Cataract surgery has been reinvented before. It’ll be reinvented again — and it’s happening right now, inside your practice.
To understand where we’re headed, it helps to understand where cataract surgery began. Ancient physicians practiced “couching” — literally displacing the clouded lens into the vitreous with a sharp instrument.[1] Primitive? Yes. But it was state-of-the-art for its time. Then came extracapsular cataract extraction surgery in 1747, intraocular lens implantation in 1949, phacoemulsification in 1967, and the migration of cataract surgery out of hospitals and into ambulatory surgery centers (ASCs) in the 1980s.[2]
Each of these transitions was met with skepticism. And each one transformed patient outcomes, access to care, and the entire business model of eye care.
We are standing before an evolutionary moment.
Over the past two decades, the revolution was refractive — advanced biometry and premium IOLs turned cataract surgery into an elective, lifestyle-enhancing procedure. Patients stopped asking, “Will I be able to see after surgery?” and started asking, “Will I be able to see without glasses?”
That shift was massive.
But the next evolution isn’t about what we do inside the eye. It’s about where we do it.
Enter Office-Based Surgery
An OBS isn’t a fancy procedure room or a glorified exam lane. It’s a fully equipped, accredited surgical facility — housed inside a physician’s own practice — designed to perform ophthalmic surgery in a setting that’s just as safe or safer, faster, more efficient, more comfortable, and more cost-effective than a traditional hospital OR or ASC.
What makes OBS different?
- No IV anesthesia. Procedures are performed under topical or oral sedation, which eliminates risk, reduces recovery time, and removes the need for an anesthesiologist.
- No pre-op physical. Patients save time and money by skipping the extra appointment and copay.
- No fasting. Patients can eat the morning of surgery — a seemingly small thing that means a great deal to anxious patients.
- 1 hour total time vs. 3 hours at a traditional facility. The entire experience — arrival, prep, procedure, recovery — wraps up in about an hour. Patients love this.
- The patient experience is dramatically better. And for practices willing to embrace this model, the financial and operational benefits are equally compelling.
Why Demand Is Surging — and Why ASCs Can’t Keep Up
The case for OBS isn’t just about a better patient experience. Market forces are creating a perfect storm that makes office-based surgery not just attractive, but necessary.
Here’s a number worth sitting with:
Cataract surgery volume is projected to surge 50% over the next five years.
That’s not a rounding error. That’s a tidal wave — driven by the aging Baby Boomer generation, improved detection, and expanded access to refractive cataract care. Tens of millions of Americans who wore glasses their whole lives are now realizing they don’t have to anymore, and they’re asking their eye doctors what to do about it.
Meanwhile, the infrastructure to handle that demand is not keeping pace.
The supply of ophthalmologists is projected to remain roughly flat over the next decade. In fact, by 2030, models suggest a 15% workforce gap relative to demand. There simply won’t be enough surgeons to keep up — unless the efficiency of each surgical encounter improves dramatically.
Now add this: Ambulatory surgery centers (ASCs), the facilities that handle most outpatient ophthalmic surgeries today, are getting crowded out.
ASCs were designed to be nimble and efficient. But over the past two decades, orthopedic and other high-revenue specialties have moved aggressively into the ASC space The result? Ophthalmology is being elbowed out.
Scheduling windows are shrinking. Eye surgeons wait months for consistent OR time. Patients wait longer for care they need now.
The math is stark: more patients needing surgery + fewer surgeons available + less facility access = a capacity crisis.
Office-Based Surgical Suites Are the Logical Answer
Instead of competing for time at an outside facility, practices can bring surgery in-house. Surgical days are scheduled on the practice’s terms — no competing with joint replacements, no last-minute cancellations because an orthopedic case ran long. The surgeon controls the calendar. The practice controls the revenue.
This is a rare convergence: what’s best for patients (faster, more comfortable, more personalized care), what’s best for practices (control, capacity, revenue), and what’s best for payors (lower cost per case) all point in the same direction.
That alignment of incentives doesn’t happen often. When it does, the transition tends to accelerate quickly.
The OBS revolution isn’t coming. It’s already here. The question isn’t whether this model will transform eye care — it’s whether your practice will be part of it. While ophthalmologists have led this evolution, optometrists have just as much to gain.
How Does Optometry Fit Into OBS?
For most of modern eye care's history, surgery has naturally belonged to ophthalmology. Optometrists see the patient, identify the need, and refer out. The cataract gets extracted at another facility, by another provider, on a separate schedule. The patient often comes back to the optometrist — but not always.
The OBS model rewrites that script.
Optometrists conduct roughly 85% of all annual eye exams in the United States. Most of those patients will need surgical care at some point — cataract, refractive, or otherwise. Until now, the only way to participate was to refer it out.
The shift from ambulatory surgery centers (ASCs) to OBS has made it possible for optometry to provide surgical care with an ophthalmologist in their practice. This model enables the optometry practice to gain ownership of surgical procedures and retain the patients.
In an OBS partnership, the optometrist owns the suite. The ophthalmologist operates. The patient never leaves the practice they already trust.
The result is a different kind of practice. One where patients get the same treatment that was recommended by their provider. One where advanced vision correction treatments are offered. And one where the financial value of a patient relationship — built over decades — finally stays inside the practice that built it.
For optometry, this is the same evolutionary moment ophthalmology is facing, just from the other side. The capacity crisis squeezing surgeons is opening a door for ODs and MDs to work together. The practices that walk through it now will define what optometry looks like for the next generation.
Whether you're an ophthalmologist looking to escape the ASC bottleneck or an optometrist looking to keep more of your patients in-house, the case for office-based surgery is the same: better outcomes for patients, more control for practices, and a model built for the future of eye care.
Ready to see how Office-Based Surgery could work for your practice?
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6139750/#sec5
[2] https://eyewiki.org/History_of_Cataract_Surgery