Ophthalmology in 2025 stands at a crossroads, defined by extraordinary clinical successes and significant systemic challenges. Patients have never had it better. With advanced technology, skilled surgeons and innovative procedures, outcomes are remarkably successful.

For many ophthalmologists and ocular surgeons, on the other hand, the clinical triumphs are overshadowed by mounting financial pressures and disputes over such issues as optometric scope of practice and office-based cataract surgery (OBS). Indeed, issues such as these underscore the need for ophthalmologists to advocate for fair reimbursement policies and reasonable practices to keep high-quality patient care at the top of their list of priorities.

“I think that advocacy is part of our professional duty,” says Vance Thompson, president of the American Society for Cataract and Refractive Surgery (ASCRS). “It helps us to help our patients, because they need that advocacy also. I feel like we’re called to do this,” adds Dr. Thompson, director of refractive surgery at his eponymous clinic and ophthalmic ambulatory surgery center (ASC) in Sioux Falls, SD.

“It’s not the time to just sit around, talk and contemplate. It’s time to act, and that means getting involved,” agrees Parag Parekh, MD, MPA, ASCRS chair of government relations and founder of Clearview Eye Consultants in State College, PA.

Four of the most significant issues facing the profession this year revolve around Medicare reimbursement, administrative burdens, optometric scope of practice and OBS. 

Medicare and private insurance: The squeeze goes on

The continuing downward spiral in the Medicare Physician Fee Schedule conversion factor is a top concern of the profession, observes Brandy Keys, director of health policy at the American Academy of Ophthalmology (AAO). The conversion factor is a dollar amount used to calculate Medicare reimbursements to physicians and surgeons by converting relative value units (RVUs) for services into payments. Recent trends show a steady decline in the conversion factor—from $36.09 in 2020 to $32.35 in 2025.

These cuts stem from budget neutrality adjustments, statutory spending rules and shifting priorities, such as increased funding for telehealth during the pandemic. And it gets worse.

“The payment cuts are compounded by the challenge of keeping up with the ever-changing requirements of the Merit-based Incentive Payment System (MIPS),” Ms. Keys says. “If clinicians do not [keep up with the requirements,] it can lead to up to a 9% payment penalty on top of the conversion factor cut.”

“Here we are facing another 2.8% cut for the surgeon’s fee. Medicare Advantage and other groups … get gigantic increases, and we get cut again and again and again year after year, negatives or tiny positives, which are just way under what they should be. That’s a huge problem, and it’s not sustainable,” agrees Dr. Parekh.
Financially, things are brighter for ophthalmic ASCs.

“For 2025, ASCs received [an average of] about a 2.4% increase in cataract surgery [facility reimbursement],” says Michael Romansky, JD, general counsel for the Outpatient Ophthalmic Surgery Society (OOSS).

However, the annual increases—running for more than 25 consecutive years—are tied to hospital-based surgical rates, but not to the actual rate of inflation in costs of providing medical services. 

This causes many ASCs to offer a hybrid of Medicare and premium, cash-pay services and products, such as multifocal lenses.

“The practices can’t survive on Medicare reimbursement alone,” says Dr. Thompson. “One of the missions of my presidency is to help our members understand how to deliver the cash-pay side of medicine to try to offset some of these cuts.”

Indirectly but equally impactful on the costs of ophthalmic practice are growing administrative burdens such as prior authorization and step therapy restrictions imposed by insurance plans, which are delaying or denying patients access to necessary cataract and other ophthalmic procedures, he adds.

“The prior authorization burdens have been very, very difficult. And the step therapy requirements of insurance plans dictating what medication a doctor can put someone on. Sometimes you need to try two or three things that aren’t as effective…because of some of these requirements,” 
Dr. Thompson says.

Office-based ocular surgery: Quality and safety concerns

Another hot-button issue we’re likely to hear more of this year is the controversy around office-based cataract surgery. First rising to the forefront in the mid-2010s, OBS is touted by proponents to improve patient convenience and accessibility to cataract surgery. However, it also raises quality and safety concerns. OOSS and AAO successfully advocated against CMS assigning professional fees for OBS in 2016 and again in 2023.

“It’s not that we oppose office-based cataract surgery. We believe that office cataract surgery is appropriate, so long as facilities meet patient health and safety requirements comparable to those applied to ASCs,” says Mr. Romansky, arguing that even an accredited office facility meets much less rigorous standards than an accredited or Medicare-certified ASC. “For example, there’s typically no RN in the office suite. There are no anesthesia personnel to manage cases with complications. Office facilities lack the rigorous federal and state oversight applied to ASCs."

Michael Repka, MD, president of the AAO, notes some additional concerns.

“OBS has to be as safe for the patient. There must be the same safeguards for quality that we have in surgery centers. My worry is that those requirements will make it difficult to run a tight and profitable operation and have high quality and satisfaction if reimbursement is too low,” says Dr. Repka.

