Global scope of glaucoma clinical practice for optometrists

The role of optometrists in glaucoma care is evolving rapidly in many parts of the world. This review aims to describe the current global scope of clinical practice for optometrists with respect to glaucoma, highlighting progress and identifying barriers to care across diverse regions.

We reviewed the current landscape of optometric glaucoma practice across Africa, Australia and New Zealand, Canada, Europe, the United Kingdom (UK), and the United States of America (USA). The review of practice in each region was led by authors active in the region using, where possible, publicly available legislation, published guidelines, and peer-reviewed publications. For Africa and Europe, where the general scope of practice and training level of optometrists varies by country, we used the World Council of Optometry Competency Framework and the European 'Blue Book' to benchmark levels of proficiency and standardize comparisons between jurisdictions. A survey was also distributed to optometrists across Europe to collect further information on glaucoma practice patterns, given the lack of published information for many European countries. No countries with optometry in Asia, Mexico, the Greater Caribbean Region, Central, or South America were included in this review.

The global landscape is characterized by a significant shift from traditional 'case-finding' to comprehensive diagnostic and therapeutic management. In the USA, all 50 states permit independent topical therapy, with an increasing number authorizing laser procedures. In the UK and New Zealand, independent prescribing and expanding roles in laser procedures are also available to optometrists with higher qualifications. Conversely, Europe and Africa exhibit stark variations between countries; while countries, such as Ghana and Nigeria, train to the Doctor of Optometry level with high nominal scope, 'effective' scope is often constrained by equipment shortages and high medication costs. A 'regulatory lag' persists in some regions, where legislative expansion has not yet translated into broad clinical uptake.

Optometrists are increasingly essential to patient access and sustainable glaucoma care delivery. Although educational and training standards continue to improve, significant barriers-including regulatory restrictions, inconsistent public funding, and resource limitations-must be addressed to optimize optometry's role in addressing the global burden of glaucoma.