In the past couple of weeks, I have read several items that make it clear that, as a profession, we can’t make our minds up on the future of eye care. Much has been made of the General Optical Council’s (GOC) wish to change legislation around the Opticians Act and, relevant to so many, whether the act of refraction should be deregulated and allowed to be carried out by dispensing opticians or even unregistered suppliers. This is a battle that has raged on for a while now and, with the advance of technology, has become very widely debated.
Optometrists have, for a long while now, had desires to move into clinical activities traditionally associated with ophthalmology and, to the great credit of an increasing number of optometrists, have undertaken further training and qualification to perform those tasks. Coupled with that has come the frustration that, on many occasions, ophthalmology has been perceived to stand in the way of progress. This has led to claims of protectionism against ophthalmology. So, fast forward to today. We see others who feel they should be allowed to refract seeking to do so and optometry seeking to preserve this function for themselves, while also seeking to move into new domains of care. Little wonder then that claims of protectionism are now levelled against optometry.
One thing evident is that the GOC seems minded to continue with the status quo and protect that refraction. Many will say that is only sensible because, if refraction were deregulated or opened out, people would suffer massively, and we would see a dangerous increase in undiagnosed eye disease. But is such a claim justified? What evidence is there that such a move would bring about such dire consequences? Every time in the past when we were stripped of monopolistic functions, we made similar claims. When dispensing was opened up, we said the same. When contact lens solutions sales were opened up, we said the same. When contact lens supply was opened up, we said the same. But in none of these scenarios have the apocalyptic forecasts occurred.
Of course, there will always be those who cite the occasional case, but these are not typical. The same claims were made by the World Council of Optometry (WCO) when British Columbia sought to deregulate refraction, but since that event has there been a mass increase in blindness in that Canadian province? Far from it.
In fact, as a result, more people came forward to check their vision, so more eye defects were diagnosed. Ask yourself what percentage of the world actually wears spectacles derived from an autorefracted test or carried out by a non-optometrist? I suspect that percentage is way higher than 50%. In those countries where this happens, is undiagnosed eye disease rife?
The recent Vision Express study is just the latest in a series of studies showing how a large percentage of our population do not get regular eye examinations, or even get any examination at all. In this latest study, 22% were postponing their eye examination because of the cost and 18% would not even consider having a test because of the cost. Put simply, it is the absence of any eye care at all that leads to undiagnosed eye disease.
Some intervention, be it a refraction-only process, at least gives the opportunity to signpost the need for a fuller examination. If even that interaction is absent, then there can be no opportunity at all to intervene. The Canadian experience shows that interaction is beneficial. Has the WCO prediction been borne out? No, it has not.
A long while back, I asked the WCO for the evidence to support the assertion that deregulating refraction would lead to undiagnosed eye disease increasing. I got no reply. On numerous occasions, when I have asked others who assert this what evidence they base the assertion on, they can provide none. There simply is no evidence that deregulation would lead to an increase in eye disease and, indeed, the contrary may well seem to be true.
In seeking to protect the role of refraction it must be remembered that the GOC does not primarily have a role to promote the reasons for eye healthcare. Its role is to protect those that attend for eye care. So, it does not matter to the GOC if millions of people do not have regular eye healthcare checks. Certainly, its policy of regulating refraction would seem to drive many away from seeking that care but that is not their primary concern. Their role is to protect them if they do attend.
Until concrete evidence can be provided that deregulating the task of refraction would be detrimental to the public, accusations of protectionism will be increasingly thrown at us. If you support keeping refraction regulated and held within a full examination, could you supply the evidence for doing this if your patient requested it or could you be liable to the claim that you are merely protecting your income? I think interesting times lie ahead.