Ontario optometrists need to stop blurring the lines between doctor and patient | Rhiannon Hills

A recent provincial review of optometry in Ontario demonstrated the chilling threat that a disgruntled optometrist holds to patients and doctors – and recommends that the optometry profession become responsible for resolving this situation.

Without additional pressure, it is unlikely that the optometrists union and the Ontario College of Optometrists will come to a resolution in negotiations – and optometrists’ responsibility for obtaining and following written consent for treatment takes precedence over the lack of it. Optometrists should be held legally accountable for their negligence in following written consent.

Patients in Ontario are frequently subjected to painful arguments with optometrists over treatment or removal of contact lenses or the examination of the retina. Based on a national report on optometry by the Royal College of Optometrists and the Royal College of General Practitioners, about 43% of all optometry practices in Ontario did not routinely communicate with their patient base on referrals and treatment decisions. As a result, patients often received treatment based on their visual acuity, not their views.

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It is common for optometrists to be suspended for failing to obtain, or seek, appropriate written consent. But when these suspensions end, the optometrists revert to a risk-free “first do no harm” approach. When optometrists require significant training and expertise to perform tasks such as insertion and removal of lenses, vitrectomy – the removal of the eye’s macula, the brightest area of the eye – and general eye care, patients can lose much of the value of services they are receiving.

An optometrist prescribing medication can be a surgeon who knows how to do surgery. Optometrists do not have the basic skills and training to perform vascular surgery, electrosurgical procedures or neurotysurgery (specifically the removal of a portion of the eye).

These professionals are properly regarded as doctors but they need to get better at managing services for patients. Patients often favour having optometrists perform minor eye surgeries such as optometry examinations, but optometrists’ lack of expertise can keep people from obtaining the necessary treatment, and are often seen as physician-like (although not officially licensed) “medical practitioners” with the authority to make medical decisions. However, that authority must be rightly limited.

There is nothing unusual about optometrists performing minor procedures. After all, Ontario allows one optometrist to oversee diagnostic eye exams and medical examinations by not only two optometrists, but also five or six optometrists. But when optometrists fail to perform the most basic eye care (or even observe eye exams in a timely manner) when they should, patients often fear being mistreated by an optometrist.

Even when optometrists perform appropriately, patients often fear being mistreated by an optometrist. However, that authority must be rightly limited

In Ontario, optometrists are able to use emergency discretion to perform surgical procedures, such as lens or vitrectomy removal when necessary.

But there is no similar emergency discretion to determine if needed evidence supports a requested drug or other service such as a vision correction device. Optometrists are not approved to perform such services.

Related to this, optometrists in Ontario can only be officially certified to a D mark. There is no evidence for the existence of a special type of eye care, and the real question should be: Is a retail optometrist more qualified than a medical doctor? The answer appears to be no.

Ontario’s optometry contract sets out the role of optometrists in developing and assessing eyecare services, patient-physician communication and patient accessibility. It is time to require optometrists to undergo physician-level education, training and qualifications to secure accreditation to actually practise.

Time is of the essence. Optometrists in Ontario owe it to their patients to negotiate a contract that reduces optometrists’ training and allows patients to decide what kind of treatment they want. Until then, they should be made responsible for finding alternative health care.

• Rhiannon Hills is senior lecturer in the department of health and medicine at York University in Toronto

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