Ophthalmology leaders push for influence in health systems amid coverage gaps and shrinking fees | AAO 2026

With its high patient volume, readily measured results and fast-moving technology, ophthalmology is well placed to drive operational improvement within health systems, according to the program for a symposium at the American Academy of Ophthalmology (AAO) 2026 annual meeting, being held October 9 through October 12, 2026, in New Orleans.

In the session, "The Power of Ophthalmology: Driving Clinical Excellence, Efficiency, Sustainability and Innovation Across Health Systems," five presenters examined how ophthalmology leaders can shape clinical operations, OR safety, hospital and emergency care, quality measurement and physician well-being.

Starting the session was Jules A. Winokur, M.D., an ophthalmologist in the New York metropolitan area, whose presentation showed what happens when that expertise is missing from hospitals. He reported that hospitals without ophthalmology coverage often transfer eye patients who do not need urgent specialty care, and the diagnosis prompting the transfer is frequently wrong.

Winokur said reimbursement has helped push ophthalmology out of hospitals. A hospital receives $2,358 for cataract surgery, compared with $11,866 for a knee replacement.

Yet eye emergencies account for 1% to 6% of the roughly 155 million emergency department visits each year, Winokur said, and ophthalmology input changes care and management for more than half of the patients seen.

Winokur's team reviewed two years of data on 747 transfers from 25 New York-area hospitals, an average of 14.7 miles away, where ophthalmology was the main reason for transfer.

The referring diagnosis was correct about 26% of the time. About 41% of transferred patients received no intervention.

"I like to think of us as the seatbelt, right?" Winokur said. "You don't need us until you really, really need us, and then when you don't have us, it's going to be a big problem."

Workforce strain in the clinic

Kimberly Stepien, M.D., John W. and Helen Doolittle Professor in Ophthalmology at the University of Wisconsin-Madison, said demand for eye care is growing with an aging population while the ophthalmic workforce is projected to decline.

Stepien has filled gaps in the ophthalmologic workforce with optometrists, describing them as “ideal partners” for routine, stable and chronic conditions. Her department added optometrists to its glaucoma service after a specialist retired, then launched an urgent care optometry service that escalates concerning findings to the right subspecialty. The model has since expanded to other subspecialties, freeing physicians for more complex and surgical patients.

One of the most important tool introductions to her practice are patient tracking boards that show where each patient is in their visit. This has led to decreased wait times for patients and an increase in efficiency, allowing Stepien to see three to six more patients per half-day session.

“Change is hard, and change takes time and effort,” Stepien said. “You have to start small and let the process evolve.”

A Q&A session followed. In the audience was John Maher, M.D., an ophthalmologist who practices in Torrance, California. “How do you define power in ophthalmology if our fees are shrinking, as mine are, or have been through cataract surgery, for instance?”

Shlomit Schaal M.D., Ph.D., presenter and executive vice president, chief physician executive, Houston Methodist, and president and chief executive officer of the Houston Methodist Physician Organization answered Maher’s question.

“I was a department chair before taking my current role, and my department was the worst performing in the system. After a few years, it became the best,” Schaal said. “We can have great volume, and we can have great patient satisfaction. We can be leaders, and that is power. Power is influence.”