This past week Health Canada registered the SVOne Pro auto refractor as a Class II medical device, and also awarded it a Canadian Medical Device License. This device is a handheld auto refractor that has a wavefront aberrometer and works with a smartphone. It can be used in a practice conveniently being moved from room to room, used on humanitarian missions supplying eye care, or as part of a remote refraction service. A model promoted by Smart Vision Labs, maker of this device, incorporates a client performing their own refraction, or someone else, optician or other. The client’s history and results are sent to an ophthalmologist who reviews the data and prescribes from the results. The prescription for eyewear is then sent to the patient and optical store.
Hmmm. Am I having a flashback? Am I in the movie Ground Hog Day? Or maybe it’s just déjà vu? I seem to remember that between about 1995 and 2001 some Ontario opticians were providing refraction services using the same model. I don’t have the exact number at hand but during that period there were tens of thousands of refractions provided using the Eyelogic system invented by Canadian Ophthalmologist Dr. Allan Dyer. It’s Interesting that during that period the opticianry regulatory agencies across Canada didn’t receive any complaints against opticians for harm done to them related to a refraction. In the few cases where opticians were singled out the complaints came from optometry, or a client being guided by optometry. Currently opticians in Alberta perform refractions as per the above model while B.C. opticians provide stand alone refractions.
Technology is everywhere and as we have seen business and the wants and needs of the public guide regulation. It’s up to regulators to protect the public without restricting access to services. The regulators must decide where risks of harm exist and put into place reasonable regulations and standards that fulfill their mandate.
Getting back to opticians refracting, you’ll notice that I intimated that Ontario opticians stopped refracting in 2011. In February of that year then health minister, Elizabeth Witmer, MPP for the Kitchener-Waterloo area, home of the Waterloo School of Optometry, sent a letter to the College of Opticians of Ontario (COO) asking it to advise Ontario opticians that they must stop performing refractions until Standards of Practice are developed in collaboration with the College of Optometrists and the College of Physicians and Surgeons. The COO complied. During the years that followed all attempts by the COO to develop Standards in collaboration with the other two O’s proved fruitless. And why would the other two O’s want to collaborate? Ophthalmology had no interest and optometry certainly didn’t want to legitimize a competitor.
The COO ended up developing Standards of Practice for opticians to refract that are very restrictive and certainly do insure patient safety. This was done without the collaboration of the other two O’s. Forty opticians were registered as Refracting Opticians before another health minister, Michael Kaplan, came along and directed the COO not to register the approximately 50 other opticians, who had completed comprehensive training and practical experience. He allowed the previously registered opticians to maintain their Refracting Optician status.
At a recent meeting with the Ministry the OOA was told that the only way to lift the ban on opticians refracting would be with the collaboration of the other two O’s. Interesting is that other healthcare professionals don’t usually have to get the approval from a competing profession in order for their profession to progress.
I have to refer to how optometrists were successful in adding prescribing TPA’s to their scope of practice; education. I believe that all opticians should count refracting in their repertoire of skills. Maybe at that point government will see that we mean business when we ask for an increase in our scope of practice.
With the current ban in place it even prohibits opticians working under delegation or direct supervision of an ophthalmologist from performing refractions. And let’s not forget that refraction is not a controlled act and anyone can perform one; except if you’re a licensed optician. Does this make sense? This only encourages opticians to give up their licenses. Where’s the public protection?
Whether you are interested in refracting or not, we must also look two steps forward and make sure that our regulations and standards don’t handcuff us as to where and how the prescriptions we are presented with are produced. This is very important as you can see technology is not standing still.
I’ve been told that our current health minister is all about collaboration. Collaboration only happens when there are two or more parties trying to work together.
Lorne Kashin, RO
Ontario Opticians Association