The Canadian Ophthalmological Society (COS) is urging the federal and provincial governments to put patient safety ahead of scope expansion as proposals emerge across Canada that would allow optometrists to perform surgical procedures without a medical degree and surgical training in accredited programs with regulatory standards and oversight.
In Alberta, the provincial government has approved in principle an application by the Alberta College of Optometrists to expand its scope of practice to include surgical interventions, pending further review. Ontario is now considering a similar proposal. The COS warns that such changes, if enacted and final, would expose patients to unnecessary risk.
COS: “Safety Isn’t a Slogan, It’s a Standard”
“Safety isn’t a slogan, it’s a standard,” said Dr. Mona Harissi-Dagher, President of the Canadian Ophthalmological Society. “The eye is unforgiving. An error measured in microns can mean permanent vision loss. Surgical eye care must remain within the expertise of physicians trained in medical and surgical management to safeguard Canadians’ sight.”
Ophthalmologists complete a minimum of ten years of medical and hospital-based training, including thousands of hours of supervised surgical experience and emergency management. Optometrists, while essential partners in primary eye care, are not medical doctors, and they do not receive training in surgery or systemic disease management.
Training Gaps Pose Patient Safety Risks
“This issue is fundamentally about patient safety and quality of care,” said Dr. Nina Ahuja, Chair of the COS Council on Advocacy. “Surgical eye procedures demand the depth of medical and surgical training required to recognize and manage complications in real time. Expanding surgical privileges beyond one’s scope of training and practice places patients at unnecessary risk, erodes public trust, and undermines the safeguards that protect their vision. Safety and trust cannot be compromised in the name of ‘modernization.’”
The COS notes that evidence from U.S. jurisdictions that expanded optometric surgical privileges shows no measurable improvement in access to care, while some studies reported increased procedure volume, higher costs, and emerging complications.
“Access to care is a legitimate challenge, especially in rural and northern communities,” added Dr. Dagher. “But the solution lies in training and retaining more physicians, and in enhancing collaboration, not exposing patients to unsafe procedures. Integrated care models linking optometrists and ophthalmologists through shared records, tele-ophthalmology, and rapid e-consults are already improving access without compromising safety.”
The COS continues to work in partnership with provincial and academic leaders – including the Eye Physicians and Surgeons Associations of Alberta and Ontario (EPSAA, EPSO), and the Association of Canadian University Professors of Ophthalmology (ACUPO) – to ensure that any modernization of eye care remains grounded in evidence, safety, and collaboration.
“When it comes to surgery on the eye, Canadians deserve one simple assurance,” said Dr. Dagher. “That those performing it are the best trained to do so.”
