15 July 2026
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.
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Comments (4)
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MEJ16 July 2026
This study highlights that, for many anterior segment laser procedures, optometrists are already routinely undertaking treatment decision-making, pre-assessment and consent, treatment delivery, and the management of any (rare) complications. It is therefore important that local and national guidelines reflect the current clinical reality.
The conversation for policy makers has progressed beyond whether specialist optometrists can safely provide autonomous laser care and towards defining the appropriate competencies, training requirements, governance structures, and practice settings needed to support high-quality patient outcomes.
It is also important to acknowledge that this expansion of scope of practice has occurred organically, with training requirements determined and delivered locally, often with minimal cost to clinicians, and without a demonstrated increase in patient harm. These experiences provide valuable insight into how future models of care can be developed in a way that supports both professional capability and patient safety.
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DHarle16 July 2026
Thanks John and Nick for your comments; you are of course, both right.
Our survey looked at optometrists based within the hospital eye services but as Nick and John both point out, optometrists provide laser services in a number of settings outside the hospital eye service, including commissioned community eye care / community ophthalmology services.
Optometrists in more primary care setting may need to ensure the clinical setting met the appropriate requirements to offer such services, for example CQC registration may be appropriate.
But the key here is that ophthalmic laser treatments are *already* currently being autonomously delivered by optometrists. As indeed they are by our nursing colleagues too.
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Nicholas Rumney16 July 2026
The AOP does not cover me for laser procedures autonomously. I now work only in either education (which does not require registration or indemnity) or clinical ophthalmology. My clinical optometry role is in an Independant Treatment Centre where I receive optometric referrals (or varying quality), undertake the cataract consent process, including risk assessment, biometry interpretation, refractive correction and IOL selection. I also undertake Nd.YAG laser capsulotomies autonomously on an NHS commissioned contract. I have extensive training (including didactic certification) and ophthalmology experiential sign-off. However, the AOP will only provide indemnity cover for laser capsulotomy if there is a supervising ophthalmologist present ? As this is not always, in fact it is rarely, possible, my practice is currently indemnified by the commissioned ITC. Were I to wish to offer laser procedures in an optometry practice this would clearly not be possible.
This is backwards and fails to reflect the considerable progress made in the scope of practice that is quietly and inevitably developing in the UK to the extent that we are in some extended areas of practice ahead of some US States, Australia and Canada.
The AOP led the push and charge to therapeutics in the late 90's against a lot of very conservative optometry views. It is about time another risk assessment was undertaken by its underwriters.
IP and advanced practitioners may do more "things" but we have a safe FTP track record which is why our AOP (and indeed FODO) indemnity component is the same price as entry level optometrists who present a higher (albeit low) risk. Long may it stay so.
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John Gurney16 July 2026
This is an important step forward for the profession and highlights how optometrists are already delivering therapeutic laser procedures safely, competently, and autonomously within hospital services. The next logical progression is to enable appropriately trained optometrists to provide these services in the community, improving patient access, reducing hospital waiting lists, and making better use of clinical expertise. For this to happen, the AOP should ensure that professional indemnity insurance fully supports optometrists performing therapeutic laser procedures autonomously within their scope of practice. With standardised training and appropriate governance, community-based laser services could significantly strengthen eye care across the UK.
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