Simon Jones: Letting go of refraction
The thorny topic of separating refraction from ocular health in the eye exam arises again
Author: Simon Jones
The General Optical Council’s call for evidence on potential reform of the Opticians Act 1989 has once again raised the thorny topic of separating refraction from the ocular health aspect of the eye exam, possibly even making refraction a delegated function in the same way that pre-exam imaging is carried out.
This would represent a seismic change in the way practices operate and while many dispensing opticians may be excited by the prospect of upskilling to perform refractions, I think advances in technology has pretty much put paid to that.
At 100% Optical recently, I tried Topcon’s Chronos device, which offers binocular autorefraction and a subjective assessment of visual acuity. Having recently had an ‘old school’ refraction and with the Rx still etched in my memory because of the first correction of presbyopia, I thought it would be a good time to test its accuracy. With just 0.25D difference to my spectacle prescription, I’d say the accuracy was pretty good.
Autorefractors have existed for decades, but we are moving into an era where accuracy and repeatability will almost be beyond reproach. If the Act was amended to allow a scenario where dispensing opticians were permitted to refract, the pace at which new technology would be adopted could make new regulation out of date before any ink had dried and it could take another 30 years before there’s another amendment.
Ten years ago, when such a call for evidence should really have been made, changes like delegated refraction may have worked, with dispensing opticians undertaking additional training and performing refractions, and optometrists upskilling with independent prescriber qualifications, and could have been quite harmonious.
As it stands, the sector is at the mercy of technology and business. Even the GOC says the call for evidence is about informing the development of any business case for future changes to the Act. The consultation closes on July 18, 2022.