Ontario Opticians refracting?

[k12311997]

IF YOU ARE UNAWARE OF ANY MEDICAL CONDITION AFFECTING YOUR EYES, A MEDICAL EYE EXAMINATION FOR ADULTS IS RECOMMENDED BY THE AMERICAN ACADEMY OF OPHTHALMOLOGY AS FOLLOWS:

Once or twice before the age of 40
Every two to four years from age 40 to 60
Every one to two years after the age of sixty
All criteria above applies to adults over the age of 18

We screen thoroughly and follow these exact guidelines.
We do not test children or seniors or anyone not previously tested in the past 4-5 years by an Optometrist or Ophthalmologist.
We do not test Diabetics or people with prismatic prescriptions.
It has worked with incredible success for us.

It is just stupid little things that catch my eye. In Canada you inform patients of the recommendations of the American Academy of Opthomology?

[AdmiralKnight]

We use ANSI standards too. :P

[Stonegoat]

Speaking of OD over-supply....I hear there is another optometry school starting in Texas. I'm so glad I practice in Canada...we are much less saturated up here.

With yet another optometry school, I wonder if ODs will start working at 7-11 or at gas stations.....maybe a free refraction with every fill-up??

[wmcdonald]

If there is such an over-supply, I wonder why salary levels continue to inch upwards, exceeding the cost-of-living index significantly? I do not see that heren in NC. On one hand, some indicate we do not have enough access to eyecare, and on the other we have an over-supply of eyecare oprofessionals of all types. What is that about?

[HarryChiling]

If there is such an over-supply, I wonder why salary levels continue to inch upwards, exceeding the cost-of-living index significantly? I do not see that heren in NC. On one hand, some indicate we do not have enough access to eyecare, and on the other we have an over-supply of eyecare oprofessionals of all types. What is that about?

Too many OD's want to practice in the cities not enough want to provide eyecare in the boondies. That's my take anyway.

[eoptics]

Surely, each professonal has its own roles.
Optician, Eye medical doctor and optometrist are sharing its own business area. Deciding its role, what should be considered primarily?
That should be the correction and cost in the side of vision patient.

Refinded vision check equipments have made opticians check vision more easily and correctly than any other.
That's why Ontario opticians got the role approved as their practice.
Also, in some other countries like South Korea, opticians have done vision exam for fitting spectacles.

In the side of patients, if optician can do the vision exam correctly, the patient can save the extra cost because usually the cost will be resolved into spectacle's cost like South Korea. Also, it is very convenient for the patient to take all simple procedure on spot.

In the U.S., I think that optician should have the role, also.

[Oedema]

I think many of you, particularly those outside of Ontario, are getting way ahead of yourselves. The relevant documents from Ontario college and Association do no authorize independent sight-testing by Ontario opticians. Rather the document from the college merely lays out the standards of practice for opticians that do engage in refraction; part of that standard is supervision either by an optometrist or physician and the requirement that patients undergo a full oculo-visual assessment by an optometrist or physician within the preceding 365 days. If anything the standards of practice, as they stand, restrict sight-testing more than they enable it.

Now, what I find particularly peculiar is the patient consent form; according to the form is a patient has a family history of cataracts then the optician cannot proceed with refraction and must make an immediate referral to OD or MD. Now, this alone would, given an accurate history from an informed patient, virtually eliminate all possible patients for optician performed refraction.

[tmorse]

The relevant documents from Ontario college and Association do no authorize independent sight-testing by Ontario opticians. ...the requirement that patients undergo a full oculo-visual assessment by an optometrist or physician within the preceding 365 days. If anything the standards of practice, as they stand, restrict sight-testing more than they enable it.

It appears like the Ontario College of Optometrists had a hand in the development of these Opticianry refraction standards of practice.
Clearly the COO chose to re-invent the wheel, and NOT follow the BC/Alberta refraction model... who knows why. Too Bad.

[Oedema]

who knows why

B/c they are following the directive of the Minister of Health and the recommendations of the HPRAC report:

That the Minister issue a new direction to the College of Opticians
of Ontario requiring it to develop a standard of practice limiting
the authority of members who perform refractometry to those
circumstances where such refracting is undertaken in collaboration
with an optometrist or a physician for the purpose of informing a
comprehensive ocular assessment;

[Refractingoptician.com]

Why would anyone want an optician to refract them if they have already had an optometrist or MD or ophthalmologist do it within 365 days ?

Now just what possible kind of sense does that make ??

The only sense it can make is either political or BS. Whoops sorry , I thought the two were different , but then there is only one reason.

[Barry Santini]

Why would anyone want an optician to refract them if they have already had an optometrist or MD or ophthalmologist do it within 365 days ?

Now just what possible kind of sense does that make ??

It makes perfect sense...especially if the refractionists around you are less than skilled:
1. ODs
2. MDs
3. Techs in #1 or #2

Since *I* have to do the clean-up and absorb the expense of when an Rx does not meet my client's satisfaction, then I think I should be able to derive the numbers myself. Of course, I don't want my visual assessment taking the place of a proper, periodic eye *exam* done by a medical professional.

As I see it, there is no reason that a skilled Optician *should not* be able to refract in this type of context.

Barry

[Refractingoptician.com]

..

[Just Optician]

Opticians foot the bill for doctor's errors because if the doctor had them remade due to his/her error they would blame the lab and expect them to foot the bill. This is where another conflict of interest exists. If the doctor made an error it's the lab's fault or the optician's where you got them. If I check the doctor's work and criticize it will be more difficult to get an rx from that doctor in the future. So we just remake and expect the labs to foot the bill that we end up paying for in the end. If we were to refract our office would be judged on our ability to refract and our ability to make a good pair of glasses. It would be nice to be in control of my own destiny for good or for bad.

