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January 05, 2026
5 min read
Key takeaways:
- Optometrists have a lot to gain as collaborators in office-based surgery.
- Optometrists and ophthalmologists can create new revenue streams by moving ocular surgery out of ASCs and hospitals.
During 3 decades in my field, I’ve seen scope-of-practice battles between optometrists and ophthalmologists impede the potential for shared success.
Yet, I have always believed we each have unique strengths and should practice in a way that utilizes these skills. As a 9-year partner in an optometry/ophthalmology practice, I have seen firsthand that collaboration is possible when we find ways to draw on each other’s strengths without stepping on each other’s toes.
An opportunity to strike that balance lies within a growing movement in eye care, office-based surgery (OBS). My practice is generating new revenue by relying on optometrists to evaluate patients and determine who is eligible for surgery while ophthalmologists perform the procedures in our on-site OBS suites.
And we’re not alone. Established in about 160 ophthalmology groups across the U.S. and Europe, OBS is now springing up in numerous settings that include optometrists in the mix. Besides blended practices like mine, these include:
- large optometry groups, which can build their own suites and contract surgeons to perform procedures;
- smaller optometry groups, which can lease OBS suites at neighboring ophthalmology practices and contract with surgeons there; and
- networks of optometry practices, which can build shared suites and collectively contract surgeons.
Optometrists have a lot to gain as collaborators in OBS. By working closely with surgical teams, we can have more control over the discussions that determine the types of lenses our patients receive during cataract or refractive surgery, supporting good visual outcomes. As the experts who conduct the majority of the routine eye exams in the U.S. each year, optometrists can rely on our relationships and optical knowledge to help guide and educate patients about the best lens options for their individual situations. No optometrist wants to manage patients who were sold lenses that will not fulfill their expectations.
In addition, the OBS model enables optometrists to have ownership over the surgical care we recommend. Instead of capturing a comanagement fee, we can retain the patient in our practice, capture the surgical revenue and pay the surgeon a fee for their surgery. Surgeons increase surgical volume while we increase our lifetime returns per patient, the overall growth of our practices and, of course, our opportunities to partner with our colleagues in ophthalmology.
Prioritizing cost-effectiveness
In my group of five optometrists and three ophthalmologists, there was some initial resistance about trying OBS, but after launching the concept in 2022, we quickly realized it was good for our patients as well as our doctors and staff. We have since created a total of four surgical suites: two dedicated to cataract surgery, one for corneal cross-linking and a fourth for laser vision correction procedures.
We have been impressed by how comprehensively OBS streamlined our workflow for cataract surgery.
With reimbursements for ocular surgeries dropping, our surgeons had been finding it difficult to book sufficient time at ASCs, which tend to prioritize more lucrative outpatient procedures such as those in the orthopedics arena. My partners and I were also frustrated by the requirement that we spend time on call for local hospitals in return for using their ORs, which doesn’t benefit our referral-only business.
As a blended practice, we found we were well positioned to support our own OBS suites by capitalizing on our surgical volume and utilizing the diversity of our skills. In an unusual approach, we tasked our optometrists not only with evaluating those in need of surgery but with educating patients about the best implant lens options for their unique situations. Our optometrists are also in charge of completing the calculations needed to order those lenses. While the art of this precision work has traditionally been reserved for ophthalmologists, this strategy allows our optometrists to make the most of their optical training while our surgeons dedicate their time to the setting where they bring the most value: the OR within the OBS suite.
As a result, we can now easily schedule full days of surgery, and this has enabled our ophthalmologists to log about 150 cataract procedures per month within our OBS.
We have also boosted cost-effectiveness by never using intravenous anesthesia or sedation in our OBS suites. As in laser vision correction procedures, our surgeons prevent pain during cataract surgeries with topical and intracameral anesthetics and sedate patients with oral Valium (diazepam, Waylis Therapeutics). This eliminates the need for an anesthesiologist and condenses the pre- and postop experience so that patients typically spend just more than an hour with us, well less than half the time they would spend at a hospital or ASC.
Our patients appreciate these efficiencies as well as receiving treatment in a familiar environment under the care of technicians they know and not needing to fast before procedures. Because we don’t use IVs, patients can be safe (Kugler et al.) and pain free without undergoing a needle stick, which many describe as more frightening than surgery. These advantages have boosted the number of patients requesting OBS, many of whom choose premium lenses when they have been determined to be good candidates.
We anticipate that these trends will dramatically increase our gross revenue even without a further boost in our patient volume because we are capturing more income on each surgical case than we did in the past. In a striking paradox, this model is also saving money for insurance companies, which don’t need to pay for presurgical physical exams or anesthesia teams for surgery.
Scanning the horizon
While OBS is often quite financially rewarding, practices can find it daunting to build and run these suites. OBS suites require area for at least one OR, pre- and postop space, and both sterile processing and storage sections. While some practices may have the time and expertise to accomplish this seamlessly, my group was unsuccessful in launching in-office surgery until we teamed up with iOR Partners. iOR is an OBS consulting firm that helped us design our suites, secure Joint Commission accreditation, select equipment, manage inventory, navigate billing and even reengage inactive clients via targeted marketing.
I anticipate that eye care practitioners, no matter how they enter the OBS arena, will soon shift the majority of their surgeries to office-based settings. In fact, a decade from now, doctors may wonder why these procedures were ever performed outside the office under IV anesthesia.
As a quickly growing movement, OBS provides a perfect entry point for optometrists and ophthalmologists who are looking to form partnerships. By working together to solidify this emerging trend, ODs and MDs can use their complementary skills not only to build business but to help their patients thrive.
For more information:
Christopher Carver, OD, practices at SightLine Laser Eye Center & Ophthalmic Associates in Pennslyvania. He can be reached at chris.carver@sightlinelaser.com and linkedin.com/in/chris-carver-od-34a1357.
Sources/Disclosures
Source:
Expert Submission
References:
Disclosures:
Carver reports consulting for iOR Partners and Zeiss.
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