Ontario Opticians refracting?

[HarryChiling]

I suppose that is why the judge came to the conclusion with "considerable reluctance."

Safety of sight testing was never the issue before the court, the issue was enforcing the optometry act as it is written.

When the judge states that the original judgemnt is correct, he is not concerned about whether or not sight testing is right or wrong, it is a matter of whether the association has standing to discipline or seek an injunction against someone that is not a member (ie not an optometrist).

And when that didn't work he did not even consider the harmful ploy. The judge saw right through that. And so did the Attorney General who represents the public by refusing to show in the first place and the judge acknowledges that by not even considering revisting the judgement.

The fact that it's harmfull to the public not being the first case presented by the plaintiff shows that it obviously wasn't a concern untill after the judge ruled against the college of optometry. Keep digging and eventually you will either dig up a bone or I'll throw you a chew toy, but optometry didn't have a leg to stand on then and it only has a leg to stand on now in a online forum where the teeth don't leave marks.

[Excalibur]

So, basicly, you're saying to everyone here, instead of argueing your point logically, you're just going to revert to name calling, and insult more than 2/3 of the people on this board. Wow.

so what is the skill level difference b/w a licensed and unlicensed optician??

[Stonegoat]

The patient that I decribed previously was not aware of having any systemic disease. I was very surprised to see the edema...not what I was expecting. There were no "red flags" to suggest any problem other than refrective error. It was only because the pateint was having his vision complaint adressed by a doctor rather than an optician that the condition was detected. His prognosis is excellent.

So what if he had been sight-tested? What is a reasonable interval between eye health assessments. Remember he had a full exam less than a year ago. According to BC opticians he would not require another exam for another 4 years. Macular edema can get pretty ugly in a few weeks, let alone 4 years.

The truth us, he simply would have slipped through the cracks of flawed eye care delivery. There would be no way to prove that he had the edema at the time of the "sight-test", so recourse would not be possible.

Why can't opticians see the problem with this?!?!?

Opticians SHOULD be able to refract...but only within the framework of a full eye exam in association with an OD or OMD.

[HarryChiling]

so what is the skill level difference b/w a licensed and unlicensed optician??

HUGE, consider yourself lucky that you don't know the answer to this question. Their was recently a fox 45 report in TX an unlicensed state in the US where a repoter took the same Rx to multiple stores and the only one that was made correctly was the one from COSTCO (COSTCO's has a policy where they only hire certified or licensed opticians). What does that say, although you could be doing the best job in providing the most competent and pristine care the end result is the same the patient can't see.

[tmorse]

You know their answer to that..... it's rare, it almost never happens, yada yada. Don't get me started on this because I can give them case after case after case. Problem is that they don't know what they don't know. :hammer:

I will tell you what I do know... that every Optician in Canada carries a minimum of one (1) million dollars ($1,000,000.00) Errors & Omissions Liability Insurance to cover themselves, including contact lens practioners and sight-testers.
Professional insurance Actuaries are utilized by insurance companies to properly assess the risk of actually having to pay out on any 'negligence' claim.
Mandatory Liabiliaty Insurance is available at two (2) different sources, our BC Provincial Association and our National body, the Opticians Association of Canada.

TOTAL PREMIUM COST for one (1) million ($1,000.000.00) to the Opticians is $65.00/$75.00 per year. Three (3) Million ($3,000.000.00) in coverage increases TOTAL PREMIUM by $12.00-13.00/yr and five (5) million is also available for an additional $13.00. So for one (1) hundred dollars ($100.00) in premiums, Opticians are covered for five (5) million ($5,000,000.00) per occurance.

Our Courts haven't commented on this insurance premium anomoly, but I think it safe to say that risk of harm for anything an Optician does can be deemed minimal. So much for risk to patient in simple sight-testing.

There is an old adage that "Doctors bury their mistakes". Does this also apply to Optometry? What is Optometry's E&O Liability insuranc premium per year as determined by Actuaries? Not your office insurance premium or lost income insurance, but just the professional negligence coverage portion.

