FROM VISION CORRECTION TO DISEASE PREVENTION: THE EXPANDING CLINICAL SCOPE OF OPTOMETRISTS EXPANDING CLINICAL SCOPE OF OPTOMETRY

Abstract

Background: Optometry has historically been framed around refractive correction and low-vision rehabilitation. Over the past decade, however, expansion of diagnostic technology, independent prescribing rights, and workforce pressures on ophthalmology have repositioned optometrists as active participants in disease detection, chronic-disease monitoring, and, increasingly, systemic health screening. Objectives: To critically synthesise recent primary research (2022–2026) describing the expanding clinical scope of optometrists across diabetic eye disease, glaucoma, systemic ('oculomics') screening, and community-based urgent eye care, and to identify controversies, gaps, and implications for clinical practice and health policy. Methods: A narrative literature search of PubMed, Scopus, Web of Science, and Google Scholar was conducted for the period January 2022 to January 2026, restricted to original primary research (randomised trials, cohort, cross-sectional, case-control, pilot, and quality-improvement studies) involving optometrists or optometry-delivered services. Systematic reviews, meta-analyses, scoping reviews, editorials, and conference abstracts were excluded. No PRISMA framework was applied, consistent with the narrative design. Review: Twenty primary studies met inclusion criteria. These demonstrate that optometrist-delivered diabetic retinopathy review clinics achieve substantial diagnostic concordance with hospital ophthalmology, that routine optical coherence tomography in optometric practice increases glaucoma case-finding, that community optometrists absorb a majority share of acute eyecare episodes previously managed by general practitioners, and that retinal imaging increasingly functions as a biomarker platform for cardiovascular and neurodegenerative risk. Independent prescribing and enhanced case-finding schemes have proved clinically safe during service evaluations, although evidence remains dominated by high-income, single-country settings. Conclusion: The clinical scope of optometry has moved decisively from refraction toward disease prevention, but the evidence base is heterogeneous, weighted toward the United Kingdom and United States, and rarely includes health-economic or low- and middle-income country data. Structured accreditation, harmonised referral pathways, and pragmatic trials of oculomics-based screening in routine optometric practice are priority next steps.