The proliferation of extended roles involving optometrists as well as nurses has had a significant impact on the NHS modernisation agenda over the past 10 years. These new extended roles have required expansion in knowledge and skills by those health care professionals involved. In particular, this has now enabled hospital optometrists to manage a patient caseload that many would have considered unthinkable for an optometrist to undertake 10–15 years ago. It is estimated that approximately 4% of the optometry profession are engaged in hospital-based work, although as much as 10–15% of the profession have actually been employed in the Hospital Eye Service (HES) at some point in their career. The limited number of trained ophthalmologists, changes in junior doctors’ training, combined with the effects of the European Working Time Directive have collectively given rise to many opportunities for hospital optometrists to expand their roles.