[Excalibur]

HUGE, consider yourself lucky that you don't know the answer to this question. Their was recently a fox 45 report in TX an unlicensed state in the US where a repoter took the same Rx to multiple stores and the only one that was made correctly was the one from COSTCO (COSTCO's has a policy where they only hire certified or licensed opticians). What does that say, although you could be doing the best job in providing the most competent and pristine care the end result is the same the patient can't see.

So if an optician decides to not be licensed and work in an optometric office, they become incompetent. Hogwash!

[wmcdonald]

Ladies and Gentlemen,
We are getting a bit heated. This is a sensitive subject and one that cannot and will not be settled here. I understand the ODs perspective, and want to say to them that I have respect for their training and education, and appreciate what they do for the public. Unfortunately, we are juxtaposed in our positions, but can find common ground. Opticians want to move forward, just as ODs moved more to the medical model. It is a logical progression, and one I am deeply involved in. Let me assure all that their are specific guidelines dictating what those involved in "sight-testing" can and cannot do. We do not want to do harm to anyone, just level the playing field a bit. No one is suggesting that Opticians just begin to refract; quite the contrary. Education and training must come first. I would LOVE to see the Schools and Colleges of Optometry work with us to design curricula and offer programs that can help us all along the path to higher levels of practice. I see advanced practice Opticians functioning much like Nurse Practioners, and can certainly be a great asset to ODs and MDs. I hope we can carry this discussion further, with some civility, because we can accomplish a great deal more that way.

Warren

[HarryChiling]

Not to mention that most sight testing opticians have 6 years of education, 2 eyeglass, 2 contact lens, and 2 sight testing. To call them uneducated would be a weak arguement.

[Oedema]

[quote=HarryChiling;217100]And when that didn't work he did not even consider the harmful ploy. The judge saw right through that. And so did the Attorney General who represents the public by refusing to show in the first place and the judge acknowledges that by not even considering revisting the judgement./quote]

You and I both know that you're now just speculating... Show us where in all of this the lawyers for the association went before the court whining that sight-testing was going to hurt people and b/c of that the injunction should be granted irrespective of the legislation and common case law.

[tmorse]

Q:what's the difference in skill level b/w a licensed optician and a non-licensed optician?

A: NONE! :)

Here in BC, 'Optician' is a restricted title indicating someone who has successfully complete an approved course of instruction and passed a National Competency exam. Of course the one (1) week 'wonders' that some OD's hire wouldn't tell you that. :bbg:

[HarryChiling]

95% of North America permits ODs to rx meds to their patients.

2% of North America permits opticians to independently sight test.

Looks like the optoms are doing just a LITTLE bit better convincing the courts and legislators whose services are more important to the public.

North America huh. I guess when someone asks you whihc country you live in you say North America. So why even visit the CA discussion forum and discuss Ontario opticians refracting? 50% of opticians in the US don't have licensing so refracting for them is a pipe dream. The educated opticians in CA who have gone above and beyond to gain the privledge to sight test have earned it and to lump them in with the rest of north america is a folly on your part as it shows your bias and shows that you are neither going to discuss the case with an open mind or be fair in your judgements. No wonder your are so worried about pathology your eyes are diseased. :D

By the way 7 Canadian provinces and 50 states in the US, that's 57 in North America. 2 allow sight testing 2/57 = 0.035 that's approximately 4%, you should stay away from the math it can cause headaches, opps I mena tumors go see an OD for that. :D

[Stonegoat]

Would an optician please address what they would have done with my patient specfically??

[Excalibur]

Would an optician please address what they would have done with my patient specfically??

I told you they would ignore your valid question. They would do nothing because they would not detect the problem. They can't diagnose what they don't look for -- so what would you expect? :hammer:

[HarryChiling]

Would an optician please address what they would have done with my patient specfically??

