Alberta has joined a growing group of 17 U.S. states by permitting trained optometrists to perform a defined set of advanced procedures, expanding the array of eye-care options available to patients.
Alberta is widening competition within eye care, a move that has prompted Canadian medical groups to urge the government to reverse course. On October 26, the provincial government announced an expansion that authorizes specially trained optometrists to carry out glaucoma laser therapies, address clouding that can occur after cataract surgery, and perform minor periocular procedures. The changes took effect on November 1, making Alberta the first Canadian province to authorize this expanded scope. Three Canadian ophthalmology organizations have urged the government to rescind its decision.
The path is not an immediate green light for all optometrists in Alberta. Practicing optometrists must finish a certified course and pass an exam, while recent graduates are required to succeed in the applicable national examination. Both groups must then complete supervised clinical training and obtain individual authorization from the provincial regulator. Courses for practitioners who graduated before 2025 will commence in early 2027. By contrast, most U.S. states still limit patients’ options in this area.
Optometrists hold degrees in optometry, conducting routine eye examinations, prescribing eyeglasses and contact lenses, and diagnosing and treating 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 safely perform these procedures. The restrictions defended by these organizations also shield ophthalmologists from competition.
Oklahoma was the first state to pass legislation specifically authorizing certain optometric laser procedures in 1998. Kentucky followed in 2011, and Louisiana in 2014. Today, 17 states have enacted laws permitting optometrists to perform select laser procedures, though the permitted treatments and qualification requirements vary. Several states authorize laser treatments for glaucoma and post-cataract surgery clouding, while others allow a narrower range. Vermont is among them, with its law set to take effect on July 1, 2028.
With health-care costs rising and patients facing barriers to timely care, lawmakers should welcome opportunities to broaden the pool of qualified practitioners. Allowing trained optometrists to offer more treatments gives patients more choices and introduces price competition. It may also reduce the need for separate specialist visits and enable ophthalmologists to devote more time to complex cases. The magnitude of these benefits will depend on local conditions, but patients should be free to weigh an optometrist’s qualifications, experience, price, and availability when deciding who provides their care.
Evidence suggests that trained optometrists can perform these procedures successfully, though outcomes vary. A British study found comparable reductions in eye pressure after glaucoma laser treatment across three hospital-eye units. An Oklahoma analysis showed that 36 percent of eyes required a second laser when an optometrist performed the first procedure, versus 15 percent when an ophthalmologist did. A separate five-state study found that expanding optometrists’ laser privileges had little impact on shortening patients’ drive times or increasing the share of people living within 30 minutes of a practitioner performing these procedures.
Patients deserve honest information about these findings when choosing a practitioner. Mixed results are not a reason for governments to restrict patients from selecting a qualified optometrist.
Alberta’s approach could prompt other provinces to follow suit. Ontario has already announced a different expansion, authorizing optometrists to independently manage open-angle glaucoma and to use diagnostic ultrasound. While this does not grant the same procedural authority as Alberta, it signals a willingness to reconsider the boundaries of professional practice.
Good ideas can traverse borders. Alberta pioneered independent pharmacist prescribing in 2006, enabling qualified pharmacists to treat patients for routine and self-limited conditions without first seeking a physician’s approval. Other provinces later broadened pharmacists’ authority, including Ontario, which began prescribing for 13 common conditions in January 2023. Canadian prescribing frameworks also helped shape Idaho’s reforms, which broadened independent prescribing in 2019, followed by Colorado in 2021 and Montana in 2023. Now Alberta is embracing eye-care reform that Oklahoma and other American states had already adopted years earlier. Both reforms empower patients by expanding the services available from qualified practitioners and by offering a wider choice of who treats them.
The remaining states should extend this freedom to eye care. Some patients will prefer the broader medical and surgical training of an ophthalmologist, while others will choose an optometrist with additional procedural training and experience. In any case, patients deserve to know their practitioner’s qualifications, the associated risks, and available alternatives. Professional associations can inform patients about those differences, and they should not mobilize the state to restrict patient choice.
