Can Optometrists Perform Glaucoma or Cataract Surgeries?
No, optometrists cannot perform cataract or glaucoma surgeries—these procedures must be performed exclusively by appropriately trained ophthalmologists. 1
Scope of Practice for Cataract Surgery
The American Academy of Ophthalmology's 2022 Preferred Practice Pattern explicitly states that cataract surgery, including use of femtosecond laser technology, should be performed only by an appropriately trained ophthalmologist. 1 This is the definitive standard of care.
Why Ophthalmologists Only
The guidelines emphasize several critical requirements that define the ophthalmologist's unique role 1:
- Surgical expertise and medical training: Cataract surgery requires specialized surgical skills, medical expertise, and judgment to evaluate medical, ocular, and psychosocial factors
- Comprehensive management: The ophthalmologist must confirm the cataract diagnosis, determine surgical necessity, design the treatment plan, perform the surgery, and provide postoperative care
- Complex decision-making: Determining appropriateness and timing of surgery requires the ophthalmologist's clinical experience and judgment
Optometrist Role in Cataract Care
While optometrists cannot perform surgery, they do play important supportive roles 2, 3:
- Postoperative co-management: Approximately 46% of optometrists participate in postoperative care of cataract patients, typically beginning their first examination 7 days after surgery 3
- Refraction and monitoring: Optometrists can perform refractions and routine follow-up examinations for uncomplicated cases 2
- Referral responsibility: When complications arise (acute glaucoma, unexplained vision loss), over 80% of optometrists immediately refer patients back to the ophthalmologist 3
Scope of Practice for Glaucoma Surgery
The same principle applies to glaucoma surgery—these are surgical procedures requiring ophthalmologic training and expertise. Recent evidence shows glaucoma surgeries like Hydrus Microstent implantation are performed by ophthalmologists during cataract surgery 4.
Optometrist Role in Glaucoma Care
Optometrists have a more substantial role in glaucoma assessment and monitoring, but not surgery 5, 6:
- Screening and detection: Optometrists can perform tonometry, ophthalmoscopy, perimetry, and other diagnostic tests 6, 7
- Co-management in clinics: Some optometrists work alongside ophthalmologists in hospital glaucoma clinics for patient assessment 5
- Referral for suspected glaucoma: Optometrists refer patients with suspected glaucoma to ophthalmologists for definitive diagnosis and surgical management 7
Critical Distinction
The fundamental distinction is that optometrists can diagnose, monitor, and co-manage these conditions, but all surgical interventions—whether for cataracts or glaucoma—are exclusively within the scope of ophthalmology. 1 This reflects the medical and surgical training requirements necessary to safely perform intraocular procedures and manage potential complications.