A new legal framework for orthoptics in Belgium

Introduction 

On 15 October, the Official Gazette published the Royal Decree of 29 September 2026 on the profession of orthoptist. 

The entry into force of this new regulation on 25 October 2026 provides an opportunity to look back at the turbulent legal framework that practitioners of orthoptics and optometry have faced for almost 10 years, and at the legal uncertainty that this Royal Decree now seeks to end (with limited success). 

1. Regulating orthoptics at the mercy of the Council of State’s annulments

Orthoptics is a paramedical profession involving the examination and treatment of disorders of the eye and the visual system. 

The profession has long been regulated. Now included in the list of paramedical professions, orthoptics was first regulated by a Royal Decree of 24 November 1997, which was replaced on 7 July 2017 by a new Royal Decree. 

Between 2019 and 2024, the King made two further attempts to overhaul the framework for paramedical eye care. Both attempts were annulled by the Council of State, each time because of shortcomings in the consultation process involving the advisory bodies. 

The first reform, the Royal Decree of 27 February 2019 on the profession of orthoptist-optometrist, sought to establish “eye care” as a single paramedical profession, practised under the title of “orthoptist-optometrist”, and repealed the Royal Decree of 7 July 2017. This was the first attempt to regulate the profession of optometrist, undertaken with the stated aim of addressing the shortage of ophthalmologists and increasingly long waiting times, and it therefore merged this newly regulated profession with the pre-existing profession of orthoptist. 

In judgment n°251.846 of 14 October 2021, the Council of State annulled this Royal Decree on the grounds that the Technical Commission for Paramedical Professions (“CTPP”) and the Federal Council for Paramedical Professions (“CFPP”) had not been validly consulted, and that a transitional measure conferred administrative powers on private entities without objective criteria or procedural safeguards. As a result of the annulment of this Royal Decree in its entirety, the Royal Decree of the same date replacing orthoptics with “eye care” in the list of paramedical professions lost its raison d’être and was in turn annulled by the Council of State (judgment n°257.630 of 13 October 2023). 

The second reform took another approach. Since the “eye care” working group had pointed out that the dual profession of “orthoptist-optometrist” did not exist anywhere else, a new Royal Decree of 7 October 2022 on the professions of orthoptist and optometrist was adopted. It recognised the two professions separately, each with its own approval requirements, technical services and delegated acts, and once again repealed the 2017 Royal Decree, which had in the meantime come back into force. This Royal Decree was also annulled, by judgment n°261.003 of 11 October 2024. The opinion of the CTPP, a significant formality, had indeed been issued but by means of an electronic vote in which only five of the eleven representatives of the paramedical professions had taken part, meaning that the attendance quorum required by Article 84 of the Coordinated Law of 10 May 2015 on the practice of healthcare professions had not been met. This shortcoming justified the annulment and left the substantive issues, such as the allocation of acts between the two professions, unanswered. 

As a consequence of this annulment, on the eve of the adoption of the Royal Decree of 29 September 2026, the profession of orthoptist, following the successive annulments by the Council of State, was still governed by the Royal Decree of 7 July 2017, that is, precisely the text that both reforms had sought to replace. 

The newly published text therefore changes this framework: it becomes the new reference standard for the profession. 

2. The Royal Decree of 29 September 2026: the end of optometry?

The Royal Decree of 29 September 2026 on the profession of orthoptist thus repeals the Royal Decree of 7 July 2017, while largely reproducing its content. In reality, it essentially just supplements it with the changes in the 2022 Royal Decree insofar as they concern orthoptists, and with a few new features relating to orthoptists’ services, the confidentiality requirements surrounding orthoptics acts and the relationship between orthoptists and commercial operators in the eye-care sector.

It should also be noted that the Royal Decree of 29 September is devoted exclusively to the profession of orthoptist, leaving observers rather unsure of what lies in store for the profession of optometrist. 

This profession currently remains formally recognised as a paramedical profession, without any technical services or delegated acts being assigned to its practitioners.

The Minister’s representative, questioned on this point by the Legislation Section of the Council of State prior to its opinion n°79.653, casts serious doubt on any intervention to organise this profession further in the future, leaving the question open. The transitional provisions of the Royal Decree do provide that a person who began training as an orthoptist-optometrist or obtained approval as such under the 2019 Royal Decree (articles 10 and 11), as well as one who obtained the right to practise as an optometrist (article 13), may apply for approval as an orthoptist, where applicable, after successfully completing additional training. 

The King thus settles the past. 

A page on the future, however, remains to be written.