How to Become an Optometrist in 2026: Complete Licensing Guide

Optometrists are independent primary eye care providers who examine, diagnose, and treat a wide range of vision and ocular health conditions. Earning your optometry license requires completing a Doctor of Optometry (OD) degree from an ACOE-accredited program, passing the NBEO national board examinations, and meeting each state's specific requirements. Across the 51 states we track, 51 require the NBEO exam series, 51 grant Therapeutic Pharmaceutical Agent (TPA) certification, and 14 allow optometrists to perform certain laser procedures.

This guide covers everything you need to know about becoming a licensed optometrist in 2026 -- from the OD degree and NBEO exams to TPA certification, laser procedure authority, jurisprudence exams, continuing education, and state-by-state differences.

What Does an Optometrist Do?

Optometrists are primary eye care professionals trained to evaluate vision, detect eye diseases, and manage a broad range of ocular conditions. Unlike ophthalmologists, who are medical doctors (MD or DO) trained in eye surgery, optometrists hold an OD degree and focus on non-surgical care -- although scope-of-practice laws in many states are expanding to include certain laser and minor surgical procedures.

Day-to-day, an optometrist's responsibilities include:

• Comprehensive eye examinations: Assessing visual acuity, refraction, binocular vision, color vision, intraocular pressure, and overall ocular health using slit lamps, retinal imaging, OCT scans, and visual field testing
• Prescribing corrective lenses: Writing prescriptions for eyeglasses and contact lenses, including specialty lenses for keratoconus, orthokeratology, and post-surgical rehabilitation
• Diagnosing and managing eye disease: Detecting and treating conditions such as glaucoma, diabetic retinopathy, macular degeneration, dry eye disease, ocular infections, uveitis, and cataracts
• Prescribing medications: Topical and (in most TPA states) oral pharmaceutical agents for infection, inflammation, glaucoma, allergies, and pain management
• Pre- and post-surgical care: Co-managing patients undergoing cataract surgery, LASIK, corneal transplants, and other ophthalmic procedures
• Laser procedures: In an expanding number of states, performing procedures such as selective laser trabeculoplasty (SLT), YAG capsulotomy, and laser peripheral iridotomy
• Pediatric and geriatric vision care: Screening children for amblyopia and strabismus, and managing age-related conditions in older adults
• Low-vision rehabilitation: Helping patients with irreversible vision loss maximize their remaining sight using magnifiers, telescopic devices, and adaptive strategies

Optometrists work in private practices, group clinics, hospital outpatient departments, VA medical centers, retail optical chains, community health centers, and academic settings. The Bureau of Labor Statistics projects strong growth for the profession through the 2030s, driven by an aging population and increasing rates of chronic conditions such as diabetes and hypertension that affect ocular health.

Step 1: Earn a Doctor of Optometry (OD) Degree from an ACOE-Accredited Program

Every state requires candidates to hold a Doctor of Optometry (OD) degree from a program accredited by the Accreditation Council on Optometric Education (ACOE). As of 2026, there are 23 ACOE-accredited OD programs in the United States, plus several in Canada whose graduates are eligible for U.S. licensure. Admission is competitive; most programs require a bachelor's degree, strong science prerequisites, and a passing score on the Optometry Admission Test (OAT).

Undergraduate Prerequisites

Most OD programs require the following undergraduate coursework before admission:

• General biology and microbiology (with lab)
• General chemistry (with lab)
• Organic chemistry (with lab)
• Physics (with lab)
• Calculus or statistics
• English composition
• Psychology
• Biochemistry (increasingly required at most programs)

The OD Curriculum

The four-year OD curriculum is divided into two phases:

OD programs typically cost $30,000 to $55,000 per year in tuition. Total educational costs, including undergraduate study, often exceed $200,000. After graduation, many optometrists complete an optional one-year residency program to develop advanced skills in areas such as ocular disease, pediatrics, low vision, contact lenses, or neuro-optometry. Residency training is not required for licensure in any state but is increasingly valued for hospital- and VA-based positions.

Step 2: Pass the NBEO Examinations

The National Board of Examiners in Optometry (NBEO) administers the standardized national examinations used for optometry licensure across the country. 51 of 51 states require NBEO examination results as part of the licensure process. The NBEO series consists of three parts taken at different stages of the OD program:

Total NBEO exam fees are approximately $1,800-$2,200 for all three parts. The NBEO also offers the Treatment and Management of Ocular Disease (TMOD) exam -- typically included as part of Part II -- which tests pharmacology competency and is used for TPA certification in many states. Retake fees apply for any section not passed on the first attempt.

States Requiring NBEO Examinations

Step 3: Obtain TPA Certification

Therapeutic Pharmaceutical Agent (TPA) certification authorizes optometrists to prescribe and administer prescription drugs for the diagnosis and treatment of ocular conditions. This is one of the most significant distinctions in optometric scope of practice. 51 of 51 states grant TPA certification or its equivalent to licensed optometrists.

