As this article goes to press, 14 states enable optometrists to perform laser procedures. These procedures are yttrium aluminum garnet (YAG) capsulotomy, laser peripheral iridotomy (LPI), YAG vitreolysis, and selective laser trabeculoplasty (SLT). (See “Advocating for Laser Procedure Access,” below.)
Further, all 25 accredited optometry schools in the United States now include such training in their curricula. This means that every new graduate is educated and qualified to perform these procedures.
As performing laser procedures can help patients and create an additional revenue stream—the theme of this month’s issue—this article provides the specific action steps required to do so.
1. Make Sure It’s Legal
Make sure performing in-office laser procedures is legal in the state you practice. These states are Alaska, Arkansas, Colorado, Indiana, Kentucky, Louisiana, Mississippi, Montana, Oklahoma, South Dakota, Virginia, West Virginia, Wisconsin, and Wyoming.
Also, it is wise to check with your state board to determine exactly what in-office laser procedures you can perform. For example, Arkansas optometrists can perform YAG laser capsulotomies and SLT, but not LPI.
2. Inquire About Liability Changes
Contact your insurance agency to see whether your malpractice coverage includes in-office laser procedures or what steps you may need to take to ensure they are covered. We recommend reaching out to your state optometric association legislative body or the American Optometric Association (AOA) to educate your insurance agency on this expansion of scope. If your insurance agency will not offer such coverage, inquire with the AOA about the malpractice insurance it offers. Finally, check with your state licensing board about where to report any potential negative outcomes of future procedures.
3. Take Courses/Training
Completing a dedicated course in in-office laser procedures, which includes hands-on training, is required to become certified in performing these services. Such courses/training can be accessed via residency programs, state optometric associations, and related eyecare events and trade shows. For instance, the NSU Oklahoma College of Optometry offers training courses across the country. Also, the 2025 American Academy of Optometry meeting in Boston offered specialized procedures training sessions. Certain states allow the 32-hour course that doctors from the state of Oklahoma offer, or the National Board of Examiners in Optometry course for laser procedures. Your state optometric organization will have all the information you need for qualifying you to be certified in providing in-office laser procedures.
In addition to obtaining personal knowledge, you will also need to select clinically-trained paraoptometric/ophthalmic personnel to help you to prep these laser procedures. Keep in mind that any staff member who will be in the laser room must be properly trained on laser safety procedures and your pre and postoperative standard operating procedures.
4. Prepare Your Physical Practice
You want to store the laser in an area that has limited access to only those who are qualified/authorized to operate it. This laser room should have proper warning signs (eg, “Authorized Personnel Only”) posted on the door. Additionally, protective eyewear should be in the room for anyone other than the patient and the doctor performing the laser procedures. Also, you should determine a Nominal Hazard Zone. This is the distance within exposure to direct, reflected, or a scattered beam greater than the maximum permissible exposure. The maximum permissible exposure refers to the highest level of exposure to a hazardous substance or energy, such as laser radiation, that is considered safe for human beings. General laser safety regulations are stated in ANSI (Z136.1-Z136.9). Most ophthalmic lasers are class 4, and some are class 3B. Whenever using class 4 lasers, a standard operating procedure is required. Laser safety officer education and training is required regardless of laser type. These trainings can be obtained online.
5. Acquire a Laser
We find that most ODs purchase a combination YAG/SLT laser, which allows YAG capsulotomy, LPI, YAG vitreolysis, and SLT procedures. We have found that most combination YAG/SLT lasers cost between $40,000 and $55,000 and often come with a 1–3-year warranty. An alternative to purchasing a laser for your practice is utilizing another practices’ laser, such as at an ambulatory surgery center (ASC). If you go this route, you would be paid the professional fee, while the ASC would be paid the facility fee.
6. Investigate Patient Candidacy
Regardless of how streamlined and safe in-office laser procedures have proven to be, they are not a “one size fits all” procedure. Contraindications (eg, cystoid macular edema, active uveitis, uncontrolled glaucoma, and prior argon laser trabeculoplasty with severe scarring) as well as estimated patient prognosis play sizable roles in treatment effectiveness and patient satisfaction.
When choosing patients for potential YAG vitreolysis, for example, it is important to allow the visual system at least 6 months after initial floater presentation to filter out this disturbance. The targeted floaters in question need to be in a safe position, steering clear of the optic nerve or the anterior vitreous in a phakic patient.
Managing patient expectations is also crucial through educating them about the risk of ocular complications, such as an intraocular pressure spike, laser damage to the retina, or cataracts, and the potential need for retreatment.
7. Determine Scheduling
We have found that many practices dedicate 1 full day or 1 half day to performing in-office laser procedures. In our experience, performing these procedures during a specific day makes the clinic flow go smoother. We assess patients prior to the procedure day and let them know they’ll be put on the in-office laser procedure day schedule. You can schedule follow-up SLT and LPI procedures during the normal clinic week, but we have found it is best to schedule YAG capsulotomy patients on your laser day in case the other eye needs to be treated or re-treatments are needed. A final note: Consent forms must always be signed before the procedure occurs. This is something your staff can have the patient fill out prior to the procedure.
8. Spread the Word
To get the word out that you perform in-office laser procedures, connect with all your local cataract and glaucoma surgeons, especially those you have strong comanagement relationships with. Also, reach out to all the other optometric practices to set up a referral network. Further, let all your patients getting ready for cataract surgery or those who may already have posterior capsular opacification know that you perform in-office laser procedures that can benefit them. It is important to start planting the seed early with patients before they need the procedure. You want to build trust and rapport with your patients.
Meeting Patient Needs
As the field of optometry continues to evolve, enhancing both procedural skills and diagnostic expertise ensures practitioners remain at the forefront of patient-centered care, offering advanced solutions safely and confidently.
In the states that have expanded optometric scope-of-practice to include in-office lasers, patients benefit from more timely care, improved disease management, and stronger treatment compliance. Expanding scope not only empowers optometrists but also directly enhances patient outcomes and access to essential services. OM
