LSW got the privilege of working out an exclusive interview with Prof Peter Hendicott, President, World Optometry Council.

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LSW: Compared to Ophthalmology and Ophthalmologists, Optometry does not have the recognition as a study and profession in many countries. Your comments

Prof Peter: There are multiple factors at play in this situation. A major issue is the lack of legislation (regulation) in many countries. Legislation, where it exists, restricts the practice of optometry to only those people who have undertaken the necessary education and training to be able to be called optometrists. Legislation’s purpose is to protect the public from people without the necessary knowledge and competencies. Legislation may also define what the level of optometry education should be, or, more importantly, the minimum skills and competencies expected as outcomes from optometry education. As a profession, being recognised by legislation, and by the level of education and its outcomes, increases public confidence in the profession, and thus builds recognition.

We also have to remember that in many countries, optometry is only a relatively new profession, and that the recognition by government and the public evident in other countries has taken many decades to develop. Even in countries where optometry is well established within the health system there can still be lack of recognition of the overall scope of practice and role of optometry by members of the public. This is a public education issue for optometry overall.

Part of the challenge in gaining recognition is providing the evidence of the contribution optometry can make to health outcomes. This evidence is needed to overcome political resistance from other professions or organisations, and their interests, which are factors in the recognition and inclusion of optometry in education and health systems. There are multiple examples that illustrate this in the published literature, but it may require local examples to be developed through targeted public health research projects.

Inclusion of optometry services in health subsidy schemes is also important in building recognition. This can be through government funded ones such as in Medicare in Australia or the National Health Service Optical Scheme in the United Kingdom, or by inclusion in private health benefit or health insurance schemes such as those that exist in many countries.

Gaining recognition is a gradual time-consuming journey of advocacy with government, politicians, and other professions, and of public education improving knowledge of the role optometry can play and the contribution it can make. This needs all groups that represent optometry within a particular country or region to work together with common agendas and goals, with consistent messaging, as it will only be achieved with a united profession.

The recent publication of the World Health Organizations “Eye Care Competency Framework” document also provides optometry with a resource that can illustrate the role that optometry can play in the delivery of eye care, which recognition of optometry. It means however that optometry needs to show that it has the level of competencies that align with this document. If we are looking to advance the role of the profession, we all need to read this document, and ensure we as optometrists have the skills, knowledge and competencies being described.

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LSW: How well Optometry is positioned in the US and how is the graduation and post-graduation study of Optometry recognised? Is Optometry a part of curriculum in schools and colleges?

Prof Peter: Let’s look at this slightly differently and consider of the first part of the question more broadly than the example of the USA you have used.

Taking the first part, what we are really talking about is where has optometry gained a broad and high-level scope of practice, which may include optometry being able to treat eye disease with a range of therapeutic drugs, or even minor surgery?

There are some common factors in all the countries where this has been achieved. The countries all have tertiary level education required to enter the profession of optometry. There typically are competencies expected from optometry education that are well defined and encompass this scope of practice, and that optometry courses are expected to develop. The qualification obtained may be from a Bachelor degree or equivalent, or a combined Bachelor/Master degree, or optometry education following a first degree (eg the OD degree). At these scopes of practice, the length of initial optometry education generally ranges from 4-7 years.

Countries with optometry at these levels typically:

• have optometry education being undertaken in recognised tertiary institutes, usually subject to government regulation and quality audit of universities

• the tertiary institutes, whether government or private, have internal processes for course approval, review and audit.

• have processes external to the tertiary institutes in place to audit standards of optometric education and its outcomes (an accreditation system)

• have a profession which is legislated at either or both of state (regional) or national levels. Some countries additionally require an assessment or examination following graduation from an optometry school to practice optometry.

• have requirements under legislation for optometrists to undertake continuing professional education to maintain their licence to practice.

Additionally, as noted earlier, the profession has been able to advocate for this scope of practice and the access to therapeutic treatment by demonstrating the public need for this and the subsequent benefit to the health system and to patients. Optometry having this scope of practice improves accessibility and equity of eye care, which are international goals for eye care as outlined in the World Health Organizations “World Report on Vision”, and the subsequent United Nations General Assembly resolutions on reducing the burden of visual impairment.

For the second part of the question, about optometry being part of the curriculum in schools and colleges, if we look at the countries where optometry has this scope of practice the education is in tertiary institutions. The academic division or unit which hosts the optometry program can variably be termed a Department, College, or School of Optometry, dependent upon the naming convention used in the institution. They may be a self-standing academic unit (typically then a School or College) or within a faculty structure with other professions or disciplines (typically then a Department or School). A number of private funded (as opposed to public funded) institutions are Colleges of Optometry. Rather than the name or host institution, what is important from the profession’s perspective is more the level of autonomy and control over curriculum, assessment, staffing and other resources that support the optometry program and the development of the required skills, knowledge and competencies that are required.

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LSW: How is Optometry as a profession perceived globally?

Prof Peter From a global perspective, optometry is recognised as an important contributor to meeting the future demands of eye care and reducing the impact of avoidable vision impairment. Representing optometry, WCO has an official relationship with the World Health Organization through a participation agreement, and a number of optometrists have represented WCO and the profession on technical working groups that have developed eye care intervention packages and the competency framework document mentioned earlier, and in other WHO eye care related work. This allows input from the profession at an overarching international level.

