A worldwide panorama of optometry unveils an evolving montage of legislation, education, practice management, service delivery and public health initiatives that defines the profession, given the unique circumstances of every country. While some professional developments parallel those within the United States, others diverge, because of context, policy processes and stakeholders involved in eye and vision care. The dynamics are growing even more complex as globalization affects the accessibility, mobility, regulation and education of optometrists within a merging marketplace.
This article provides a snapshot of the status of optometry in select countries. Comparisons are often equated with the World Council of Optometrys (WCO) Global Competency-Based Model of Scope of Practice in Optometry to reconcile the disparities in definitions and scope of practice around the world. (See A Global Model for Optometry, below.)
Asia and Oceania
In Japan, for example, optometry is restricted to refraction, with no official recognition by the Ministry of Health or Ministry of Education. In response, the All Japan Optometric and Optical Association developed a certification program with 8,260 participants to self-regulate quality assurance and educational competencies. After April 2010, no practitioners will be able to register without possessing the educational background stipulated by the association. This professional development strategy should position optometrists in Japan for future growth.
Optometrist Akio Kanai of Japan volunteers his services to refugees in the Caucasus region.
In New Zealand, practitioners earn a Bachelors degree in optometry after five years of study. Credentialed optometrists may prescribe the full range of topical eye medicationsexcluding glaucoma medicines. In 2000, a post-graduate certificate in ocular therapeutics was introduced in Victoria.1 New Zealand and Australia have a mutual recognition agreement in which optometrists who are registered in one country may practice in the other, provided they comply with all jurisdictional statutes. Both countries permit practice in category 4 of the WCOs Global Model.
|A Ghanaian optometrist volunteers her services to a local patient.|
Innovation is paramount to the delivery of eye and vision care in developing nations throughout Africa, where 10% of the worlds population resides and 19% of the worlds blindness exists.2 Insufficient and poorly distributed personnel, variable qualification levels, limited career paths and fragile health care infrastructures significantly impair eye and vision care. Until recently, just six of 57 countries trained optometrists or refractive personnel at varying competency levels.
Three educational institutions accredited by the National Universities Commission offer optometry programs in Nigeria. Admission requirements include a West African School Certificate and passing the Joint Admissions Matriculation Board exams with credits in physics, chemistry, biology and English. The exams goal, similar to that of the Optometry Admission Test in the U.S., is to measure academic ability and comprehension of scientific material.
According to Nigerian Optometric Association President Uduak Udom, optometrists are permitted to perform comprehensive eye examinations, correction of refractive error, orthoptics, low vision, ocular first aid and treatment of minor eye diseases that do not pose a threat to the integrity of the visual system.3 This places Nigerian optometrists at the threshold of category 4: prescribing therapeutic agents. While the new National Health Insurance Scheme does not provide for optometric services in the three-year trial period, indications are that optometry will be included in the future. In the meantime, patients pay out-of-pocket.
South Africa has 2,500 registered and regulated optometrists who are currently practicing ocular diagnostic services (category 3) for a population of 47.9 million. But, the expansion of optometrys scope of practice into ocular therapeutic services (category 4) is under consideration, with plans for curriculum development and outcome assessments. Four academic institutions offer a four-year Bachelors degree in optometry.
In South Africa, private insurance reimbursement is the most common form of paymentbut only 16% of the population has coverage. Group practices, independent practices and franchises comprise the three basic private practice models. Just 5% of optometrists are employed within the public sector. The South African Optometric Association is facilitating the delivery of accessible and affordable eye care in economically compromised communities.4 For example, it has formed the Bonang Eye Care Centres, a company with strategically placed clinics throughout the country.
Pilot projects in Malawi and Mozambique now train mid-level and professional optometric personnel via a multiple entry/exit approach.5 Graduates from the two-year program may provide preventive eye care services, basic refraction, dispensing services and pathology screening in the public sector. Select graduates will complete two additional years of education to earn a Bachelors degree in optometry and work in either the public or private sector. Ultimately, success depends upon government recognition of the profession, multilateral collaboration and regulatory measures. Longevity and sustainability will require accessible eye care service centers that are strategically located in hospitals or clinics providing primary care.
A Global Model for Optometry
In 2005, the World Council of Optometry (WCO) adopted the Global Competency-Based Model of Scope of Practice in Optometry, which provides a rational framework for addressing the challenges of professional harmonization.
This historic document may stimulate greater uniformity when applied to teaching syllabi and statutory definitions of the scope of practice. It may also help regulatory bodies assure practitioner competency when faced with the migration of optometrists across national borders.
