Optometrists Performing Surgeries Sparks Ophthalmologist Safety Concerns

A quiet but significant shift is occurring in the landscape of eye care in Canada, one that has pitted two key professions against each other and raised fundamental questions about patient safety, professional scope, and the future of medical services. In several provinces, legislative changes are paving the way for optometrists to perform certain surgical procedures, a role traditionally and exclusively held by ophthalmologists. This move, intended to improve access to care, is being met with serious concern from medical doctors who specialize in eye health.

The debate centers on a critical distinction: optometrists are primary eye care professionals trained to diagnose, manage, and treat vision changes and certain eye diseases, while ophthalmologists are medical doctors (MDs) who have completed years of specialized surgical residency and are trained to handle the full spectrum of complex eye diseases and surgeries.

The Expanding Role of Optometrists

For years, the responsibilities of optometrists have been steadily growing. Beyond prescribing glasses and contact lenses, they are licensed to diagnose conditions like glaucoma, macular degeneration, and cataracts. In many regions, they can also prescribe therapeutic medications. The latest frontier in this expansion is surgery.

Provinces like Ontario, Alberta, and Saskatchewan have either passed or are considering legislation that would allow optometrists to perform specific laser procedures. These are not the complex surgeries like cataract removal or retinal repairs, but rather simpler laser interventions such as:

Proponents, including optometry associations and some provincial governments, argue that this change is a necessary and safe solution to a pressing problem: critically long wait times for specialist care. By allowing highly trained optometrists to take on these specific procedures, patients can receive faster treatment, reducing the risk of vision loss from conditions that require timely intervention.

The Ophthalmologists’ Safety Concerns

The Canadian Ophthalmological Society (COS) and its members are pushing back forcefully. Their opposition is not rooted in territorialism, they argue, but in a deep-seated concern for patient welfare. The core of their argument rests on the vast difference in training.

A Matter of Training and Experience

An ophthalmologist’s path to performing surgery is a long and rigorous one. After obtaining a medical degree (typically 4 years), they must complete a residency in ophthalmology (a minimum of 5 years), which includes intensive, supervised surgical training in the operating room. This is followed by further examinations to become a Fellow of the Royal College of Physicians and Surgeons of Canada.

In contrast, optometrists complete a four-year doctoral program after undergraduate studies. Their training is extensive in ocular disease and primary care, but it does not include the same depth of surgical residency. The proposed model often involves optometrists taking additional, shorter-course certifications for specific lasers.

Ophthalmologists contend that this condensed training is insufficient. Performing a laser procedure is not just about the technical act of applying the laser; it’s about managing the entire medical situation. They raise several critical questions:

A Clash of Perspectives on Regulation and Risk

The optometry community sees these concerns as overstated and points to other jurisdictions, such as certain states in the USA and the United Kingdom, where optometrists have been safely performing these procedures for years. They emphasize that the proposed procedures are low-risk, that the optometrists who would be performing them are among the most highly skilled in their field, and that strict regulatory standards and certification processes would be put in place.

They frame the issue as one of modernizing the healthcare system to better serve patients. With an aging population and a growing prevalence of eye disease, the status quo is unsustainable. Leveraging the skills of all eye care professionals is, in their view, a pragmatic and necessary evolution.

However, ophthalmologists counter that “low-risk” does not mean “no-risk.” They argue that even simple procedures carry the potential for serious, vision-threatening complications. For them, the fundamental question remains: should anyone without a full medical and surgical residency be performing surgery on the human eye? They believe the answer is a resounding no and suggest that the better solution to wait times is to increase funding and resources for the existing ophthalmology-led system.

The Patient’s Place in the Debate

Caught in the middle of this professional dispute is the patient. On one hand, the prospect of shorter wait times is undeniably attractive. The anxiety of waiting for a necessary procedure, with vision potentially deteriorating, is a significant burden.

On the other hand, patients may not be fully aware of the distinction between an optometrist and an ophthalmologist. There is a concern about informed consent—does a patient truly understand the qualifications of the person performing their surgery when the lines between the two professions are blurred in the public eye?

Looking Ahead: A Resolution on the Horizon?

This debate is unlikely to be resolved quickly. It reflects a larger trend in healthcare, where the roles of various professionals are being re-evaluated to improve efficiency and access. Nurse practitioners and physician assistants are other examples of this shift.

Finding a path forward will require careful collaboration. Potential solutions could involve:

The goal shared by all is clear: providing the safest, most effective, and most accessible eye care for Canadians. How to achieve that goal, and who is best equipped to wield the surgical laser, remains the contentious question at the heart of this growing debate. The outcome will undoubtedly shape the future of vision care in the country for generations to come.