TPA-certified optometrists can prescribe medications such as:

• Topical antibiotics: For bacterial conjunctivitis, corneal ulcers, and other ocular infections
• Topical anti-inflammatory agents: Including corticosteroids and NSAIDs for uveitis, postoperative inflammation, and allergic eye disease
• Glaucoma medications: Prostaglandins, beta-blockers, carbonic anhydrase inhibitors, and alpha agonists for intraocular pressure management
• Antivirals and antifungals: For herpetic and fungal ocular infections
• Oral medications: In many TPA states, systemic oral medications for eye conditions are also within scope, including certain analgesics and anti-allergy agents

In most states, TPA certification is included in the standard OD license. Some states require additional examination (commonly the NBEO TMOD), a separate application, or documentation of pharmacology training to obtain TPA authority. TPA certification is practically essential in modern optometric practice -- without it, optometrists are limited to diagnostic-only scopes.

States with TPA Certification for Optometrists

Laser Procedures: An Expanding Scope of Practice

One of the fastest-evolving areas of optometric scope of practice is the authority to perform certain laser procedures. Traditionally restricted to ophthalmologists, 14 states now allow optometrists to perform specific laser procedures. The procedures most commonly authorized include:

• Selective Laser Trabeculoplasty (SLT): A first-line or adjunctive treatment for open-angle glaucoma that improves aqueous outflow through the trabecular meshwork
• YAG laser capsulotomy: Treatment for posterior capsule opacification -- a common complication following cataract surgery -- by creating an opening in the clouded capsule
• Laser peripheral iridotomy (LPI): A procedure to create a small hole in the iris to treat or prevent angle-closure glaucoma
• Laser suture lysis: Post-trabeculectomy management to adjust intraocular pressure after glaucoma filtration surgery
• Panretinal photocoagulation (PRP): In states with broader surgical scope laws, treatment for proliferative diabetic retinopathy

States that authorize laser procedures typically require additional training documentation, proof of competency, or specific postgraduate laser surgery coursework. Common prerequisites include completion of a minimum number of supervised laser procedures (often 10-15 of each type) and a laser training certificate from an accredited course. Requirements vary significantly by state -- always verify the specific procedures permitted and training prerequisites on your state board's website.

This area continues to evolve as more states consider expanding optometric laser authority. Several states have legislative proposals pending, and professional organizations continue to actively engage on the issue.

States Where Optometrists Can Perform Laser Procedures

Step 4: Pass the Jurisprudence Examination (Where Required)

37 of 51 states require optometry license applicants to pass a jurisprudence examination before licensure is granted. A jurisprudence exam tests knowledge of the state's specific optometry practice act, rules, and regulations. Topics typically covered include:

• State optometry scope of practice laws
• Licensing and renewal requirements
• Prescribing regulations and controlled substance rules
• Patient record-keeping and documentation requirements
• Disciplinary procedures and grounds for license revocation
• Requirements for optometric assistants and support staff supervision
• Professional ethics obligations under state law

Jurisprudence exams are typically administered online by the state optometry board or through a third-party testing vendor. Some states provide a study guide or reference to the relevant statutes. Passing scores and the format of the exam vary by state.

States Requiring a Jurisprudence Exam

Step 5: Apply for Your State License

Once you have completed your OD degree, passed the required NBEO exams, and satisfied any state-specific requirements, you submit your license application to the state board of optometry. A typical application requires:

1. Official OD degree transcript from your ACOE-accredited program
2. NBEO score reports confirming passing grades on all required examination parts
3. Jurisprudence exam passing score (if required in your state)
4. TPA certification documentation or TMOD exam scores (if separately required)
5. Background check and fingerprinting (required in most states)
6. Proof of professional liability insurance (required in some states)
7. Application fee payment

Processing times range from 2 to 12 weeks depending on the state. Several states offer a temporary or provisional permit so that newly graduated optometrists can begin working under supervision while the full license application is processed. Once approved, you receive your optometrist license number and may practice independently.

State-by-State Optometrist Licensing Requirements

The table below summarizes key optometry licensing requirements across all 51 states we track. Click any state for the full breakdown including detailed requirements, fees, scope of practice, and renewal information.

Continuing Education (CE) Requirements

All states require licensed optometrists to complete continuing education (CE) to maintain their license and stay current with advances in eye care. The average CE requirement across all states we track is approximately 33.8 hours per renewal cycle. Common continuing education requirements include:

• Total CE hours: Requirements typically range from 20 to 50 hours per renewal cycle (usually 1 or 2 years), with most states requiring 30-40 hours
• Clinical CE: A majority of required hours are generally clinical in nature, covering ocular disease, contact lens management, pharmacology, and low vision
• TPA-specific CE: Many states require a set number of hours specifically focused on pharmacology or therapeutic management for TPA-certified optometrists
• Laser procedure CE: States that permit laser procedures often require CE hours related to laser safety, technique, and patient selection
• Ethics or jurisprudence CE: Some states require at least 1-2 hours per renewal cycle on professional ethics or state optometry law updates
• Glaucoma-specific CE: Some states mandate dedicated hours in glaucoma diagnosis and management as a condition of maintaining glaucoma treatment authority
• Delivery methods: Live courses, webinars, self-study modules approved by COPE (Council on Optometric Practitioner Education), and optometry school coursework are generally accepted

The Council on Optometric Practitioner Education (COPE) is the primary body that approves CE courses for optometrists. Most states require that CE credits come from COPE-approved providers or providers approved by the American Optometric Association (AOA). Check your state board's website for a list of approved CE providers and any specific subject-area requirements for your renewal cycle.

