Proposed regulation in Canada would allow opticians to refract

Issue: August 2004

ByJennifer Byrne

Practice Scope: Legislation Affecting the Practice of Optometry [logo] A pending provincial regulation in British Columbia that would permit opticians to perform automated refraction has elicited strong objections from the optometric community, both in Canada and the United States.

“It would be folly for us as an organization to support any legislation that would be harmful to the public,” said Sherry Cooper, manager, state government relations for the American Optometric Association. “This is way at the top of the list of things that would be dangerous to the public. This is bad public policy.”

According to Mary Field, chief administrative officer of national affairs for the Optician’s Association of Canada (OAC), the regulation would be carefully monitored and restricted in the interest of patient health.

“The standards and guidelines will very specifically outline who is eligible for an optician-performed sight test,” Ms. Field told Primary Care Optometry News. “We believe this will be a very safe procedure.”

Automated sight testing

The Minister of Health of British Columbia announced the new regulation regarding refraction (sight testing) on March 30, 2004. The regulation would allow opticians to refract patients using automated sight-testing equipment. The customary 90-day consultation period was extended.

“The consultation period was for the purpose of having stakeholders comment on the regulation, and it was also for the purpose of allowing the College of Opticians in British Columbia the opportunity to present the specifics that would surround the regulation,” she said.

The Minister of Health has called together a group consisting of ophthalmologists, optometrists and opticians to meet through a “facilitated review forum” to discuss the legislation.

Optometrists claim that this type of testing might lead patients to erroneously believe they have undergone a full eye examination.

“Our position has always been that you should not separate a refraction from a health assessment,” said Scott Mundle, OD, president of the Canadian Association of Optometrists. “Our position isn’t to discuss whether the procedure of refraction is or isn’t safe. Our concern is that this is misrepresentative to the public.”

In an interview with Primary Care Optometry News, Dr. Mundle said the primary danger of this automated testing is that it might allow serious eye diseases to remain undetected. “The fact is, you will have people with undetected pathologies,” he said, “because a significant amount of asymptomatic pathology is missed.”

Ms. Cooper maintained that even the most intelligent and savvy patient could confuse a refraction with an eye exam. “When a patient sits in front of a machine and it gives a reading, they are going to think they just had an eye exam,” she told Primary Care Optometry News. “And, of course, patients are not going to walk into your office and say, ‘I may have undetected pathologies.’”

Standards and guidelines

Ms. Field said the minister of health has specifically emphasized the need for patients to be fully aware of the distinction between a refraction and a comprehensive eye exam.

“That is one of the most critical issues that the minister was concerned about,” she said. “He has indicated that opticians need to take a specific strategy to inform consumers prior to undergoing a sight test that there is a difference between a refraction and an eye exam.”

Ms. Field said the College of Opticians in British Columbia has developed standards and guidelines to ensure that the sight tests would be conducted responsibly. “So it has been undertaken to make certain that when this test takes place, it takes place within a context and with restrictions.”

Ms. Field added that not every patient will be permitted to undergo automated sight testing by an optician. Those who fall into higher-risk categories – such as the elderly – may be advised to see an OD or MD.

“If you look at the Canadian National Institute for the Blind Web site, it tells you that there are two or three prominent diseases that cause blindness, and they are all related to age,” she said. “That is one category that is easily identified. Other categories would also lead the optician to refer the patient instead to an optometrist or ophthalmologist.”

Beneficial or harmful?

According to an OAC press release, most opticians in British Columbia do not charge for the sight testing, making it an affordable option for consumers.

“We believe this change will benefit consumers and the health care system by providing a safe and affordable option for individuals looking to change their prescription lenses,” said Don Smith, OAC president, in the press release. “At the same time, the association is committed to providing ongoing public education to help consumers understand how opticians can assist them in meeting their eye care needs, particularly as it relates to sight testing equipment.”

According to Dr. Mundle, however, automated testing by opticians could potentially lower ophthalmic and optometric standard of care.

“Optometry has always been held to the same standard as medicine. We have always had to prove that we are able to offer the same care that [ophthalmologists] offer,” he said. “This sets up a different standard of care. This lowers the standard of care for eye care by saying that now you don’t need to have a health assessment.”

Dr. Mundle said the CAO has launched a coordinated effort with the British Columbia Association of Optometrists. “Our goal is to educate the minister of health services about this issue,” he said. “I personally think he has been misled to think this is a simple turf battle and he doesn’t understand that it is a serious health concern.”

For Your Information:

Sherry Cooper can be reached at the AOA, 243 North Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100; fax: (314) 991-4101.

Mary Field can be reached at Opticians Association of Canada, 2706-83 Garry Street, Winnipeg, Manitoba, Canada, R3C 4J9; (800) 847-3155 or (204) 982-6060; fax: (204) 947-2519.

Scott Mundle, OD, can be reached at 234 Argyle Ave., Ottawa, Ontario, Canada, K2P 1B9; (888) 263-4676; fax: (613) 235-2025.