Regulation would allow Canadian opticians to refract, upgrade prescription lenses

Issue: March 2006

ByJennifer Byrne

Proposed regulations that would allow opticians in British Columbia to perform sight tests and prescribe lenses have sparked a call to action by the Canadian Association of Optometrists (CAO).

“This proposal is a radical departure from accepted eye care standards and is not in the public interest,” said Dorrie Morrow, OD, president of the CAO, in a press release. “The government appears to be appeasing the economic interests of a small group of opticians and is proceeding with the change, contrary to the advice from medicine, optometry and others in the eye care sector.”

According to Mary Field, chief administrative officer of the Opticians Association of Canada (OAC), sight testing by opticians is part of an ongoing evolution and can be beneficial to patients.

“It is natural that all professions undergo growth and change as new technology and educational opportunities evolve and improve,” Mrs. Field told Primary Care Optometry News. “Automated sight testing systems have provided such potential for growth. The government of British Columbia has recognized the benefit to consumers of automated sight testing as performed by opticians.”

Details of the proposal

The proposed regulation was originally introduced in 2004 by the Hon. Colin Hansen, British Columbia Minister of Health. The regulation would allow opticians to refract using automated sight-testing equipment.

“Simply put, eye examinations should not be performed without an assessment of eye health, which results in the timely diagnosis of eye disease and ocular complications related to systemic disease,” Dr. Morrow said. “The evidence is undisputed.”

Mrs. Field argued that in keeping with the College of Opticians of British Columbia’s (COBC’s) Standards of Practice and Limitations, automated sight testing services can be safely performed by opticians who have been specifically trained in sight testing protocols and pre-screen tests.

“These pre-checks are designed to eliminate as candidates those individuals who would be better served by an eye examination,” she said. “Optician-performed automated sight testing is a safe, cost-effective and convenient method of providing citizens with correction upgrades to their prescriptions. It is also an excellent point of focus to educate consumers in general about the necessity for periodic eye health examinations.”

Mrs. Field said the COBC document “Seeing Clearly” is very explicit in defining the conditions under which a candidate for automated sight testing can be accepted.

“For example, the document defines the amount of change in correction that can be authorized by an automated sight testing optician within a specified period of time,” she said. “It also details the conditions under which a candidate for automated sight testing must be referred for an eye health examination.”

The new regulation would allow opticians to incorporate corrective changes to spectacles only, Mrs. Field said.

Currently, Canadian health regulations specify that a qualified doctor must be accountable for all optical prescriptions, according to the CAO release. This thinking is based on the concept that a full eye examination is the only way to test for possible conditions such as cataracts, glaucoma or detached retinas.

The CAO is calling for “an urgent national dialogue” on the proposed regulations in hopes of putting them on hold.

The AOA’s stance

The American Optometric Association (AOA) has spoken out in defense of its Canadian optometric colleagues. According to AOA President Richard L. Wallingford, OD, the proposal is “concerning” and would lead to substandard care.

“There are so many eye diseases that show up in a routine eye exam that opticians would not be able to detect or even be aware of,” Dr. Wallingford told Primary Care Optometry News in an interview. “Some of the studies I’ve read cite that one in every seven patients who come in for a routine examination end up having an eye disease.”

Dr. Wallingford said the real danger lies in the possibility that a patient who receives a sight test from an optician could falsely believe that he or she has been given a comprehensive eye exam.

“The public will perceive that they have received eye exams,” he said. “And even if the patient is astute enough to recognize that it wasn’t an eye exam, this will be an excuse for him or her to put off getting an eye exam.”

Dr. Wallingford said the AOA has sent a letter to the government of British Columbia expressing the AOA’s opposition to the legislation. He expressed concern over the sort of precedent this might set for optometry in America. “This could allow opticians in some states in the United States to see this as an example,” he said. “We don’t want to see this establish a bad precedent.”

Mrs. Field said she hopes opposition to the regulation will give way to a constructive dialogue among the groups. “Unfortunately, the groups representing optometrists have chosen to be obstructionist,” she said. “The Opticians Association of Canada supports the government of British Columbia in its belief that the appropriate measures have been taken by opticians and, in particular, by the College of Opticians of British Columbia to provide a positive outcome for the citizens of British Columbia.”

Ms. Field said the government continues to affirm its intention to move forward with the regulation.

For more information:

Dorrie Morrow, OD, is president of the Canadian Association of Optometrists and can be reached at 234 Argyle Ave., Ottawa, ON K2P 1B9; (888) 263-4676; fax: (613) 235-2025; e-mail: info@opto.ca; Web site: www.opto.ca.

Mary Field is chief administrative officer of the Opticians Association of Canada. She can be reached at 2706-83 Garry St., Winnipeg, Manitoba R3C 4J9; (800) 847-3155; e-mail: canada@opticians.ca.

Richard L. Wallingford, OD, is president of the American Optometric Association. He can be reached at 243 N. Lindbergh Blvd.,1st Floor, St. Louis, MO 63141; (800) 365-2219; fax: (314) 991-4101.