Letting optometrists do laser procedures cuts costs for patients. Why don’t more states allow it?

Alberta is opening the door to more competition in eye care, and Canadian medical groups want the government to close it. On October 26, the provincial government announced an expansion that allows specially qualified optometrists to perform certain glaucoma laser treatments, treat clouding that develops after cataract surgery, and perform minor procedures around the eyes. The changes took effect on November 1, making Alberta the first Canadian province to authorize this expansion. Three Canadian ophthalmology organizations have urged the government to rescind its decision.

Alberta isn’t giving optometrists the green light overnight. Practicing optometrists must complete a certified course and pass an exam, while recent graduates must pass the applicable national exam. Both groups must then complete supervised clinical training and get individual authorization from the provincial regulator. Courses for practitioners who graduated before 2025 will begin in early 2027. Most U.S. states still deny patients comparable choices. 

Optometrists hold optometry degrees and provide routine eye exams, prescribe glasses and contact lenses, and diagnose and treat certain eye conditions. Ophthalmologists are physicians who specialize in the medical and surgical care of the eyes. For decades, optometrists have sought permission to provide additional treatments, but they have faced organized resistance from the American Medical Association (AMA), the American Academy of Ophthalmology (AAO), and state medical societies. 

The AMA describes its efforts as “keeping the scalpel and laser in ophthalmologists’ hands.” The AAO’s policy statement emphasizes differences in education and training as reasons to question whether optometrists can perform these procedures safely. The restrictions these organizations defend also protect ophthalmologists from competition.

Oklahoma became the first state to enact legislation explicitly authorizing certain optometric laser procedures in 1998. Kentucky followed in 2011, and Louisiana in 2014. Today, 17 states have enacted laws authorizing optometrists to perform certain laser procedures, though permitted treatments and qualification requirements vary. Many authorize laser treatments for glaucoma and post-cataract surgery clouding; others permit a narrower range. The count includes Vermont, whose law takes effect July 1, 2028.

With health care costs rising and patients struggling to access timely care, lawmakers should welcome opportunities to expand the pool of qualified practitioners. Allowing trained optometrists to offer more treatments gives patients additional choices and creates opportunities for price competition. It may also spare patients a separate specialist appointment and allow ophthalmologists to devote more time to complex cases. The size of those benefits will depend on local conditions, but patients should be free to consider an optometrist’s qualifications, experience, price, and availability when deciding who provides their care.

Studies suggest that trained optometrists can perform these procedures successfully, though findings vary. A British study found similar reductions in eye pressure after laser treatment for glaucoma across three hospital eye units. An Oklahoma analysis found that 36 percent of eyes underwent a second laser treatment when an optometrist performed the first procedure, compared with 15 percent when an ophthalmologist performed it. A separate five-state study found that expanding optometrists’ laser privileges did little to shorten patients’ drive times or increase the share of people living within 30 minutes of a practitioner who performed these procedures. 

Patients deserve candid information about these findings when choosing a practitioner. Mixed results are no reason for the government to bar patients from choosing a qualified optometrist.

Alberta’s experience could encourage other provinces to follow suit. Ontario has already announced a different expansion, allowing optometrists to independently manage open-angle glaucoma and use diagnostic ultrasound. That falls short of Alberta’s procedural authority but signals a willingness to reconsider professional boundaries.

Good ideas can travel both ways across the border. Alberta laid the groundwork for independent pharmacist prescribing in 2006, allowing qualified pharmacists to treat patients for routine and self-limited conditions without first obtaining a physician’s permission. Other provinces subsequently expanded pharmacists’ authority, including Ontario, which introduced prescribing for 13 common conditions in January 2023. Canadian prescribing models also helped shape Idaho’s reforms, which broadened independent prescribing in 2019. Colorado adopted similar legislation in 2021, followed by Montana in 2023. Now Alberta is embracing an eye-care reform that Oklahoma and other American states adopted years earlier. Both reforms give patients more control over their care by allowing qualified practitioners to offer more services and by giving patients a wider choice of who treats them.

The remaining states should extend that freedom to eye care. Some patients will prefer an ophthalmologist’s more extensive medical and surgical training, while others will choose an optometrist with additional procedural training and experience. Either way, patients should know their practitioner’s qualifications, the risks, and their alternatives. Professional associations can advise patients about those differences. They shouldn’t enlist the state to take that choice away.