There seems to be a pride in the assumption that the UK suffers less from organised antipathy between the professions of optometry and ophthalmology found elsewhere, the US and Australia in particular. For example we have no restriction on ophthalmologists lecturing to optometry meetings as in the US and we rarely find ourselves competing on the same primary care ground as Australian optometry.
The big question could be; are we in fact echoes of the famous John Cleese, Ronnie Barker and Ronnie Corbett television sketch on social class – ‘I know my place’ and maybe this has held UK optometry back? Surely not all consensus is always positive for both parties and out of conflicting opinion can come advancement in the public interest?
An interesting perspective recently arose with the simultaneous announcement that the Optometrist Board of Australia (OBA) and the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) had reached an out of court settlement. This was preceding a planned judicial review in the Supreme Court of Queensland on scope of practice in glaucoma.
In 2013 RANZCO challenged new OBA guidance on the use of scheduled medicines, stating the right for suitably qualified optometrists to diagnose and treat glaucoma independently. As is usual in these cases, both sides represented the outcome as a victory for what appears to be the status quo ante and in fact a situation that is close to, but clearly not the same as, that which pertains here. Essentially the outcome is that a therapeutically trained optometrist (no specific additional glaucoma qualifications) can make the diagnosis and initiate treatment for glaucoma, but that the optometrist must refer to an ophthalmologist for confirmation and development of a treatment plan within four months. A situation specifically denied to UK optometrists under NICE.
It is necessary to understand the situation pertaining in Australia. While primary care optometry is very similar, ophthalmology is by and large, not a hospital-based speciality. In fact in the large towns optometrists and ophthalmologists co-exist in the same suburb. It is quite a different thing in the country where the populations are sparse and access is difficult. I am sure that this is why RANZCO did not fight the principle of optometric initial diagnosis and subsequent co-management. In fact, I wonder if, with negotiations on glaucoma co-management stalled, the 2013 OBA declaration was provocative and intended to flush ophthalmology to the negotiating table in the public interest?