Bill Harvey Tell me a little about your background and what inspired you to become an optometrist
Christos Papageorgiou I come from a family of opticians. My father started a business in 1980 and following on his steps my two sisters and I also qualified as opticians. I graduated from the optics department of Athens Technological Institute in 2005 and later the same year I entered the optometry course at City University.
Following my graduation in 2008 with first class I completed my pre-registration year, became a member of the College of Optometrists, the AOP and registered with the GOC. Today I still hold the above memberships and follow CET. I remember from a relatively young age my father talking to me about optics and optometry so I guess this inspired me to choose optometry as a future profession. The United Kingdom has undoubtedly the highest level of optometry in Europe and I consider myself very fortunate for being able to receive part of my education at City where I had many great teachers.
BH In many European countries, eye care has traditionally been provided by ophthalmologists and opticians/technicians, the former prescribing and the latter providing appliances. Optometry is a relatively new profession and has grown at different rates in different countries – what is the situation in Greece?
CP Today the majority of primary eye care is still provided by ophthalmologists. There is a longstanding effort to establish optometry which is continuously gaining ground despite some occasional drawbacks.
To better understand the current situation I will mention a brief history about the qualification of opticians in Greece. Initially optics was a craft not requiring special qualifications. As a first stage of regulation opticians had to have two years’ work experience in a shop and pass a set of practical and theoretical exams qualifying as technical opticians.
Since then all shops need a valid license with a qualified optician always present. In 1978 the first school of optics was launched in Athens. A few years later the course included contact lens teaching and all graduates were effectively contact lens opticians. The curriculum changed many times introducing the first optometry classes in 1994 and today the school is seven semesters long with an additional six months pre-registration period and a dissertation requirement.
In 2006 the school was officially renamed to ‘Optics & Optometry’ and is recognised as level six (Bachelor) in the European Qualifications Framework. In 2007 there was a second Optics & Optometry school launched at Aigio with the same standing as the one in Athens. The school of Athens launched a much needed Masters degree called ‘Techniques of Optometric Evaluation’. Prior to this all graduates wishing to progress their studies had to follow postgraduate courses of other departments or go abroad.
Significant changes happened in 2017 on three levels. Initially there was a law setting the framework for a new regulating body similar to the GOC. A lot remains to be clarified because the body has not been launched yet. On the level of education there is a change in progress. Taking into account that the Technological Institute of Athens was launched as a Polytechnic then recognised as University of Applied Science it is due to complete its transformation by merging with another institution to form the University of West Attica.
The new university will allow students to enrol in PhD studies not previously possible. The school will be part of a four-year department called ‘Biomedical Sciences’ which after the initial year will have directions (eg Optics & Optometry, Radiography, etc). Although the title and framework are appealing there is still an effort to keep Optics & Optometry independent. The outcome is yet to be seen.
In the equivalent Opticians Act of 1978 there was a law forbidding the practice of optometry allowing eye testing only to be performed by ophthalmologists. The part of the law prohibiting optometry was withdrawn sometime before 2010 stating that optometry (no longer forbidden) will be regulated by decision from the Ministry of Health.
This created a gray period during which optometry was not forbidden but neither regulated. Last year there was a law mentioning that optometrists will be licensed, test eyes and even use diagnostic drugs but all had to be performed under the supervision of an ophthalmologist. The type of supervision has not been specified since but the result of this law was a number of local professional associations to appeal in the Greek High Court opposing the supervision. The case will be due in the next 12 to 18 months.
Greece has 2.56 ophthalmologists for every 10,000 citizens making it one of the highest in Europe. The current statistics create a socioeconomic challenge but optometry can prove to assist the continuously reduced health budget by providing cost effective services.
BH How is healthcare funded and provided in Greece – is there a state-funded service or is it primarily private and insurance-led? Has recent turbulence in the economy had any impact?
CP Healthcare in Greece is to a large extent private supplemented by cover through employment. The social security funds provide pensions and healthcare. With regards to eye care this means basic eye testing at a number of registered ophthalmologists or the HES. In terms of spectacles there is a provision every four years, formerly every two. The patient is issued with a prescription by the ophthalmologist, which is then filed from the beneficiary for a refund. There are social provisions for the unemployed and other sensitive groups but to a limited extend not including eye care.
The government is trying to change the system by contracting the opticians which was the case in the past. The previous bad experience and a continuously reduced health budget create a fluid situation so what we describe today may not be the case in the near future.
A modern Greek practice
BH How many optometrists are there and what is their role (therapeutic role, contact lenses, low vision, hospital and community services etc)?