The WCO is also active with the International Agency for the Prevention of Blindness and its advocacy efforts to improve eye care.

It is important for the profession to be at these tables, as this is where the international agenda around eye care is set, and WCO is recognised as a valued participant at this level.

We have discussed earlier factors around country by country recognition and perspectives of optometry.

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LSW: What are the objectives of the World Council of Optometry?

Prof Peter: WCO’s vision is of a world where optometry makes high quality eye health and vision care accessible to all people.

WCO’s mission is to facilitate the development of optometry around the world and support optometrists in promoting eye health and vision care as a human right through advocacy, education, policy development and humanitarian outreach.

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LSW: What is the role of the World Optometry Foundation?

Prof Peter The World Optometry Foundation (WOF) is a non-profit organization that finances the development of optometry around the world to reduce avoidable blindness. All funds raised by WOF are used to support the World Council of Optometry’s programs and projects that develop or enhance education in optometry schools, provide educational materials, and create public health programs and community outreach initiatives. Funding through the WOF supports the WCO’s general and education mentor grant schemes, as well as specific WCO projects such as the initial development of the OPAL advocacy and leadership program. Details of the grant schemes can be found on the WCO website at https://worldcouncilofoptometry.info/about-the-wco-grant-program/

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LSW: Are Optometry councils in other countries affiliated to WCO?

Prof Peter: WCO’s country members are the national associations organisations that represent the profession of optometry, and to which individual optometrists in those countries belong. In some countries this may mean more than one association might be a WCO member. The country members are the voting members of WCO.

WCO also has an affiliate membership category, which are organizations and institutions that represent special optometric interests, but do not satisfy all the conditions of a Country membership.

WCO also has an individual membership category, and a corporate member category for industry that supports optometry

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LSW: Cannot there be some kind of centralised activities or official affiliations with councils in other countries in order to create a uniformed program, studies that will help promote Optometry as an important sector?

Prof Peter: I would look at this in a different way. What is important, and what will help promote optometry and further its role, is to think about outcomes from optometry education, as opposed to the structure and content of an optometry program.

In my view, this is an important distinction. We should be describing optometry in terms of what we can do as a result of optometry education – that is, what are the skills, knowledge and competencies that optometrists have. Optometry needs to highlight to governments and health policy makers that it has the educational foundation and the relevant knowledge, skills and competencies that will enable optometry to participate at its fullest scope in health care delivery systems at both national and international levels. In particular, optometry needs to demonstrate that it has competencies in ocular disease and the requisite clinical and management skills that support a role in this space; and in public health so that optometry both recognizes and contributes to the wider public and social needs of health care in terms of health care teams, and in prevention, detection, and management.

So what is important is that we have a set of outcome statements, or competencies, that describe what we can do. These then represent the goals of optometry education. They can describe internationally what optometry is capable of contributing.

The educational program that then leads to the development of these competencies can be structured in many different ways, with different modes of the delivery of learning, and multiple methods of assessment. There is no “one size fits all” approach. What is necessary is for the educational program to be able to demonstrate how its curriculum structure, teaching and learning methods, and assessment all lead to the effective development of these outcome competencies.

How is WCO supporting this approach? We have redeveloped the WCO Competency Model for Optometry and Curriculum Model documents into a new combined Curriculum and Competencies document. In doing so, we have also considered the following when describing optometry as a profession, and its education:

• ensuring optometry is positioned to participate widely in the future of eye care

• Optometrists work in teams with allied ophthalmic personnel, nurses and other health care workers.

• the impact of current and future technology on eye care delivery and human resource needs

As a result, WCO has grouped its competencies into five broad curriculum domains, described below with indicative content of each domain. Each domain contains a number of competencies, developed to describe optometry at a minimum level, consistent with a tertiary educated profession.

Domain 1: Refractive error: assessment and management: subjective and objective refraction, near point and presbyopia, spectacles, contact lenses, myopia control (ortho-K, other CL strategies, spectacle lens strategies, pharmacologic control etc.), cycloplegia.

Domain 2: Visual function assessment: binocular vision, low vision assessment and vision rehabilitation, vision and learning, occupational visual assessments, populations with special needs.

Domain 3: Ocular health and ocular disease: assessment and management: anterior and posterior segment assessment, signs and symptoms of ocular disease, pharmacology, management, referral, diagnostic pharmaceutical agents (DPA), therapeutic pharmaceutical agents (TPA) (non-prescription/over the counter and prescription).

Domain 4: Public health: the demographics, social determinants of health and epidemiology of the community and the patient population, information on matters of visual and general health and welfare, current trends and topical issues regarding eyes, vision and health care.

Domain 5: Professional practice: communication, case history, examination plans, management plans, record-keeping, referral documents, reports to other members of the patient’s health care team.

For each of these domains, and for the individual competencies they encompass, the curriculum content that would be required to support the development of the competency is described.

This revised WCO Curriculum and Competency publication will be released shortly.