YAG procedures by doctors of optometry, after cataract surgery, better for patients’ care and convenience

July 13, 2023
Survey of 10 states, where doctors of optometry are certified to perform the YAG capsulotomy to treat complications from cataract surgery, finds patients are more likely to get in to see their doctors of optometry for the laser eye surgery than their ophthalmologists, and many see cost savings. Survey results provide evidence or grounds for further optometric scope expansion to other states, especially in light of workforce shortages.
Person demonstrating YAG Laser

When states authorize doctors of optometry to perform capsulotomies after cataract surgery, patients reap the benefits in convenience, shorter wait times and continuity of care for the fairly common procedure, according to a new survey by the AOA Research & Information Committee (RIC). 

The RIC survey looked at states where doctors of optometry can or do currently perform capsulotomies: Alaska (2017), Arkansas (2019), Colorado (the latest, in 2022), Indiana (2015), Kentucky (2011), Louisiana (2014), Mississippi (2021), Oklahoma (the first, in 1998), Virginia (2022) and Wyoming (2021)—half of them in the past four years. The survey found that more than half of doctors of optometry who responded (56%) reported providing YAG laser capsulotomies in their practices and an overwhelming majority (89%) have the availability to perform the procedures within a week. 

Among the survey’s results: 

  • 89% of doctors of optometry report scheduling availability to perform YAG in their offices within one week or less. Comparatively, doctors of optometry reported that only 9% of their patients were able to see their ophthalmologists in a week or less.
  • 35% of necessary YAG procedures by doctors of optometry are performed in the office on the same day.
  • 97% report patient satisfaction in convenience of having YAG performed in an optometrist’s office.
  • 95% report satisfaction and value in the continuity of care provided when YAG is performed by their doctor of optometry.
  • 46% report patient satisfaction with direct cost savings when YAG procedures are performed in their local doctor’s office.

“The AOA RIC survey demonstrates that patients benefit from optometric scope expansion allowing doctors of optometry to provide YAG laser surgery in their offices,” say the survey’s results, recently published in a report by the AOA Health Policy Institute. “Patients’ treatment is typically delayed, often by weeks, when they must be referred to an ophthalmologist for the procedure. Ophthalmologists often require a consultation with the patient prior to scheduling the YAG procedure after a doctor of optometry has already diagnosed and referred the patient for care resulting in multiple copays, visits and costs associated with time and travel. 

“Patients value the convenience of having necessary procedures performed by their primary doctor of optometry in their local office with a flexible schedule allowing most procedures to be performed on the same day or within a week,” the report continues. “Patients value continuity of care and trust the quality of care received by their doctor of optometry.” 

The survey was in the field from April 5-28, 2023. 

Demand for capsulotomies increases

Ninety million Americans over the age of 40 have vision problems, including 25.4 million of them with cataracts.

Meanwhile, the number of ophthalmologists able to meet surgical demand is declining; 50% of ophthalmologists, for instance, are closer to retirement than training. The Health Resources and Services Administration predicts a shortage of more than 6,000 ophthalmologists by 2025. The number of doctors of optometry, meanwhile, will remain steady; the optometric workforce is projected to grow 1.4% annually—that’s a rate greater than the U.S. population, the AOA report says. Read more about the AOA’s letter to two members of Congress on how to address workforce shortages in health care. 

The purpose of the survey was to consider the benefits and value patients experience when doctors of optometry are authorized to perform YAG capsulotomies. The RIC’s online survey examined patient experience prior to and after optometric scope expansion authorizing doctors of optometry to perform YAG laser capsulotomies in those 10 states. A total of 5,645 doctors were invited to participate in the survey. The survey received 406 qualified responses from practicing doctors of optometry. 

YAG capsulotomies are performed in response to a complication following cataract surgery (called secondary cataract or posterior capsule opacification [PCO]), which can occur in 20% to 50% of cases. Patients with PCO may experience post-surgical blurriness or haziness in their vision, light halos, an inability to perceive contrasts and colors, or decline in visual acuity after cataract surgery.  

Doctors of optometry are able to diagnose PCO through comprehensive eye examinations. PCO is treated with YAG laser capsulotomy, which is a noninvasive procedure that can be done in the doctor’s office.

“Patients should not have to delay their eye care procedures or incur unnecessary costs for multiple visits or added travel when doctors of optometry are fully trained to perform these procedures,” the HPI report concludes. “Doctors of optometry are in a unique position to fill the gap for YAG surgery (and other ophthalmic procedures) as they are locally accessible to patients in 78% of all U.S. counties and county equivalents and 82% of counties or county equivalents where most of the population is rural.” 

Register for AOA Regional Advocacy Meetings

Have you signed up to attend one of the regional advocacy meetings across the country?

The meetings gather affiliates’ grassroots advocates, leadership and volunteers for best-practices discussions and a workshop-style approach to work on honing states’ advocacy strategies. Building on the overwhelming success of last year’s inaugural meetings, this year’s AOA State Government Relations Center (SGRC) Regional Advocacy Meetings  promote a collaborative environment with seasoned statehouse veterans to put affiliates’ advocacy strategies first. The meetings are:

AOA SGRC Regional Advocacy Meetings are supported by Johnson & Johnson Vision, Lumenis, the Health Care Alliance for Patient Safety and SightSciences. Additionally, attendees will have the opportunity to try out a laser with a hands-on demonstration by Lumenis. 

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