Although OBS facilities represent only a small fraction of surgical locations nationwide, they are seen as market disruptors owing to lower operational costs and less stringent regulations. “It disrupts fair competition,” Mr. Romansky explains, underscoring the importance of ongoing advocacy to maintain patient safety standards.

Stay in your lane: Optometrists and scope of practice

A third major issue expected to draw attention this year is scope of practice for optometrists. In recent years several states have either considered or passed legislation allowing optometrists to perform laser surgeries and injections, also raising concerns among ophthalmologists about patient safety and quality of care.

“Optometrists have a role on a team, and we’re honored to work with them, but they’re not surgeons,” says Mark Cribben, director of government affairs for the ASCRS. “They’re not qualified, and so they should not be allowed to be doing surgery.”

Rebecca Hyder, the AAO’s vice president of governmental affairs, says it’s not just a matter of knowing how to perform a given procedure but also knowing when to perform it.

“That’s a big part of what we hear from our doctors who are in states that have expanded optometric scope,” says
Ms. Hyder. She says the variance in state scope of practice laws for optometrists can make it challenging for patients to choose the best provider for their care.

“Our focus is making sure patients are … being cared for by those who are trained to do it,” she says.

Social media enables

As has been made clear in recent years, social media platforms have turned out to be a powerful tool for advocacy — including in ophthalmology. Dagny Zhu, MD, a cornea, cataract and refractive surgeon, and medical director and partner at NVISION Eye Centers in Rowland Heights, Calif., points out that they enable not just organizations, but also individuals, to rapidly share updates, reach out to new audiences and engage with policy makers. She herself is active on multiple social media platforms and has more than 50,000 followers on Instagram.

The AAO’s campaign outreach on the dangers of rubber bullets during the volatile summer of 2020, Dr. Zhu says, are one such example. “During social unrest, rubber bullets are often used for crowd control, but their impact can cause severe eye injuries, including vision loss or blindness,” she explains. “The AAO leveraged social media to educate the public about these risks, sharing infographics, patient stories and expert commentary. The campaign effectively reached millions, spurring discussions on safer alternatives and influencing public opinion on the responsible use of non-lethal force.”

Another recent battle in anesthesia offers further proof of the power of social media, Dr. Zhu notes. “Anesthesiologists recently championed a successful effort to overturn a health insurance policy limiting payments to anesthesiologists for surgeries exceeding a specific time frame. The Anthem Blue Cross policy threatened patient care by discouraging necessary extended procedures, particularly in complex surgeries,” she says. “By utilizing social media, anesthesiologists and patients were able to voice their concerns. Posts highlighting the potential impact on patient safety, combined with coordinated advocacy campaigns, created widespread awareness and pressure on policymakers to reverse the decision. A similar approach could be utilized in ophthalmology to overturn unfavorable insurance policies or legislative scope expansion proposals.”

Get engaged in 2025

Ophthalmology and ophthalmic surgery professional organizations offer many opportunities to advocate on issues affecting ophthalmic practice:

• The American Academy of Ophthalmology. Visit https://www.aao.org/advocacy/eye-on-advocacy for news on the AAO’s latest advocacy efforts, as well as for advice on how to engage in grassroots advocacy, templates for letters that can be sent to your congressional representatives, and other resources.
• The Ophthalmic Outpatient Surgery Society. Visit https://ooss.org/ooss/advocacy/ and https://ooss.org/ooss/advocacy/advocacy-center/ for news and resources such as pre-written letters that can be customized and emailed to congressional representatives.
• The American Society for Cataract and Refractive Surgery. Visit https://ascrs.org/advocacy for information on becoming an ASCRS “Eye-Contact” member as well as a downloadable PDF handbook on grassroots advocacy engagement and other resources.
• Congressional Advocacy Day. This annual event organized by the AAO as part of its Mid-Year Forum in Washington, D.C., takes place April 3, 2025, from 8 a.m. to 3 p.m. Ophthalmologists, including those in training, will have the opportunity to meet with legislators on Capitol Hill to advocate for the profession and patients. For more information, visit https://www.aao.org/mid-year-forum/overview.

Advocacy and collaboration: A path forward

The financial, administrative, and scope of practice challenges facing ophthalmology are certain to continue in the months ahead. Engaging in advocacy at the local, state and national levels is crucial for ophthalmologists to protect their interests and ensure high-quality patient care.

“Join the organizations and keep your membership up. Contribute to the political action committees. That’s the way business is done,” Mr. Romansky says. “Stay abreast of developments and talk to your members of Congress.”

“When our members do their part in advocacy, it amazes me how much our [Congress people] appreciate the personalized contact,” agrees Dr. Thompson. “I always worry that they’re overwhelmed, but it’s just the opposite. It really helps our cause.” OASC