Dear Colleagues,
World Optometry Day, March 23rd, highlights optometry as a health profession, and the contribution of optometry to achieving access to eye health care as a human right.
So why has WCO chosen as its theme for World Optometry Day 2023 “Expanding Optometry’s Role – the Time is Now!”?
There are multiple challenges facing eye care and the impact of vision impairment on achievement of the United Nation’s Sustainable Development Goals, and the inclusion of addressing refractive error correction within Universal Health Care. These challenges have been well documented in The World Report on Vision (WRV), published by the World Health Organization in 2019. This report highlights the impact of changing demographics worldwide, specifically, population growth and ageing, along with the growth and impact of uncorrected refractive error, including presbyopia. An ageing population increases the absolute number of people with chronic disease that accompanies ageing, including significant eye health issues that can lead to visual impairment and possibly blindness. Many of these conditions which cause avoidable vision impairment, such as glaucoma, diabetic retinopathy, and age-related maculopathy, do not necessarily cause significant symptoms at early stages of the disease. This is why regular eye care is important, at all ages, in order to detect and manage these eye health issues early. This is an easy statement to make, but a harder one to put in place in many regions of the world.
We need to remember that for many people significant inequities exist in their ability to access vision care. The burden of preventable vision loss is greater in areas of social and economic disadvantage, in rural areas, for older people, ethnic minorities, indigenous peoples, and women. It is equally important for optometry to recognise that these inequities exist in all areas of the world, even where health systems, including eye care, may be well-developed.
Why do we need to think about expanding optometry’s role? The World Report on Vision notes that, in many countries, primary eyecare is delivered in secondary and tertiary healthcare settings which can restrict access: “Given that many of the eye conditions that can be effectively managed at the primary care level are often conditions for which people seek eye care in secondary and tertiary eye care settings, building both strong primary care and community delivered eye care can increase the efficiency of eye care services.”
The United Nations in its 75th session, during Agenda item A/75/L.108 calls on its member states to “ensure access to eye care services for their population and to mobilize the necessary resources and support…to contribute to global efforts to reach, by 2030, at least 1.1 billion people who have a vision impairment and currently do not have access to the eye care services they need.” The UN resolution also recognizes that eye care is essential to achieving Sustainable Development Goals 1, 2, 3, 4, 8 and 11, and further calls on member states to include eye care as part of Universal Health Coverage and to implement integrated people-centred eye care in health systems. Integrated people-centred eyecare means eye health care services managed and delivered so that people receive a continuum of health interventions covering promotion, prevention, treatment, and rehabilitation; services addressing eye conditions according to individuals’ needs and which are coordinated across different levels and sites of care within and beyond the health sector; and which recognize people as participants and beneficiaries of these services, throughout their life course. An emphasis is placed on health service delivery within communities, which is the strength of optometry.
Why is it imperative to look to expanding optometry’s role? With this international agenda for eye care, optometry needs to ensure that, in addition to our traditional role in managing refractive error, it has the relevant competencies in assessing and managing ocular disease, clinical and management skills, teamwork, leadership and advocacy that will enable the profession to participate fully in growing healthcare systems to deliver enhanced health outcomes. In some countries optometry is educated with all these necessary skills and competencies. In others that is not necessarily the case.
Optometry also must recognise that solutions to the issues facing eye care will not necessarily be attained by simply training more practitioners. We also need to work smarter and more effectively. This will require us to develop future alternative models of the provision of eye care by optometrists, aimed at improving equity, access, efficiency and outcomes. As a profession, we need to consider the inclusion of eye care delivery by other practitioners, how they may work together with optometry, and how optometry can take a leading role in partnerships to develop models of delivery, training, leadership, and management of eye care teams. We need also to consider the impact of current and future technology on the delivery of eye care, and how these tools can be utilized by optometry, working with other eye care professionals, to improve equity, access, and outcomes. We need to think of how the skills and competencies of optometry can be more widely utilized with health care systems. There is ample evidence supporting an increased primary care role for optometry, demonstrating improved outcomes for patients through earlier detection of conditions with ocular morbidity, and a reduction in unnecessary referrals to ophthalmology at the secondary care level. Utilising optometry in collaborative care and shared care schemes is a cost-effective way to increase the provision of eye care, thus making eye care integral to Universal Health Care, and the achievement of the Sustainable Development Goals.
To grow optometry’s competencies and wider involvement in health care is a complex process, needing either or both of educational and legislative change, as well as recognition. This is why the time is now. Optometry needs to position itself to speak and act towards the achievement of improved healthcare outcomes for society in terms of eyecare, and to also recognize the impact of improved eyecare on social, financial, and educational outcomes as well.
On World Optometry Day 2023, it is important to make the call for all optometrists and their representative organisations to work proactively together with other health professions involved in eye care, and with government, to make eye care accessible, equitable, affordable, and effective.
Peter Hendicott