CP Currently there is no single register and every province holds its own. This will soon change with the introduction of a GOC equivalent responsible to hold and renew the register of opticians and optical businesses. Since the renaming of the local department in 2006 all students are graduating as optician-optometrist. This has not been followed with an officially expanded scope of practise. There is a number of graduates from abroad with different backgrounds but all eventually receive the existing licence giving them rights as contact lens opticians.
There are around 150 local graduates per year. On top of this number we need to add the graduates from abroad. They are involved in a mixture of activities. Many decide to start a retail business involved in dispensing and lab work. Most of them are involved in contact lens fitting and a smaller number provide low vision services.
A number of professionals are employed by private ophthalmological clinics especially those providing refractive and cataract operations. In those environments optometrists can have expanded roles similar to those in the UK. Traditionally the pre-registration period has been taking place in optical shops but lately there are cases of students taking their pre-registration period at hospitals. Considering the evolving process of the profession although refraction may not be recognised it is often practised.
BH You trained at City – is this the norm to train overseas or are there optometry teaching and qualifications based in Greece?
CP The majority of professionals are graduates from the two local ‘Optics and Optometry departments. The second source of graduates comes from Italy and a smaller number was educated and registered in the UK. A number of local graduates have received postgraduate education (MSc or PhD) in the UK without registering.
As previously mentioned this creates a mixture of educational backgrounds but eventually all register under the same local license. This will change with the introduction of new licenses and expanded role of practice but a lot of the details remain to be clarified.
BH How do you see optometry developing in the future in Greece?
CP I actually see optometry developing as we speak. Of course politics play a big role but my dream would be as defined by the World Council of Optometry being an independent primary health profession similar to that in the UK. Of course this will take time but the profession has reached a point where evolution is not desired but demanded. There is a rich pool of local knowledge waiting to be recognised.
BH You have been instrumental in the setting up of the Hellenic Academy of Optometry. What are its aims and at what stage in its evolution is it at?
CP As in the UK the optical sector has a number of regional and national professional associations. Those associations in some of which I am also a member are primarily involved in commercial aspects and lobbying. There is some overlap but the Academy is not aiming to replace any of the existing associations but instead to satisfy the unmet need for continuous education.
Clinical excellence and lobbying are like water and olive oil – they just don’t mix. I believe that for the development of the profession we need both tiers but they need to be distinct. In the UK we have the College of Optometrists and the Association of Optometrists, in the US we have the American Academy of Optometry and the American Optometric Association and in Europe we have the European Academy of Optometry and Optics and the European Council of Optometry and Optics. The Academy is hoping to fulfil a cause similar to that of the College.
The Academy is a non-profit organisation whose members are individual optometrists who wish to develop their skills and support the effort of establishing optometry as a primary health profession in the region. I am just one of many people who contribute to the cause. I call anyone interested in becoming a member or wishing to assist our efforts to contact us. The sole criterion for membership is being a graduate of optometry. Among our members are a number of UK educated optometrists also members of the College of Optometrists.
Raising professional standards, delivering guidance and striving for clinical excellence are at the core of the Academy’s mission. To achieve these goals we run two educational events per year on various topics and have published so far two manuals on contact lenses and low vision. The Academy has recently registered with the GOC as a CET provider. On our next event on April 22, 2018, taking place in Athens, we will talk about pathology and examination of the fundus. It includes both lectures and a clinical workshop and CET points will be awarded to those interested. For us this is also a proof of our commitment to continuous education.
Our next goal which will hopefully be met within 2018 is our membership to the European Academy of Optometry. Whoever wants to follow the Academy can do so at www.eao.gr or by liking the page www.facebook.com/eaooptometry. Anyone wishing to contact the Academy can email info@eao.gr, alternatively my personal email is chris_papageorgiou@yahoo.co.uk.
BH Tell us about the library project – if Optician readers want to be involved, how might they go about this?
CP One of our projects on the topic of cultivating the mentality of continuous education is the formation of a dedicated library on optics and optometry. Taking into account the non-profit character of the Academy the enrichment of the collection will be pursued through donations by individuals, companies and other organisations. Anyone interested in making a donation of books (irrespective of condition) or funds for purchasing new books can declare their interest by sending an email at info@eao.gr.
The library project holds a special place in my heart and I truly hope to mobilise as many people as possible in order to create a book collection capable to support students as well as professionals in developing their skills. In order to minimise cost and assist those from the UK wishing to contribute we have the kind permission of Optician for anyone interested to post their donation to Bill Harvey c/o Optician, St Jude’s Church, Dulwich Road SE24 0PB. At a second stage a collective shipment will be made to the Academy’s office. All donations will be publicly recognised.