[Barry Santini]

What you are describing is different

But, although I agree with you in principle, we all know that eyewear is sooo much more complex than just "filling the Rx", as commoditized pharmeceuticals do.

I think that a properly-trained, refracting optician is necessary today if opticians are going to keep eyewear with each-client's "sweet-spot".

Barry

[tmorse]

[quote=tmorse;215149]
Insistence by OD/OMD on a comprehensive eye health exam every time a person is tested for a change in Rx is similar to a GP insisting on a 'comprehensive physical' medical exam every time the patient presents at his office with the sniffles. /quote]

Obviously this point wasn't stressed to the Health Minister. Even requiring that every second (2nd) refraction be performed by a OD/OMD would have ensured a modicum of safety to the patient's eye health.

Given the terms of reference from HPRAC for three (3) O agreement on Optician refraction protocols, I am surprised that any Refraction Standards of Practice agreement was achieved at all.
It’s much like the farmer insisting that the fox be included in determining security arrangements for the henhouse.
Clearly, the COO believes that a flawed refraction arrangement is better than no arrangement at all. Perhaps Bruce Bergez and his Great Glasses chain will find a way to make these refraction protocols workable. :idea:

[HarryChiling]

When I was younger my parents told us, "A bird in the hand is worth two in the bush"

As I got older I heard the true story about a state that was trying to get licensure and had everyone in agreement that it was a good thing, but then someone decided that opticiasn should also be able to fit contact lenses (whihc I agree with), then things got a little messy and they didn't get licensure for the state since optometry felt that opticians should not be allowed to fit contact lenses, apparently to this day they have no licensing. I forget who told me that and whihc state it was, but I am sure opticians here would know.

The way I see it is, thank goodness you got refraction no matter what the stipulations are, you iron out the details later. Congratulations, this is the trickle bfore the dam breaks.:cheers:

[Refractingoptician.com]

With a willing student and a great teacher , how long would it take to learn to refract and at what cost and would it fit the present standards ?

[HarryChiling]

With a willing student and a great teacher , how long would it take to learn to refract and at what cost and would it fit the present standards ?

Last I checked here in the states Dr Warren McDonald taught a two day crash course on the basics which would cover refracting procedures, from there of course you would need as much practice to gain the skills to be proficient (different for everyone). I think it was $250.00 of course with a minimum amount of students. I don't know if it would meet the requirements of your country though, but you could check with him he's a member of this board and listed in the speakers section.

[Laurie]

Hello,

While Warren and his course are both fabulous (Hi Warren!), it is unlikely that it would be enough time.

Here in the US, when OD's went for DPA and TPA privilages, they modeled a 100 hour course.

Years ago, I took the OAA refractometry course, and it was 100 hours, and cost $1,500.00.

Presently, I teach refractometry theory, lab I and lab II, and the total time I spend with students is 106 hours, over three semesters.

: )

Laurie

[wmcdonald]

The weekend courses I have been doing are introductory only. To adequately teach the subject matter, we will need somewhere between 80 and 100 hours, to include some outcome analysis (testing) indicating that the student has successfully gained an understanding of the material.

That said, I have been generally pleased with the quick grasp large numbers of those at the Southeastern had of the material. I also was impressed with the quick understanding of those in Allentown.

[tmorse]

....I hear there is another optometry school starting in Texas.

Can you provide any details on this new Optometry school in Texas?

[Oedema]

Can you provide any details on this new Optometry school in Texas?

UIW (University of the Incarnate Word), Austin, TX

[tmorse]

To adequately teach the subject matter, we will need somewhere between 80 and 100 hours, to include some outcome analysis (testing) indicating that the student has successfully gained an understanding of the material.

Number of hours is never mandated by accreditating agencies, including the COA, so that educators can be innovative and make good use of emerging technologies and such.

I also took the 100 Hour OAA Refractometry program and it was a wonderful experience. However, a significant portion of that program included 'retinoscopy'. While retinscopy is used for babies or the bed-ridden, today's sight-testing protocols in Canada preclude these categories of patients. And todays automated refractors provide an accurate and consistent starting point for a phoropter refraction, so that refining of the RX can take place.

So maybe Warrens 80-100hrs could be pared down to 60-80hrs... who knows. The important determination should be 'demonstrated competencies', and the number of hours in a particular program should not be an issue. In Warren's words, the program..."to include outcome analysis (testing)". If the students can do it, then the refraction program has merit, regardless of length. :cheers:

[wmcdonald]

Some students may be able to read a textbook and do a bit of experiential learning and go do a competent refraction. In my experience however, it is important to teach some of the ancillary things surrounding the refraction in addition to spinning dials. We review anatomy and physiology, and basic optics among other things. Retinoscopy is one of the things we teach and is the most widely used objective technique employed by refractionists in the US. It takes time to become proficient, and I do feel some minimum time is required to achieve a thorough understanding of the process.

I also understand that in Canada Opticians are using automated systems to refract, but I also think that learning the history and additional methods will only support their knowledge of the process. I have more of an interest in developing professionals than technicians.

[tmorse]

Retinoscopy is one of the things we teach and is the most widely used objective technique employed by refractionists in the US.

Well Optiboard optometrists, let's hear from you... is retinoscopy still so widely used in your practice, or do you start from the person's previous Rx or from an automated Rx?