Optometrist-performed YAG capsulotomies shown effective, safe and beneficial for patients

Doctors of optometry safely and effectively improved patients’ visual acuity using YAG laser capsulotomy, per a first-of-its-kind study that supports the use of the in-office procedure in optometric practice.

Published in the journal Optometry & Vision Science, the study formally assessed the efficacy and safety of Nd:YAG laser capsulotomy procedures performed by optometrists with 99% of patients reporting subjective improvement in visual acuity post-procedure and 95% of patients showing objective visual improvement that allowed for a better quality of life. Importantly, no significant adverse events were noted in any subject. With optometric scope of practice in 10 states authorizing doctors of optometry to provide YAG capsulotomies for treatment of secondary cataract, some for a decade or more, the study adds weight to advocates’ efforts to bolster patient access to such care.

Nate Lighthizer, O.D., Northeastern State University Oklahoma College of Optometry associate dean and professor, and study lead author, says doctors of optometry have provided this procedure for quite some time and study results bear out optometry’s efficacy and care, as well as patient satisfaction.

“Optometry is well qualified to provide YAG laser capsulotomy; it’s a procedure that can be done in-office in a matter of minutes and so optometry really is improving patient access to this kind of care,” Dr. Lighthizer says.

What did the YAG capsulotomy study find?

Per this prospective study, researchers at six primary care optometric settings performed YAG capsulotomies on eligible participants and were assessed at 1-week, 1-month and 3-month follow-up visits. All procedures were carried out in states that permit optometrists to perform YAG capsulotomies and conducted by optometrists that had completed requisite training and certifications to perform therapeutic laser procedures.

The study assessed 92 eyes in 79 subjects diagnosed with posterior capsule opacification (PCO) that had decreased Snellen acuity of worse than 20/40 or reported subjective visual complaints, such as glare that reduced vision by two lines or more. Prior to the procedure, researchers recorded patients’ visual acuity, intraocular pressure, macular thickness and central lens defects, then compared post-operatively at follow-up visits.

Of the 78 subjects (91 eyes) who completed the post-procedure survey, 77 reported subjective improvement in vision. Likewise, 87 of 92 eyes demonstrated objective visual improvement of at least one line of Snellen acuity. No significant adverse events were reported in any subject.

“This study demonstrates that capsulotomies can be effectively and safely performed by doctors of optometry with minimal risk to patients and significant benefit to visual function and provides evidence to support the use of YAG capsulotomy in optometric practice,” study authors conclude.

Additionally, Dr. Lighthizer emphasizes the strength of this study as being comparable with the current literature on YAG capsulotomies in terms of eyes studied, average amount of laser energy used and average final visual acuity. In fact, the number of eyes assessed in this study places it among the upper quartile of studies assessing YAG capsulotomy, and has the added benefit of assessing patient outcomes as opposed to solely relying on billing data.

David Cockrell, O.D., Health Care Alliance for Patient Safety chairman and study co-author, says this study not only proves optometry’s efficacy of care as compared with other providers but also directly refutes a tired narrative recycled by opponents to optometry’s scope battles.

“The bottom line here is that this multi-site study shows efficacy of the procedure as done by optometrists, and we’re hoping this will encourage and increase utilization for the benefit of our patients,” Dr. Cockrell says.

Demand for capsulotomies increasing

These study results illustrate the critical crossroads that optometry—and health care, broadly—finds itself as the need for age-related eye care increases dramatically in the years ahead. By 2030, every 1 in 5 Americans is projected to be aged 65 or older. Such is the case, the ophthalmology workforce is not poised to meet this demand as even the Health Resources and Services Administration predicts a shortage of more than 6,000 ophthalmologists by 2025. Other estimates suggest that an additional 3,500 ophthalmologists would be necessary just to account for cataract surgeries alone, regardless of other age-related eye procedures.

Routinely, optometrists comanage cataract cases and diagnose PCO, a common complication of cataract surgery. In 10 states, doctors of optometry are already authorized under their scope of practice to correct this complication through YAG laser capsulotomy. This minutes-long, non-invasive procedure is done in-office to restore patients’ visual acuity and, when performed in the optometrists’ office, can save patients subsequent visits or added travel to the cataract surgeon.

In fact, a 2023 survey conducted by the AOA found that in states where doctors of optometry can or do currently perform capsulotomies, the overwhelming majority can schedule and perform a YAG capsulotomy within a week or less. By comparison, these same doctors reported only 9% of their patients had the ability to see their ophthalmologists within a week or less.

Moreover, the survey found:

• 35% of necessary YAG procedures by doctors of optometry are performed in the office, same day.
• 97% of surveyed doctors report patient satisfaction in convenience in having YAG performed in the optometrist’s office.
• 95% of surveyed doctors report patient satisfaction and value in the continuity of care provided when YAG is performed by their optometrist.

An AOA Health Policy Institute fact sheet describing the survey results notes that when patients are referred to ophthalmology for a YAG capsulotomy, treatment is typically delayed—and often by weeks. That’s because ophthalmologists often require a consultation with the patient prior to scheduling such a procedure, even after a doctor of optometry has already diagnosed and referred the patient for care. This results 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 fact sheet states.

Access AOA’s fact sheet on YAG capsulotomy

In addition to the study itself published in Optometry & Vision Science, doctors of optometry may access an AOA fact sheet describing the research for their quick reference when discussing the procedure, its efficacy when performed by optometry and patient outcomes.