In the spotlight: ophthalmic laser procedures performed by optometrists

In May, new research was published in Ophthalmic and Physiological Optics outlining the results of a survey of 75 hospital optometrists who perform ophthalmic laser procedures.

OT spoke with optometrists and study co-authors, Drs Deacon Harle and Grant Robinson, about the research and a new therapeutic laser module delivered by Cardiff University.

Why did you conduct this survey?

Dr Grant Robinson (GR): The optometrist role continues to evolve, and this has led to the opportunity for increased involvement in the delivery of clinical and medical treatments for the eye. In the main, optometric clinical treatment has primarily focused on the use of medicines, both topically and orally. However, not all ocular disease is best managed in this way and optometrists have also become progressively more involved in ophthalmic laser treatments. We designed this study to explore the current scope, autonomy and training requirements of hospital-based optometrists who are already delivering these laser treatments.

What were the key findings of your research?

GR: Hospital optometrists are clearly involved in the delivery of ophthalmic laser procedures up and down the UK. Activity predominantly relates to glaucoma and cataract care with training predominantly being conducted in-house. The level of autonomy and independence reported when delivering laser procedures within the hospital eye service was striking.

How common is it for optometrists in hospitals to deliver therapeutic laser?

GR: Presently the exact number of hospital optometrists in the UK is unknown. However, a reasonable estimate is around 300–400 (approximately 2% of all General Optical Council-registered optometrists). Around 10–15% of hospital optometrists were involved in ophthalmic laser procedures in 2020, assuming an increase over the past five years in alignment with the direction of travel for optometry, then we estimate around 90–100 hospital optometrists are currently involved in the delivery of therapeutic laser. This of course does not include any optometrists performing these techniques outside the hospital eye service. We received 75 responses to our survey which we believe to be a good representation of this cohort.

The level of autonomy and independence reported when delivering laser procedures within the hospital eye service was striking

How much ophthalmologist oversight is there of ophthalmic laser procedures delivered by optometrists?

Dr Deacon Harle (DH): Over 90% of the hospital optometrists who responded to the survey reported that they performed laser treatments independently and autonomously. They reported that they made the clinical decision to treat patients with ophthalmic lasers themselves.

What types of laser procedures are delivered by optometrists?

GR: The most commonly performed procedures were Nd:YAG capsulotomy (88% respondents), selective laser trabeculoplasty (39% respondents) and peripheral laser iridotomy (20% respondents). A small number of optometrists also reported that they perform laser retinal treatments.

What action would you like to be taken as a result of the research?

DH: The vast majority of optometrists based within the hospital eye service across the UK tell us that they perform ophthalmic laser treatments with autonomy and independence. Those responsible for providing professional indemnity to optometrists need to consider that this is usual common professional practice for optometrists, and ensure their professional liability policies reflect this.

Guidance should empower optometrists to continue to diagnose and treat their patients safely using ophthalmic lasers where appropriate, both within the hospital eye service and, where local facilities allow, in community eye care settings. In alignment with this it is our hope that glaucoma and cataract guidelines will be revised to better reflect the reported level of optometrist involvement and autonomy in this area.

Ultimately the implementation of ophthalmic laser clinics led by optometrists would strengthen glaucoma and cataract care services by increasing the opportunity to treat people promptly, while enabling ophthalmologists to prioritise more complex cases.

Ultimately the implementation of ophthalmic laser clinics led by optometrists would strengthen glaucoma and cataract care services by increasing the opportunity to treat people promptly

What do we know about how optometrists are currently trained in therapeutic laser?

DH: Most optometrists (80%) told us that they had solely in-house training within their hospital. During their training period, only one in four practised performing ophthalmic laser on simulated eyes. One potential issue with this approach is the lack of a standardisation. This was highlighted via the variation in end-points reported, for example some optometrists completed their training period when they had treated a predefined number of patients, whereas others had to demonstrate their skillset in an informal assessment situation. Since we now know that optometrists in the UK readily perform laser treatments to patients, we would like to encourage more optometrists to have theoretical and introductory practical simulation training before commencing in- house patient facing clinical training.

Could you provide OT with some details about the therapeutic laser module delivered by Cardiff University?

DH: The OPT043: Ophthalmic Therapeutic Laser Procedures course is open to all optometrists as well as ophthalmologists, ophthalmic nurses and orthoptists. It provides theoretical and introductory practical simulation training, focusing on the most commonly reported ophthalmic laser procedures currently performed by optometrists.

The module is taught via pre-recorded online lectures, a webinar, an online teaching day, supporting resources delivered online and a practical training day hosted at Cardiff University School of Optometry and Vision Sciences. During the practical training day optometrists gain hands-on experience of performing laser procedures on simulation eyes within our on-site laser training suite. In addition, they will have the opportunity to refine their gonioscopy skills and improve their ability to obtain informed patient consent. Optometrists can apply by contacting the postgraduate team by email.