This question is made with an assumption that all opticians are now qualified to sight test. I am not, so I cannot answer your question. I do also want to hear what a sight testing opticians would do but they are an advanced trained optician and as such only the best and brightest will attain that level of practice.

I told you they would ignore your valid question. They would do nothing because they would not detect the problem. They can't diagnose what they don't look for -- so what would you expect? :hammer:

Same to you as above. You guys really need to get off this kick it's going to happen with or without your venomous input, it would be nice to see optometry embrace it and help create something better for the patients, but it's not about that, apparently.

[Excalibur]

North America huh. I guess when someone asks you whihc country you live in you say North America. So why even visit the CA discussion forum and discuss Ontario opticians refracting? 50% of opticians in the US don't have licensing so refracting for them is a pipe dream. The educated opticians in CA who have gone above and beyond to gain the privledge to sight test have earned it and to lump them in with the rest of north america is a folly on your part as it shows your bias and shows that you are neither going to discuss the case with an open mind or be fair in your judgements. No wonder your are so worried about pathology your eyes are diseased. :D

By the way 7 Canadian provinces and 50 states in the US, that's 57 in North America. 2 allow sight testing 2/57 = 0.035 that's approximately 4%, you should stay away from the math it can cause headaches, opps I mena tumors go see an OD for that. :D

Sorry to burst your bubble Mr. Geography, but Canada has 10 provinces and a few territories on top of that. So your calculation is incorrect.

Also, take another look at your post above. Spelling and grammatical mistakes galore, and you are giving ME a math lesson? Give me a break.

Furthermore, I practice in Ontario where HPRAC saw through the optician lobby on independent sight testing and flushed it pronto. Read their decision on independent refraction here:

http://hprac.org/en/reports/resource...il_2006_EN.pdf

It seems that this wise panel of health policy academics knew what they were talking about. :D

[HarryChiling]

I suppose that is why the judge came to the conclusion with "considerable reluctance."

Safety of sight testing was never the issue before the court, the issue was enforcing the optometry act as it is written.

When the judge states that the original judgemnt is correct, he is not concerned about whether or not sight testing is right or wrong, it is a matter of whether the association has standing to discipline or seek an injunction against someone that is not a member (ie not an optometrist).

Health Professions Act[/b], R.S.B.C. 1996, c. 183]

Part II — Public Interest Criteria

Criteria for designation of health professions

5 (1) For the purposes of section 10 (1) of the Act, the minister must consider the extent to which the practice of a health profession may involve a risk of physical, mental or emotional harm to the health, safety or well being of the public, having regard to
(a) the services performed by practitioners of the health profession,
(b) the technology, including instruments and materials, used by practitioners,
(c) the invasiveness of the procedure or mode of treatment used by practitioners, and
(d) the degree to which the health profession is
(i) practised under the supervision of another person who is qualified to practise as a member of a different health profession, or
(ii) practised in a currently regulated environment.
(2) The minister may also consider the following criteria:
(a) the extent to which the health profession has demonstrated that there is a public interest in ensuring the availability of regulated services provided by the health profession;
(b) the extent to which the services of the health profession provide a recognized and demonstrated benefit to the health, safety or well being of the public;
(c) the extent to which there exists a body of knowledge that forms the basis of the standards of practice of the health profession;
(d) whether members of the profession are awarded a certificate or degree from a recognized post-secondary educational institution;
(e) whether it is important that continuing competence of the practitioner be monitored;
(f) the extent to which there exists within the health profession recognized leadership which has expressed a commitment to regulate the profession in the public interest;
(g) the likelihood that a college established under the Act would be capable of carrying out the duties imposed by the Act, having regard to factors which in the view of the minister may affect the viable operation of the college;
(h) whether designation of the health profession is likely to limit the availability of services contrary to the public interest.
[am. B.C. Reg. 358/2004, s. 2.]

The appeal was based on a provision that concerns the health of the public and the judge decided that since the attorney general didn't show that it was obviously of no concern. My sister works on the appealate level and the amoutn of homework that goes into these briefs is redonkulous, the judge has seen any arguement that you are trying to mak eand considers them moot. So again if your digging for a bone try diggin somewhere else.

