination that costs $2300. Once certified, ocularists must renew every four years through re-examination or 200 credits of continuing education. Most also join the American Society of Ocularists, adding a $500 membership fee to the tab
It is, by any measure, a serious commitment. And because practicing without board certification creates real challenges — with insurance reimbursement challenges, insurance reimbursement, malpractice coverage, and patient trust — the vast majority of working ocularists pursue national certification.
However, for one state, practicing without board certification is not just uncommon — but also illegal.
The primary goal of state occupational licensing is to protect consumers and the public from harm that could be caused by low-skilled professionals in their state. Usually, competition is enough to filter out the poor performers on its own. For ocularists, NEBO’s multi-year process, rigorous exam, hefty fees, and regular re-certification requirements do exactly that, without any state needing to step in. And indeed, no state does. Every state has left the ocularist profession to self-regulate through national board certification —except Washington.
After Ohio delicensed the ocularist profession at the end of 2024, Washington became the last remaining state who requires ocularists to obtain a state license before they can serve their community. Washington’s State Board of Health requirements for licensure are a high school diploma, 10,000 hours of apprenticeship training, and passing an exam, which is separate from the exam required for national certification with NEBO.
By not following the example set by the rest of the country, requiring a state licensure and not national certification, becoming a professional ocularist in Washington state becomes much less desirable as costs, wait times, and burden grow.
At a moment when states across the country are actively looking to reduce unnecessary regulatory barriers and streamline occupational licensing. Washington’s continued requirement stands out, and not in a good way. When every other state has trusted the rigorous national credential system to do the job, requiring this redundant state license shows that Washington is turning a blind eye to an easy reform.