First World Congress on Optometric Globalization addresses state of vision care worldwide

Issue: August 2004

ByNancy Hemphill, ELS, FAAO

ORLANDO, Fla. — Here at the first World Congress on Optometric Globalization (WCOG) in June, a representative from the World Health Organization announced that the WHO admitted the World Council of Optometry into “official relations” with the group.

Representatives from optometric organizations around the world gathered at the WCOG to address the changing state of vision care and trade agreements. As part of the closing session, Serge Resnikoff, MD, PhD, director of the WHO’s Prevention of Blindness and Deafness programs, Geneva, announced that in recognition of the WCO’s role in global public health, the WHO officially admitted the WCO into relations with the organization. The announcement led to a standing ovation from all of the approximately 150 attendees in the room from around the world. The WCO joins 188 other organizations that have official relationships with the WHO.

Dr. Resnikoff also shared statistics on worldwide blindness and vision care. “Eighty percent of blindness is avoidable either through treatment or prevention,” he said. “This is the good news. The bad news is that good quality eye care is not always available. But more importantly, good quality of care is not always accessible even where the services are existing.” He added that 75% of eye care services are concentrated in major cities.

Governmental support for blindness prevention is declining, Dr. Resnikoff said. “In turn, blindness and visual impairment will continue to increase unless we do something more aggressively,” he said. “The WHO and International Agency for the Prevention of Blindness got together to set up the Global Initiative for Prevention of Blindness by 2020, whose goal is to reverse the trend and treat avoidable blindness.”

Trade, licensure mobility

In the opening session of the WCOG, Damien P. Smith, AM, MScOptom, PhD, FAAO, president of the World Council of Optometry, welcomed presenters who discussed the role of the World Trade Organization in the globalization of trade in services; licensure mobility in Australia, New Zealand, the United States and the European Union; and development of a competency-based model for the scope of practice in optometry.

According to Dale B. Honeck, counselor for the World Trade Organization, Geneva, under the General Agreement on Trade Services (GATS) commitments on professional services, optometry is found under “medical and dental services,” but there is no specific reference to optometrist or optometry in any of the GATS schedules or the agreement. The WTO is consulting with the WCO on the potential applicability of the accountancy disciplines to optometry.

Jane Duffy, of Victoria, Australia, executive officer of the Optometry Council of Australia and New Zealand, stated that the Trans-Tasman Mutual Recognition Agreement allows for recognition of New Zealand optometrists in Australia and vice versa. While the boards in Australia withdrew recognition of all foreign optometry qualifications, New Zealand still recognizes those of the United Kingdom.

Richard Carswell, secretary general of the European Council of Optometry and Optics (ECOO), London, recognized that the 25 European Union member states all have different competencies for optometry. Ophthalmologists are included under “sectoral directives,” and optometrists and opticians are included under “general system,” he said. While ophthalmologists have the automatic right to recognition in another state of the European Union, optometrists have conditional, but not automatic, right of recognition. The ECOO proposal for a new directive on the recognition of professional qualifications has not been accepted yet, but it will probably form the groundwork for facilitating the mobility of professionals in Europe, Mr. Carswell said.

Steven H. Eyler, OD, FAAO, past president of the Association of Regulatory Boards of Optometry and a board liaison for ARBO’s Council on Endorsed Licensure Mobility for Optometrists, Charlotte, N.C., reviewed the progress U.S. optometrists have made in clinical care privileges, pointing out that only 11 states accept licensure by endorsement. “We’ve come a long way, but we owe it to our young ODs to allow them to move around,” he said. “Not only are they bright, but so are their spouses.”

Jeffrey L. Weaver, OD, MBA [photo] Serge Resnikoff, MD, PhD [photo]
World Congress on Optometric Globalization: Jeffrey L. Weaver, OD, MBA, MS, (left) explains the AOA's clinical guidelines process. Serge Resnikoff, MD, PhD, (center) welcomes the WCO into official relations with the World Health Organization. Damien P. Smith, AM, MScOptom, PhD, FAAO, closes the conference, stating the goals for the next WCOG meeting.

Dr. Eyler emphasized how the armed forces also need this, and the American Optometric Association has passed resolutions in support of endorsement. WCO and ARBO have also formed the International Advisory Group on Optometric Competencies to develop an internationally acceptable competency-based model of optometry to allow objective comparisons of the optometric scope of practice between states that would ensure public safety and allow mobility, said Norman Wallis, PhD, OD, DSc, FCOptom, FAAO, of the National Board of Examiners in Optometry, Bethesda, Md. In an effort not to reinvent the wheel, the advisory group recommended using Australian competency statements and systems, Dr. Wallis told attendees. What resulted was a model that allows states to locate their current scope of practice in a two-dimensional matrix.

