In this month’s cover feature, “Preparing to Offer In-Office Laser Procedures,” Drs. Brooke Major, Emma Strunks, and Nathan Lighthizer address the question of whether it’s time to ready your practice for this technology. To borrow a phrase from the Magic 8 Ball toy, “All signs point to yes.” Additionally, the article provides tips to get a practice prepared to offer procedures, such as yttrium aluminum garnet capsulotomy and selective laser trabeculoplasty. In addition to being sight-saving interventions, in-office laser care can also provide a new practice revenue stream—this issue’s theme. So, what exactly are these signs that point to yes?
OD Skillset
Out of 146,403 laser procedures per-formed by optometrists in 12 states, 2 had negative outcomes, according to a 2024 study in Clinical and Experimental Optometry.1
“These metrics outline the effectiveness of these procedures performed by optometrists and show strong support for future optometric scope expansion,” the study’s authors note.
Lack of Patient Access
A 2025 cross-sectional study identified higher patient-to-surgeon ratios in rural areas in the United States.2 An estimated 9.7 million Americans ages 65 and older—out of a total of 61.2 million3 (close to 16%)—currently live in rural areas.4 This population often has some form of age-related eye disease, such as cataract and/or glaucoma. Further, the US ophthalmology workforce is projected to have a “sizeable shortage” in relation to demand by 2035.5
An Aging Population
The aforementioned 65+ patient population is projected to increase to 82 million by 2050.6 This equates to increases in the need for age-related eye disease interventions, such as in-office laser procedures.
Successive Laws Passed
A total of 8 of the 14 state scope-of-practice expansion laws enabling optometrists to perform in-office laser procedures were passed between 2019 and 2025.7 Also, 13 states either introduced or reintroduced such bills in 2025.
So, is it time to prepare to offer in- office laser procedures? To borrow another phrase from the Magic 8 Ball toy, “the outlook is good.” OM
References
1. Lighthizer N, Patel K, Cockrell D, et al. Establishment and review of educational programs to train optometrists in laser procedures and injections. Clin Exp Optom. 2025;108(3):248-257. doi:10.1080/08164622.2024.2380075.
2. Ahmed A, Ali M, Dun C, Cai CX, Makary MA, Woreta FA. Geographic distribution of US ophthalmic surgical subspecialists. JAMA Ophthalmol. 2025;143(2):117-124. doi:10.1001/jamaophthalmol.2024.5605.
3. United States Census Bureau. Older adults outnumber children in 11 states and nearly half of U.S. counties. Accessed December 3, 2025. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html
4. USDA Economic Research Service. Amber Waves 2024 Edition. Rural America at a glance. As rural populations grow older, communities increasingly rely on smaller labor force. Accessed December 3, 2025. https://www.ers.usda.gov/amber-waves/2025/may/as-rural-populations-grow-older-communities-increasingly-rely-on-smaller-labor-force
5. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology. 2024;131(2):133-139. doi:10.1016/j.ophtha.2023.09.018.
6. PRB. Resource Library. Fact sheet: aging in the United States. Accessed December 3, 2025. https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/
7. American Optometric Association. AOA Focus. Destination: scope expansion. Accessed December 3, 2025. https://www.aoa.org/news/advocacy/state-advocacy/destination-scope-expansion