Seán McCrave: Irish eye services need to change to meet demand
Association of Optometrists Ireland (AOI) CEO Seán McCrave says the role of optometrists in Ireland needs to be significantly expanded to overcome serious eye care capacity problems
Author: Seán McCrave
The Association of Optometrists Ireland (AOI) welcomes an insightful article published in Optician titled, ‘The grass is rarely greener, and certainly not in Ireland’ (Visus 25.08.17).
The article sets out how the Irish Health Service Executive (HSE) published the Primary Care Eye Services Review Group Report this summer and described it as a missed opportunity in terms of improving the Irish eye care system.
While AOI contributed to the HSE led report, the Optician article correctly stated that no Irish optometrist was invited onto the review group committee and that the report gave ‘limited recognition of the aspiration of Irish optometry and no mention of any extension in scope of practise into diagnosis and treatment’.
AOI overall agrees with the conclusions set out in the article and welcomes the debate and response which it has stimulated.
AOI has been, and will continue to, highlight how a greater role for optometry is a cornerstone in how public eye care needs to develop in Ireland.
AOI welcomed the report when it was published at the end of June as it did identify inadequacies including: outdated work methodologies, understaffing, inappropriate use of qualified eye care professionals and poor pathways between service providers.
It also estimated that 60% of existing outpatient activity could be moved to the community.
However, Ireland faces a major crisis with regard to access to public eye care – and AOI believes the solution lies in an enhanced role for optometrists which is much greater than the scope set out in the report.
Eye care has the biggest waiting list of any medical speciality in the country. Almost 12,500 people were waiting for eye procedures at the end of August. A further 38,000 were on outpatient lists, waiting to receive appointments, up from 32,000 at the end of 2016 – an almost 20% increase in just eight months.
Crisis-level delays in eye care are compromising health – and services urgently need fundamental change.
The Review Group Report recommends setting up new regional eye care centres, with some involvement of optometrists. However, there is already a skills and equipment infrastructure in situ of 600 qualified optometrists in 300 locations to meet many of the demands of public eye care.
Reform is needed which would see public examinations, treatment, monitoring and follow up provided in the community through an increased role for optometry, and specialist or complex cases referred to hospital eye departments which are unburdened of lengthy waiting lists.
Over-dependence on a hospital eye departments cannot and will not meet ever-growing patient demand. In the UK and across Europe there has been an increasing move towards community based eye care – and that is clearly the way Ireland needs to go.
AOI estimates that greater use of optometry could save €32m while delivering a better and quicker service. This is because it is 50% less expensive to treat via the local optometrist than in the hospital system. Also, early detection rates would be improved.
There are three identifiable areas where optometrists can immediately reduce waiting times: children’s eye care, cataracts and review of stable patients post-treatment, particularly those with glaucoma and AMD.
AOI estimates annual savings can be made in children’s eye care of €7.2m, glaucoma €19.3m, triage €3.9m and red eye €1.9m. An optometrist examination costs an average of €45, while an outpatient department or community clinic appointment is estimated to cost double this and also involves high levels of non-attendance, plus patient costs (travel and parking).
It is frustrating to continuously hear about the growing numbers on Ireland’s eye care waiting lists, and the patient risks this brings, while optometrists are in a position to immediately make significant inroads into solving the problem.
There are certainly many welcome plans and recommendations in the HSE report. However, it needs to go further on the role and contribution which optometrists can make.
The Irish Health Service Executive could solve Ireland’s problem quickly by reviewing optometrists’ contracts and sanctioning them to provide increased public care.
It is estimated there are 225,000 people with low vision and sight loss and approximately 13,000 blind people in Ireland today. These numbers will continue to increase in the coming years as the population grows and ages.
AOI is calling for discussions with the HSE to begin immediately.