New regulations expand scope of care for Alberta optometrists

Regulatory change in the Canadian province of Alberta will see optometrists perform lid lesion removal and laser procedures.

A statement from the Government of Alberta confirmed that from 1 November optometrists with additional training in Alberta will be able to perform a range of minor laser procedures such as capsulotomy, laser peripheral iridotomy (LPI) and selective laser trabeculoplasty (SLT).

The enhanced scope of practice will also see optometrists perform an agreed list of injections, skin and eyelid procedures, including the removal of skin tags, warts and persistent styes.

Alberta minister of primary and preventative health services, Justin Wright, highlighted that the regulatory change would provide patients with timely access to care.

“Getting the right care shouldn’t mean travelling hours or waiting longer than necessary for a procedure a qualified health professional can safely provide closer to home. We’re giving Albertans more choices, reducing unnecessary barriers and making health care work better for patients, while keeping safety our highest priority,” he said.

Alberta Association of Optometrists (AAO) president, Dr Sophia Leung, described the announcement as a “milestone” for the profession.

“As a clinician and educator with firsthand experience performing these procedures, I know the difference they can make for patients. Alberta’s doctors of optometry have the training and expertise to deliver this care safely,” she said.

In Canada, practitioners must complete a three-year undergraduate degree, as well as a four-to-five-year postgraduate optometry degree before they are qualified as a doctor of optometry.

There are 950 practising optometrists within Alberta – equivalent to one optometrist for every 5368 people. In the UK, the equivalent statistic is one optometrist for every 3575 people.

Only optometrists who complete approved education, examinations and clinical supervision will be permitted to offer the enhanced services.

University of Waterloo School of Optometry and Vision science director, Dr Ben Thompson, welcomed the expanded scope of practice.

“Optometrist-delivered lid lesion removal and laser care leverage the full capabilities of optometrists and provide patients with another option for receiving care from highly trained and accessible providers,” he said.

The path to change

Leung shared with OT that “for many years” optometric training and clinical training have evolved in Alberta – but legislation has not kept pace with this evolution.

“While doctors of optometry have the education and clinical competencies to perform certain laser and minor surgical procedures, patients in Alberta have historically needed to be referred to an ophthalmologist for these services,” she explained.

Leung highlighted that the need to refer to ophthalmologists for these procedures created barriers to timely care – particularly for patients in rural and remote areas.

“Some of these procedures, such as SLT, are now recognised as first-line treatment options for certain forms of glaucoma, while others, such as LPI, may require more timely intervention depending on the clinical presentation,” the optometrist highlighted.

The Alberta College of Optometrists (ACO) first submitted its scope modernisation proposal to government in December 2020.

Since this submission, the Alberta Association of Optometrists (AAO) has also advocated for the changes contained within the proposal.

“As with any significant change to a regulated health profession, there were important questions surrounding education, clinical competency, patient safety, and professional accountability,” Leung shared.

She explained that the ACO played a central role in advancing the regulatory work surrounding education, certification, competency requirements, and ongoing oversight, while the AAO worked alongside the ACO in advocating for scope modernisation and the benefits of access to care for Albertans.

Leung added that the experience of other jurisdictions internationally – where appropriately trained optometrists have been performing these procedures for many years – were also integral to supporting the request for an enhanced scope of practice.

“Their established track records of safety and clinical effectiveness provided valuable evidence in support of our efforts,” she said.

It was an incredibly exciting moment, and one that many of us had been hoping to see for a very long time

The benefits for rural and remote areas

Leung told OT that one of the most compelling aspects of extending the scope of practice for optometrists in Alberta is the benefits for patients living in rural and remote areas.

“Consider a patient living in a rural community who needs a minor eyelid procedure or laser treatment,” she said.

“What may take only a few minutes in the clinic could require travelling several hours to a larger urban centre, sometimes involving time away from work, arranging transportation, or even an overnight stay,” Leung highlighted.

She added that these barriers can prove particularly challenging for people with limited mobility and those without reliable transportation.

“Optometrists are already embedded in communities throughout Alberta. We often care for patients over many years, getting to know them, their medical and ocular histories, and the unique circumstances that may affect their access to care,” Leung shared.

“We now have an opportunity to bring these services closer to home through appropriately trained and certified optometrists, reducing the need for lengthy travel, minimising delays due to wait times for ophthalmology, and improving continuity of care,” Leung said.

“An important milestone for optometrists across Canada”

Describing her reaction to the approval of an enhanced scope of practice, Leung shared with OT: “It was an incredibly exciting moment, and one that many of us had been hoping to see for a very long time.”

Leung added that the implications of the approval stretch beyond Alberta.

“I believe Alberta's scope modernisation represents an important milestone for optometry across Canada,” she said.

“While these procedures have been part of optometric practice in other jurisdictions internationally for many years, Alberta is the first province in Canada to authorise these specific laser procedures, minor surgical procedures, and injections for appropriately trained doctors of optometry. That is a significant step forward,” Leung emphasised.

She noted that the approval was the result of a collective effort and illustrated the benefits of collaboration.

“The ACO, AAO, University of Waterloo School of Optometry and Vision Science, and Government of Alberta have each played important and complementary roles in bringing these changes forward,” Leung said.

She expressed her wish that the regulatory change would catalyse further conversations across Canada.

“Alberta has raised the bar for what is possible in Canadian optometry, taking an important step toward modernising access to eye care,” Leung concluded.