The model includes four categories of clinical care:
1. Optical technology services. Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system.
2. Visual function services. Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system.
3. Ocular diagnostic services. Investigation, examination and evaluation of the eye and adnexa, and associated systemic factors to detect, diagnose and manage disease.
4. Ocular therapeutic services. Use of pharmaceutical agents and other procedures to manage ocular conditions/disease.
The model reconciles variations in the scope of practiceto be defined as an optometrist, a practitioner must provide the services in both categories 1 and 2 at a minimum. This has become the entry-level threshold for the practice of optometry worldwide. In addition, it complements the unifying principle that optometrists strive to provide their patients with quality, cost-effective eye and vision care.
Israel has nearly 700 registered optometrists serving a population of 7.2 million. A 1991 law includes a clause that forbids optometrists from examining children and the elderlyalthough it does not specify the age range of either group.
But, in 1995, the Israeli government approved the conversion of optometry to an academic profession and changed this restriction. Now, optometrists may serve as the primary point of access for all age rangesbut they must recommend that children under the age of six and adults 60 years and older also seek a medical eye exam from an ophthalmologist. This is based upon consensus among representatives from the Ministry of Health, ophthalmology and optometry. An official amendment will soon be presented before Parliament.
Two Israeli schools of optometry offer four-year academic degrees that permit graduates to provide visual function services (category 2). The Israel Council of Optometrists is currently seeking diagnostic privileges for qualified optometrists, advancing them to category 3 of the Global Model.
The United Kingdom (U.K.), on the other hand, recently passed a statute granting optometrists independent prescribing privilegesmoving them from diagnostic to therapeutic practice (category 4). Until now, optometrists could carry out some additional roles in supplying and administering medicines or prescribing them in partnership with a doctor Independent prescribing will mean that specially trained optometrists will be able to write a prescription if they diagnose a problem needing treatment, saving the patient from having to make a separate appointment with their GP.6
The Bachelors is the current entry-level degree for practicing optometry in the U.K. It is reported that the Institute of Optometry, in collaboration with London South Bank University, recently launched a post-graduate, professional doctorate in optometry program.7
The U.K. is also implementing a revalidation process in which optometrists must demonstrate continuing competency for re-licensure every six years. The regulatory body, the General Optical Council (GOC), will develop a risk profile for optometrists based upon their scope and context of practice. The nature and level of revalidation will be proportionate to the risk posed to the public, the GOC says.8 Continuing education and other professional development activities may serve as evidence of continued training and skills.8
Each aforementioned country is a member of the WCO, an international optometric organization with 75 member organizations that represent more than 40 countries. The WCO maintains official relations with the World Health Organization and membership in the International Agency for the Prevention of Blindness. These milestones help establish parity among optometry and other health care professions. Involvement with these global bodies provides optometry with a pubic platform to voice its concerns and contribute its expertise on an international level.
With the adoption of the Global Competency-Based Model of Scope of Practice in Optometry, international optometry is now poised to continue its dynamic growth within a framework that promotes professional career development that is responsive to the public health needs of society.
Ms. Padilla is the director of professional studies and international programs at Salus University, Elkins Park, Pa. Dr. Di Stefano is the vice president of academic affairs at Salus University. Both are past executive directors of the World Council of Optometry.
1. Optometrists Association Australia Web site. Milestones in Australian optometryEducation. Available at: www.optometrists.asn.au/optometry/milestones/education (accessed May 27, 2009).
2. Naidoo K. Poverty and blindness in Africa. Clin Exp Optom 2007 Nov;90(6):415-21. Review.
3. Udom U (personal communication, April 30, 2009).
4. Rosen H (personal communication, April 29, 2009).
5. Optometry Giving Sight. New School to Train 130 New Optical Staff. Press release. Available at: www.givingsight.org/about_us/news/boskco.asp (accessed May 8, 2009).
6. U.K. Department of Health. Prescriptions from Your High Street Opticians. Press release 2007 Aug 28. Available at: http://nds.coi.gov.uk/content/detail.asp?ReleaseID=310329&NewsAreaID=2 (accessed May 6, 2009).
7. London South Bank University Web site. Course Information. Available at: http://prospectus.lsbu.ac.uk/courses/course.php?UCASCode=unknown&CourseID=4501 (accessed May 27, 2009).
8. Levett J. Revalidation takes shape. General Optical Council Bulletin Winter 2009;12:6. Available at: www.optical.org/goc/filemanager/root/site_assets/publications/bulletins/Winter09.pdf (accessed May 6, 2009).
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