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WCO: Refraction should not be offered as stand-alone service

Issue: December 2012

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The World Council of Optometry recently released a position paper against “sight testing,” stating that ocular disease and abnormalities can be detected only through a comprehensive eye exam and agreeing with the stance of the Canadian Association of Optometrists and the College of Optometrists in the U.K.

Refraction, or sight tests, should not be offered as a stand-alone treatment, even in areas where there are high levels of sight loss through refractive error, according to the organizations.

“Patients who have a ‘refraction only’ service may assume their eyes have been examined to see if they are healthy,” according to the World Council of Optometry (WCO) paper, issued in October. “A comprehensive eye examination also includes an assessment of how both eyes work together and a full eye health assessment, as well as refraction.”

Refraction is a limited eye exam performed by an optician that does not have the required education or clinical experience to diagnose ocular conditions, according to the Canadian Association of Optometrists (CAO). The CAO promotes the need for comprehensive eye health care and argues that sight tests are lowering the professional standards of care.

The College of Optometrists in the U.K. released a similar statement against refractive-only screenings in February 2012.

“The college believes that the legislative requirement for the optometrist or doctor who conducts the sight test also to carry out examinations for the purpose of detecting injury, disease or abnormality is essential for public health,” the authors wrote.

A sight test will not be able to detect disorders in the brain relating to the visual system, glaucoma, high blood pressure, cataracts, retinal detachments or diabetes, the college said.

The American Optometric Association spoke out against sight testing when legislation was passed in British Columbia for opticians to independently conduct automated refractions for healthy patients.

“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,” Richard L. Wallingford, OD, then-president of the AOA, said in Primary Care Optometry News (“Regulation would allow Canadian opticians to refract, upgrade prescription lenses,” March 2006, page 4).

A thorough ocular-visual, medical and family history are important components of an eye examination, according to the Canadian Optometric Regulatory Authorities (CORA). CORA’s concern is not about whom the individual may be that performs the stand-alone refraction, but the consequences of permitting an individual to perform the test at all.

The WCO wants the optometric workforce to be developed globally, and for ophthalmology resources to be used in areas where medical intervention is necessary. – by Cheryl DiPietro