Frequently Asked Questions

How long does it take to become a licensed optometrist?

From the start of college, expect approximately 8 years: 4 years for a bachelor's degree with pre-optometry prerequisites, 4 years for the OD program, and then a 1-3 month license application process. Most students pass the NBEO exams during optometry school, so there is no additional waiting period after graduation in most cases. Candidates who pursue an optional one-year residency add another year to the timeline.

What is the difference between an optometrist and an ophthalmologist?

Optometrists hold an OD (Doctor of Optometry) degree and complete a 4-year professional doctoral program at an optometry school. Ophthalmologists are medical doctors (MD or DO) who completed medical school plus a 3-year ophthalmology residency and are trained to perform intraocular surgery. Optometrists focus on primary eye care, vision correction, and pharmaceutical management of eye disease. The two professions frequently collaborate in co-management arrangements, with optometrists handling routine care and ophthalmologists managing surgical cases.

What is the NBEO and are all three parts required?

The National Board of Examiners in Optometry (NBEO) administers standardized national examinations for optometry licensure. The three main parts are Part I (Applied Basic Science), Part II (Patient Assessment and Management), and Part III (Clinical Skills Examination). Most states require all three parts. 51 of 51 states in our database require NBEO scores for initial licensure. The NBEO also offers the TMOD exam for TPA certification documentation in states that require it separately.

Can optometrists prescribe controlled substances?

It varies by state. Most TPA states authorize optometrists to prescribe Schedule III, IV, or V controlled substances relevant to eye care, such as certain analgesics used during in-office procedures. A smaller number of states extend broader controlled substance prescribing authority. Some states restrict optometrists to non-scheduled therapeutic agents only. Optometrists with controlled substance prescribing authority generally must register with the DEA and comply with all federal controlled substance regulations.

How much does it cost to become a licensed optometrist?

Optometry school tuition is the primary expense, typically ranging from $30,000 to $55,000 per year for 4 years, plus living expenses and undergraduate education costs. NBEO exam fees total approximately $1,800-$2,200 for all three parts. State licensing fees average $4894 but range widely. Most candidates also incur NBEO review course and study material costs. Total educational debt for optometry school graduates averages over $200,000.

What is ARBO and how does it relate to optometry licensure?

ARBO (Association of Regulatory Boards of Optometry) is the organization representing optometry licensing boards in the United States and Canada. ARBO works to promote consistency and portability in optometry licensure across states, publishes data on state licensing requirements, and supports interstate licensing coordination. ARBO also manages the OD-to-OD licensure by endorsement process that some states use to grant licenses to optometrists already licensed in another state.

Can I practice in multiple states with one optometry license?

Unlike CPAs, optometrists do not have a universal reciprocity or mobility agreement. However, most states offer licensure by endorsement for optometrists already licensed in good standing in another state and who have passed the NBEO exams. Some states have bilateral or multilateral reciprocity agreements. If you plan to practice in multiple states, you will generally need a separate license in each state, though the process may be streamlined through endorsement. NBEO scores are generally portable across states.

Is the NBEO exam difficult?

The NBEO exam series is considered rigorous. Part I tests detailed knowledge of anatomy, physiology, pharmacology, and optics. Part II requires clinical reasoning through complex case simulations. Part III demands proficiency in live patient examinations. First-time pass rates vary by section but are generally between 80-95% for students at accredited OD programs. Most candidates use third-party NBEO review courses and dedicate several months to exam preparation.

Next Steps

Click any state in the table above or the state tags throughout this page to see its complete optometrist licensing requirements. Each state page includes detailed information on NBEO requirements, TPA certification, laser procedure authority, jurisprudence exam details, fees, and renewal processes with links to official state board websites.

Sources

Licensing requirements, scope of practice, examination, and fee data are sourced from official state boards of optometry, the NBEO, AOA, ARBO, and ACOE.

• Individual state board of optometry websites (cited on each state page).
• NBEO (National Board of Examiners in Optometry) -- exam structure, parts, scoring, and fee schedule. optometry.org
• AOA (American Optometric Association) -- scope-of-practice updates, laser legislation tracking, and state advocacy resources. aoa.org
• ARBO (Association of Regulatory Boards of Optometry) -- state licensing board data and endorsement information. arbo.org
• ACOE (Accreditation Council on Optometric Education) -- accreditation standards and list of accredited OD programs.
• COPE (Council on Optometric Practitioner Education) -- CE course approvals and continuing education standards for optometrists.

Data was last verified in March 2026. Scope of practice laws, examination requirements, and licensing fees can change as states update their optometry practice acts and regulations. Always confirm current requirements with your state's board of optometry before beginning the licensing process.