{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/ophthalmologists-except-pediatric/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Ophthalmologists, Except Pediatric",
    "soc_code": "29-1241",
    "category": "Healthcare",
    "us_employment": 8950,
    "median_annual_wage": 300080
  },
  "verdict": "SAFE",
  "risk_resistance": 83,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 14,
    "embodiment": 17,
    "liability_shield": 19,
    "trust_premium": 16,
    "judgment_accountability": 17
  },
  "reasoning": {
    "task_resistance": "Cataract extraction, anti-VEGF injections into the vitreous, YAG capsulotomy, trabeculectomy and scleral buckling are the daily schedule for most comprehensive ophthalmologists — and while the slit-lamp exam grading and OCT/fundus interpretation feeding those decisions is genuinely being automated, that displaced reading layer is a real fraction of clinic time, which is why this sits at 14 and not 18 like a purely operative specialty.",
    "embodiment": "You work with a hand on a joystick-mounted phaco handpiece inside a 12mm globe, tilt patients under an operating microscope, perform scleral depression and indirect ophthalmoscopy on uncooperative or photophobic patients, and manage intraoperative bleeding or capsule rupture in real time; it stops short of 20 only because a meaningful share of the week is clinic-based refraction, imaging review, and dictation at a desk.",
    "liability_shield": "State medical licensure, ABO board certification, ASC and hospital credentialing, and DEA registration for controlled post-op analgesia all gate the work, and the operative note plus the informed-consent discussion for endophthalmitis and retinal-detachment risk carry your name — a wrong-IOL-power implant or a missed giant cell arteritis is your malpractice claim, not the technician's who took the biometry.",
    "trust_premium": "Patients agreeing to have someone open their only good eye, or to return every four weeks for years of intravitreal injections, are choosing a specific surgeon; but a large volume of cataract work still arrives through optometrist referral pipelines and Medicare-driven ASC scheduling where the patient meets you twice, which caps this below the 19-20 range of a concierge practice.",
    "judgment_accountability": "Deciding whether a macula-off detachment goes to the OR tonight, whether to continue aflibercept in a non-responder or switch off-label, when to stop tapering steroids in uveitis with rising IOP, and whether a monocular patient's cataract density justifies surgical risk at all — these are calls made on incomplete evidence with irreversible outcomes, though many high-volume days follow well-established post-op and glaucoma-monitoring protocols."
  },
  "rationale": "The diagnostic image-reading layer — fundus photos for diabetic retinopathy, OCT for macular degeneration, visual field interpretation — is where AI is already FDA-cleared and genuinely good, and that will compress screening volume and referral triage. But the revenue core is microsurgery: phacoemulsification, intravitreal injections, laser capsulotomy, retinal detachment repair, performed on a moving, anesthetized human eye with sub-millimeter tolerances no current robot handles autonomously. State licensure plus personal malpractice exposure means a physician signs every surgical plan and every off-label injection decision.",
  "outlook": "By 2035 routine screening and imaging interpretation are largely machine-read with physician oversight, while surgical demand rises with an aging population — the job shifts further toward the operating room.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift: as FDA-cleared autonomous screening (IDx-DR/LumineticsCore, EyeArt) absorbs routine diabetic retinopathy grading and normal-OCT triage, the residual clinic day concentrates on ambiguous cases — atypical uveitis, indeterminate choroidal lesions, surgical candidacy in comorbid eyes, complication management — which current models handle poorly. The genuinely two-tier structure here (screen vs. decide-and-operate) makes this a real rise, not a reframe.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "liability_shield",
        "change": "If CMS finalizes reimbursement rules for autonomous AI retinal screening that require an attributable physician of record for any AI-flagged referral, and/or state medical boards adopt language (as some have for teleradiology) that AI output is 'preliminary' until a licensed ophthalmologist attests, the sign-off requirement becomes explicit rather than customary.",
        "plausibility": "plausible",
        "would_add": 1
      },
      {
        "dimension": "judgment_accountability",
        "change": "If malpractice carriers (OMIC, the ophthalmology-specific mutual) condition coverage on documented physician override review of AI screening outputs — an underwriting condition already appearing in radiology AI policies — the role formally owns the false-negative call.",
        "plausibility": "plausible",
        "would_add": 2
      }
    ],
    "ceiling_note": "Already 83/100; realistic headroom is a few points. The binding constraint is surgical embodiment and licensure, both saturated — score movement is mostly noise unless autonomous intraocular robotics arrives, which would move it down, not up."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 11610,
        "wage": 239200
      },
      {
        "y": 2022,
        "emp": 12580,
        "wage": 219810
      },
      {
        "y": 2023,
        "emp": 11530,
        "wage": 239200
      },
      {
        "y": 2024,
        "emp": 12110,
        "wage": 239200
      },
      {
        "y": 2025,
        "emp": 8950,
        "wage": 300080
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": -22.9,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}