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The recent rescission of longstanding Americans with Disabilities Act (ADA) guidance in the past year has signalled a shifting landscape for disability accommodations, including for the millions of people living with permanent visual impairment. Many of these individuals rely on accommodations both in and out of the clinic, making this moment of uncertainty notably urgent for those in ophthalmology to expand their role as advocates, not just in the USA but around the globe.1 While legal frameworks provide important protections, they can prove insufficient without active engagement from healthcare providers who understand both the clinical and the lived realities of visual disability. This article argues that ophthalmologists must move beyond simply treating visual impairment in the examination room to actively dismantling systemic barriers, including redesigning clinic environments for accessibility, supporting patients navigating workplace and community accommodations and ensuring that disability protections translate from legal systems into lived reality.