Surgeons share what they’ve learned and how OBS can change your practice. PUBLISHED IN CATARACT &...
How optometrists can capture the surgical revenue they've been sending out the door
Optometrists already own the refractive pipeline.
Optometrists (ODs) perform approximately 85% of all comprehensive eye exams in the United States. The patients most likely to be surgical candidates — presbyopes tired of readers, hyperopes frustrated with strong glasses, early cataract patients not yet at the point of functional decline — are sitting in your exam chair right now.
For decades, the standard of practice has been to identify those patients, provide optical services or refer them out to a surgeon, and co-manage the post-operative care. As online competition grows and patient expectations evolve, that model has grown stale. It also leaves enormous value on the table.
Here's what changes with an office-based surgical suite (OBS): instead of sending those patients to an another provider who collects the surgical fees, you can keep them — and the revenue — inside your own practice.
What exactly is office-based surgery — and how is it different from an ASC?
Unlike ASCs, ODs can participate in OBS ownership and revenue.
Office-based surgery is any surgical or invasive procedure performed by a licensed physician in a location other than a hospital or ASC. OBS provides safe, efficient, more streamlined care along with many other benefits to patients and providers.
OBS operates under a different framework entirely. The single most important structural difference for optometry is this: ASCs do not allow OD ownership. OBS does. That one fact is the reason this category exists for optometry. You can add OBS to your practice, hire a surgeon to perform the procedure, and retain all surgical revenue in-house. Because the surgery occurs within your own practice rather than at a separate referred facility, the anti-kickback concern doesn't apply in the same way. ODs can own, operate, and collect revenue from an OBS — and this is arguably one of the most significant financial opportunities the profession has ever seen.
What this means in practice
- You already have the patients. Your practice is the front door for surgical candidates.
- You already have the trust. Long-term patient relationships make surgical conversations feel natural, not transactional.
- You already have the clinical skills. Pre-op evaluation, co-management, post-op care — ODs are doing this work already.
- Now you can capture the revenue, too.
So what procedures can be done in an OBS?
From clear lens exchange to cataract surgery — the full scope of what's possible.
A common misconception about office-based surgical suites is that they're limited in scope — useful only for minor procedures, not “real” surgery. The reality is far more expansive. Office-based surgical suites are full operating theaters designed explicitly for the procedures performed in them with the same facility layout and environment standards as those of an ASC.
An accredited OBS can support a wide and growing range of ophthalmic procedures. Here's a breakdown of what's being done today.
Refractive Lens Exchange (RLE) / Clear Lens Exchange (CLE)
This is the procedure that, perhaps more than any other, represents the full potential of OBS for optometrists. RLE involves removing the natural crystalline lens — before a cataract has formally developed — and replacing it with a premium IOL.
The ideal candidate? A presbyopic patient who's tired of wearing glasses and doesn't want to wait for a cataract. High hyperopes, often aren't good candidates for laser vision correction (LASIK/PRK/SMILE) — RLE is frequently their best option. The procedure eliminates the need for future cataract surgery, corrects distance and near vision simultaneously, and provides lasting, stable outcomes because the IOL doesn't age the way the natural lens does.
These patients are already in your practice. They're in their late 40s, 50s, or early 60s. They're asking about their options. They're candidates for RLE — and OBS is where it can happen.
Intraocular Collamer Lens (ICL / Visian EVO)
For younger, highly myopic patients who aren't good candidates for laser vision correction — often due to thin corneas, high prescriptions, or dry eye disease — the phakic ICL is an excellent solution. Unlike RLE, it's an additive procedure: the natural lens stays in place, and a collamer lens is implanted in front of it. Patients with significant myopia and astigmatism can achieve dramatic improvements in visual quality.
Laser Vision Correction (LASIK, PRK, SMILE)
These procedures have been performed in office settings for decades and represent the most established proof-of-concept for the OBS model.
Traditional and Refractive Cataract Surgery
Cataract surgery — with or without premium IOL options — is the core volume driver for most OBS practices. With the right infrastructure, bilateral same-day procedures become possible, dramatically improving the patient experience and practice efficiency.
Emerging Categories
Progressive OBS practices are also expanding into retina, oculoplastics, and select glaucoma procedures — further extending the model's reach and revenue potential.
The bottom line
An OBS isn't a procedure room. It's a surgical facility that handles a full spectrum of vision care — and for an optometric practice, it's the missing infrastructure that converts an existing patient pipeline into a fully captured surgical revenue stream.
The pipeline is yours. The patients are yours. The clinical relationships are yours. The question is whether you'll take the next step and capture the full value of the care you're already providing.
Ready to see how Office-Based Surgery could work for your practice?
Get started with a feasibility analysis with surgical revenue potential and expenses to forecast the financial impact to your practice.
