Eye Surgeons Oppose Expanding Optometrist Surgical Procedures

A significant debate is unfolding across Canada, pitting two essential eye care professions against each other. At the heart of the issue is a proposal to expand the scope of practice for optometrists, allowing them to perform certain minor surgical procedures. While optometrists argue this is a necessary step to improve patient access to care, ophthalmologists—medical doctors specializing in eye surgery—are raising serious concerns about patient safety.

This conflict has come to a head as several provinces, including Ontario, Manitoba, and Alberta, consider regulatory changes that would grant optometrists these new responsibilities.

Understanding the Key Players: Optometrists vs. Ophthalmologists

To fully grasp the debate, it’s crucial to understand the distinct roles and training of these two professions.

Optometrists (ODs) are primary eye care providers. They are healthcare professionals who hold a Doctor of Optometry degree. Their expertise lies in:

Conducting comprehensive eye exams.

Prescribing corrective lenses (glasses and contact lenses).

Diagnosing and managing common eye diseases like glaucoma, macular degeneration, and diabetic retinopathy.

Providing pre- and post-operative care for surgical patients.

Ophthalmologists (MDs) are medical doctors who have completed medical school, a residency in ophthalmology, and often further subspecialty fellowship training. Their scope includes:

All the services an optometrist can provide.

Performing complex eye surgeries, from cataract removal to retinal detachments and corneal transplants.

Diagnosing and treating all eye diseases, especially those requiring advanced medical or surgical intervention.

Prescribing a wider range of medications.

The proposed changes would allow optometrists to perform procedures like laser surgeries for certain conditions, injections into the eyelid or the surface of the eye, and the removal of minor skin lesions around the eye.

The Case for Expansion: Improving Access and Efficiency

Proponents of the scope expansion, primarily led by provincial optometry associations, present a compelling argument centered on patient access and the efficient use of healthcare resources.

Addressing Critical Wait Times

In many parts of Canada, particularly in rural and remote areas, patients can face lengthy wait times to see an ophthalmologist. Optometrists argue that by being trained to perform a select list of minor procedures, they can help clear these backlogs. A patient with a blocked tear duct or a certain type of glaucoma could receive treatment from their local optometrist without traveling long distances or waiting months for a specialist appointment.

Leveraging Existing Expertise

Optometrists are already highly trained in the anatomy, physiology, and diseases of the eye. They contend that with additional, specific training on the new procedures, they can perform them safely and effectively. They point to other jurisdictions, such as several U.S. states and the United Kingdom, where optometrists have successfully performed these minor surgeries for years without compromising patient safety.

A Collaborative Care Model

The vision is not for optometrists to replace ophthalmologists but to work alongside them in a more collaborative model. In this system, optometrists would handle the more routine minor surgeries, freeing up ophthalmologists to focus their skills and time on the most complex and sight-threatening cases. This, they argue, creates a more efficient and sustainable eye care system for everyone.

The Case for Caution: Patient Safety and Training Gaps

The Canadian Ophthalmological Society (COS) and provincial ophthalmologist associations are firmly opposed to the proposed changes, citing fundamental concerns about training and the potential for serious complications.

The Irreplaceable Rigor of Medical Training

This is the cornerstone of the ophthalmologists’ argument. They emphasize that their medical school and surgical residency provide an unparalleled depth of training in managing the entire human body. An ophthalmologist is trained not just to perform a procedure, but to manage the unforeseen complications that can arise. This includes:

Systemic health conditions that can affect the eye and its response to surgery (e.g., diabetes, high blood pressure).

Recognizing and managing rare but serious adverse events, such as a severe allergic reaction to medication (anaphylaxis) or a retrobulbar hemorrhage (bleeding behind the eye).

The ability to perform complex rescue procedures if a minor surgery goes wrong.

When “Minor” Procedures Become Major Problems

Ophthalmologists argue that there is no such thing as a truly “minor” surgery when it involves the eye, one of the most delicate and complex organs in the body. A simple injection, for example, carries risks of perforating the eyeball, causing an infection, or damaging the optic nerve. Without the extensive hospital-based training of an ophthalmologist, they question whether an optometrist would be adequately prepared to handle these acute emergencies, which can lead to permanent vision loss.

Fragmentation of Care

Another concern is the potential for fragmented patient care. Ophthalmologists are trained to see the “big picture” of a patient’s ocular and overall health. They worry that splitting care between multiple providers—an optometrist for procedures and an ophthalmologist for complex disease—could lead to missed diagnoses or communication gaps that ultimately harm the patient.

A Clash of Perspectives on Training and Standards

The debate often circles back to the proposed training programs for optometrists. While optometry associations have developed detailed curriculum proposals for the new procedures, ophthalmologists remain skeptical.

They question whether a series of weekend courses or a short preceptorship can truly equate to the thousands of hours of supervised surgical training that is the standard for medical surgeons. The COS has stated that without a formal, accredited surgical residency model, the proposed training is insufficient to guarantee patient safety.

Looking Ahead: Regulation, Collaboration, and the Patient’s Interest

As provincial governments weigh their decisions, they face a difficult task. On one hand, there is a genuine need to improve access to timely eye care, a concern that is only growing with an aging population. On the other hand, the principle of “first, do no harm” must be paramount.

The path forward will likely require a careful, evidence-based approach. Potential compromises could include:

Piloting the scope expansion in a controlled, closely monitored setting to gather data on safety and outcomes.

Establishing rigorous, standardized, and independently accredited training and certification programs for any new procedures.

Creating clear guidelines that define which patients are suitable for optometrist-performed procedures and which must be referred to an ophthalmologist due to complexity or comorbidities.

Implementing robust reporting systems to track complications and ensure accountability.

Ultimately, both professions share the same fundamental goal: preserving and improving the vision and eye health of Canadians. The challenge lies in finding a way to expand access without compromising the high standards of safety and care that define Canada’s healthcare system. The outcome of this debate will shape the future of eye care delivery in the country for generations to come.