Are ophthalmologists the Rodney Dangerfield of healthcare specialists?

Ophthalmic surgeons play a vital role within the healthcare system, yet their contributions often do not receive adequate recognition. Cataract procedures significantly restore vision and enhance the daily lives of seniors. With the increasing prevalence of cataracts among individuals aged 50 to 70, advancements in technology and implantable lenses have enabled restoration of near, intermediate, and distance vision—often surpassing the capabilities of traditional glasses.

Despite these achievements, conversations about expanding outpatient procedures tend to focus primarily on orthopedics, spine, and cardiology—fields noted for their high revenue potential and innovative care models. The transition of such procedures to ambulatory surgery centers (ASCs) has led to improved outcomes and reduced hospital stays. Ophthalmology, however, has kept pace with these specialties through advancements in surgical techniques, such as femtosecond laser incisions, nucleus softening, and innovations like light-adjustable intraocular lenses and micro-invasive glaucoma surgery (MIGS). These developments have not only enhanced visual acuity but also addressed diseases that previously led to blindness. Nevertheless, ophthalmology is seldom featured in discussions surrounding value-based care or healthcare system reform.

Currently, ophthalmology cases comprise 30% of procedures performed in ASCs, while 34.7% of cataract surgeries in the United States still occur in hospital outpatient departments (HOPDs). As higher revenue cases shift from hospitals to ASCs, there will be increased demand for operating block time. For example, a two-hour orthopedic procedure may displace six to ten cataract cases; yet the financial return of a single total hip arthroplasty (THA) is comparable to that of multiple cataract surgeries.

Although revenue generation is similar across these specialties, the growing preference for orthopedics and spine procedures within ASCs may limit opportunities for ophthalmology. Single-specialty ophthalmic ASCs are less affected by this trend; however, Ophthalmic surgeons in multi-specialty facilities may face constraints in scheduling. A logical progression for some ophthalmic cases is the establishment of office-based surgery suites (OBS). Research—including studies conducted by Kaiser Permanente—has demonstrated that, when properly managed, office-based procedures can match the safety standards of ASCs and HOPDs. Concerns regarding safety and quality mirror those expressed during the early adoption of ASCs. At a minimum, self-pay refractive cases, such as refractive lens exchanges and ICLs, could transition to the office setting, creating capacity for Medicare cataract cases originating from HOPDs.

Historically, ophthalmology has led efforts to move care from inpatient settings to outpatient facilities and then to ASCs. It is time for the specialty to once again take initiative and lead the next evolution in eye care delivery!