An international review suggests that optometrists’ scope of practice in glaucoma care is expanding from case-finding toward more independent diagnosis and management.
A review article published in the July 2026 issue of Optometry and Vision Science, titled Global Scope of Glaucoma Clinical Practice for Optometrists, examines the role of optometrists in glaucoma care around the world. The review draws on sources including national legislation, clinical practice guidelines, and a survey of optometrists across Europe.
The following are some of the key findings from the article, authored by experts from universities and healthcare organizations in six different countries.
Examples of optometrists’ scope of practice in different countries
Glaucoma is one of the leading causes of irreversible blindness. In 2024, an estimated 80.5 million people worldwide were living with glaucoma, and this number is projected to exceed 190 million by 2060.
As populations age, optometrists are becoming increasingly important in the detection, diagnosis, and management of glaucoma. Their role is evolving from identifying patients at risk toward more independent diagnosis and management.
In the United States, all 50 states allow optometrists to independently prescribe topical glaucoma therapy, and 13 states also authorize laser procedures.
In the United Kingdom, Australia, and New Zealand, the scope of optometric practice has likewise expanded through additional training and specialist qualifications. In New Zealand, optometrists with an Independent Glaucoma Prescriber endorsement can independently diagnose and manage glaucoma.
In Canada, optometrists in all provinces are permitted to prescribe topical glaucoma medications, although the extent of independent glaucoma care and reimbursement arrangements varies between provinces. Laser procedures are not yet within the optometric scope of practice.
Africa, the role of optometrists varies considerably between countries. In Ghana and Nigeria, for example, optometrists are educated and authorized to diagnose glaucoma, initiate treatment, and provide ongoing medical management. More than 90% of optometrists reported routinely diagnosing glaucoma. However, clinical practice is often constrained by equipment shortages, high medication costs, and limited healthcare resources.
In Europe, optometrists are still primarily involved in glaucoma case-finding and referral of suspected cases to ophthalmologists. The most commonly used assessment methods are non-contact tonometry and optic nerve head assessment. Visual field testing, OCT imaging, and gonioscopy are used to varying degrees. In many countries, restrictions on the use of diagnostic and therapeutic drugs further limit optometrists’ involvement in glaucoma diagnosis and management.
Regarding Finland, the review notes that optometric training covers all aspects of glaucoma assessment and some elements of management. Most optometrists perform non-contact tonometry, while only a minority perform gonioscopy and Goldmann applanation tonometry. Optometrists may be involved in glaucoma care at various levels, from case-finding and referral in primary care to shared-care arrangements with ophthalmologists in hospital settings.
Challenges and opportunities in expanding the scope of practice
A key finding of the review is that optometrists’ effective scope of practice does not always match their educational preparation or legal scope. Professional authority granted through legislation is often not fully translated into clinical practice. Contributing factors include insufficient funding, limited access to equipment, medication costs, and the lack of additional training opportunities and standardized clinical guidelines.
Broader involvement of optometrists in glaucoma assessment, diagnosis, management, and long-term monitoring could improve access to care, facilitate earlier detection of disease, and reduce pressure on ophthalmology services. Achieving this would require further development of education and training, greater harmonization of legislation, adequate funding, and stronger collaboration between optometrists and ophthalmologists.
