Actus writes: Where’s the evidence for evidence-based practice?
As an eye care practitioner, I am often glad my chosen profession has prepared me for getting on with just about anybody. So you are clear, most strangers think opticians are rip-off merchants if they wear spectacles or contact lenses, and those that don’t have never given the services of optometrists a second thought.
So there you have it, undeniable evidence that opticians charge too much for the optical appliances they sell, and their healthcare role is completely unrecognised.
The opinions of a few people are unlikely to be statistically significant, but that doesn’t necessarily make them wrong, and it appears recent research backs them up. Back in the day job it was a bit quiet and the esteem in which opticians are held was a topic of conversation with a colleague who is doing the new Canterbury Christ Church University top up degree for FBDOs to get a BSc (Hons).
The module at the time was evidence based practice and the paper being reviewed was ‘A comparison of spectacles purchased online and in UK optometry practice’ by Alderson et al. This paper shows that significant numbers of spectacles supplied in the UK do not conform to BS/EN/ISO 21987: 2009 and disappointingly there is no significant difference in this regard between online retailers and optical practices. Online spectacles are three times more likely not to be fit for purpose in the opinion of the patient, however, the largest causes are unsurprisingly frame fit and optical centration.
What is the point of research if it proves the obvious? We know some opticians don’t check their spectacles, trusting the lab to have got them right, and we know labs try to get away with errors whether they’re supplying a practice or owned by an online retailer.
We know that glasses ordered online to average measurements and without the frame being tried on for size are likely to be unacceptable to the patient, and even unsafe, but now the GOC has the evidence what is it going to do about it? It has forced evidence based practice on registrants yet appears not to take notice of this research itself – why is internet supply of high powered lenses and varifocals even allowed?
Standard of practice requires that registered opticians keep their knowledge and skills up to date and ‘be aware of current good practice, taking into account relevant developments in clinical research, and apply this to the care you provide’.
Student optometrists and qualified College members receive Optometry in Practice and Ophthalmic & Physiological Optics, and in common with those student dispensing opticians on university degree programmes have access to electronic academic library facilities such as Open Athens making research straightforward.
Yet some optometrists and almost all dispensing opticians do not have access to such a facility making checking advertising claims or the references in their CET difficult as they will often only be able to view papers if they pay swingeing fees. The same goes for British Standards and Case Law, even GOC cases.
Lack of affordable access to research is only part of the problem. A reliance on open access documents available through Google Scholar or PubMed potentially only gives half the story, so what use is that? The brewer Arthur Guinness once said ‘half the money I spend on advertising is wasted, the trouble is I don’t know which half!’ The same may be true of research since much of it is not reliable in its assertions. This makes reliance on abstracts, and a minority of free papers even more perilous, if one is changing tried and tested modes of practice on the basis of one’s reading.
Which brings us to an even more fundamental point. One of the results of the paper above states: ‘practice PALs (median ranking 2nd, IQR 1-4) were particularly preferred (online 6.5th, IQR 4-9, Mann-Whitney U = 455, p<0.001)’. How many registrants understand what this means? Remember this is a paper about selling glasses online, not neuro-ophthalmology or behavioural optometry, and its interpretation is difficult, yet the problem gets even worse. Much research really is wrong.
If you’ve bought an Elsevier text such as Kanski recently you might subscribe to their regular ophthalmology updates. Recently highlighted was Li and Dickersin’s June 2013 ‘Citation of Previous Meta-analyses on the Same Topic. A Clue to Perpetuation of Incorrect Methods?’ which shows that glaucoma papers using incorrect statistical methods (nine out of 21) are 2.6 times more likely to be cited than those using the appropriate statistical analysis. One wonders which papers NICE have relied on.