According to George Woo, dean and faculty member, Health and Social Sciences, Hong Kong Polytechnic University, and a member of the World Council of Optometry Education Committee, the development of optometric education in China has been slow relative to medical education. He pointed out that while the development of optometry in Hong Kong is very different than in China and Taiwan, the role of optometrists should be the same.

The European Council of Optometry and Optics established the European Diploma in Optometry to determine a performance and competence level, said Kjell Inge Daae, professor in the department of optometry, Buskerud College University, Kongsberg, Norway. However, because Europe represents diverse cultures and languages, it is necessary to establish a decentralized accreditation system for schools. Further diversification must be avoided as a result of these efforts, Dr. Daae said, instead, concentrating on the Bologna Declaration, which says: “It is a commitment freely taken by each signatory country to reform its own higher education system in order to create overall convergence at the European level.” He said it is likely that an accreditation body will be proposed as part of ECOO.

Any optometrist seeking licensure in Canada must pass the Canadian Standard Assessment in Optometry (CSAO), according to J. Martin McDowell, executive director of the Canadian Examiners in Optometry, Ontario. He said the Canadian Examiners in Optometry is responsible for setting these exams, which were designed from statements that articulate the competencies necessary for optometric practice. Mr. McDowell said the CSAO is distinguished from exit examinations of professional educational institutions or examinations based on curriculum.

Setsuya Tsuda, president of All Japan Optometric and Optical Association (AJOOA), Tokyo, said that the AJOOA has adopted a private-sector, self-certification system that depends on each person’s amount of education and training to use as a first step toward a national licensing system. The AJOOA also seeks to establish an official licensing system by upgrading and continuing optometric education, obtaining consumers’ support for the system and obtaining cooperation from international optometric organizations.

Globalization affects ANSI standards

Lane Hallenbeck, vice president of conformity assessment for the American National Standards Institute (ANSI), Washington, described the role of the ANSI as a member of the International Organization for Standardization (ISO). He said that the activities of standards committees relevant to the World Council of Optometry are being influenced by globalization, deregulation and convergence of technology.

After establishing basic standards for optical and geometrical properties, the Spectacle Lens Group of the ISO is focusing on the characteristics of lens coatings, said Werner Koeppen, director of quality and norms for Essilor International and convener of the ISO Spectacle Lens Group. Another priority is frame requirements and tests to ensure physiological compatibility.

AOA clinical practice guidelines

The American Optometric Association’s Jeffrey L. Weaver, OD, MBA, MS, director of the Clinical Care Group, focused on the implications of internationalization of optometric clinical practice guidelines. The AOA now has 20 guidelines available. They are reviewed on a regular basis to keep them current. Dr. Weaver said the key to the effectiveness of these guidelines is an evidence-based approach.

Such guidelines can establish optometry in the national arena of health care reform and managed care as well as offering implied standards of care, Dr. Weaver said. Clinical practice guidelines are beginning to proliferate internationally, he said. The Conference on Guidelines Standardization identified eight requirements for such guidelines: validity, reliability, clinical application, flexibility, clarity, documentation, development by multidisciplinary participants and plans for review.

Telehealth becoming mainstream

Jorge Cuadros, OD, PhD, an assistant clinical professor at the University of California, Berkeley Optometric Eye Center and Informatics consultant, told attendees that telehealth will soon become a regular part of health care. Geographical location is no longer important with distance education; online continuing medical education is growing.

Corporate entities also participated in the conference by discussing the effects of globalization on the ophthalmic industry. Representatives from Transitions Optical, Vistakon, Essilor, Carl Zeiss Meditec and Alcon addressed global trends in the contact lens, spectacle lens, ophthalmic instrument and pharmaceutical market sectors.

WCO president Dr. Smith closed the 3-day conference by pointing out that the WCO relationship with WHO places optometry within worldwide eye care. He added that some of the speakers at the conference had never before lectured to a group of optometrists.

“At our next meeting, we will narrow down the topics we need to deal with so we can address them in more detail,” he said. “What pleases me is that the WCO has recognized the need for this meeting. Whatever the outcomes globalization has for us as a health care profession, we can only measure them according to how they bring accessible and affordable eye care to the whole world.”