What else you got. :p

[Excalibur]

This question is made with an assumption that all opticians are now qualified to sight test. I am not, so I cannot answer your question. I do also want to hear what a sight testing opticians would do but they are an advanced trained optician and as such only the best and brightest will attain that level of practice.



Same to you as above. You guys really need to get off this kick it's going to happen with or without your venomous input, it would be nice to see optometry embrace it and help create something better for the patients, but it's not about that, apparently.

If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:

[tmorse]

I would LOVE to see the Schools and Colleges of Optometry work with us to design curricula and offer programs that can help us all along the path to higher levels of practice.
Warren

YOU MUST BE JOKING... You want to empower Optometry to propose curricula so that Opticians can do independant refractions to reduce OD incomes? Just re-visit the recent Ontario Refraction model that was recently developed by Ontario Opticians in conjuction with Optometry, and then compare it to the BC/ALBERTA model. Sight-testers in Ontario are now effectively hamstrung.

On the other hand, New York proposed a compromise that could work... Simply that every second refraction must be performed by an OD or OMD, along with the other present sight-testing safeguards already in place.

As to danger to the patient? In my mind, minimal. It has already been proven in surveys that 70% of all contact lens patients fail to follow the safety and hygiene protocols that both Opticians and OD's have stressed... and yet the hospital wards are not crammed to the rafters with eye complaints. If a patient is so concerned about safety he has an option... simply chose to forgo sight-testing services by Opticians and go to his OD every time for a Rx update.

[HarryChiling]

If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:

If you are going to use history at least use it correctly it was opticians and they were esentially selling ready made glasses from outside of jewelry shops. OD's as a profession stemmed from those brighter opticians in the back of jewelry shops who felt they could provide more accurate, so they educated themselves in refraction and called themselves OD's. Due to refractions not causeing any harm to the public over the years optometry has gained an incredible increase in scope of practice. Optometry of today is nothing at all like the optometry of your forefathers, and Ophthalmology was fighting it then like they fight now for therapeutics and other privledges.

If optometry was left to refractions alone that would be regression, but opticianry refracting is progress and as such should be embraced. Bakc then 2 years was adequate for refractions, and due to the success optometry as a profession has acheived I would tend to agree, that's is why opticians are now stepping up to the plate for that additional 2 years of education to learn refraction.

[tmorse]

Qiulk question to independant sight-testers. Yesterday I had a 53 years old male patient complaining that his vision seemed a bit "off". His last exam was less than one year ago. He was correctable to 20/20 OD, OS with a low minus Rx. Examination of the fundus OS revealed clinically significant macular edema. This is a serious ocular condition. How do you handle this situation? This is serious stuff and it's real.

Another canard!!:D You know that sight-testers don't use an ophthalmoscope, don't examine the fundus and don't diagnose. If he still complains that his vision seems a bit "off" after the sight-test, using the excellent logic of Admiral, send him pronto to an Ophthalmologist, which I assume YOU also did. :hammer:

[Oedema]

The appeal was based on a provision that concerns the health of the public and the judge decided that since the attorney general didn't show that it was obviously of no concern. My sister works on the appealate level and the amoutn of homework that goes into these briefs is redonkulous, the judge has seen any arguement that you are trying to mak eand considers them moot. So again if your digging for a bone try diggin somewhere else.

What else you got. :p

Try again Harry, the appeal is based on section 52 of the Health professions act which gives powers to seek injunction:

Injunction to restrain contravention

52 (1) A board or a person may apply to the Supreme Court for an interim or permanent injunction to restrain a person from contravening any provision of this Act, the regulations or its bylaws.
(2) A contravention may be restrained under subsection (1) whether or not a penalty or other remedy has been provided by this Act, the regulations or the bylaws.

And again, all I'm saying here is that your argument that sight testing is safe b/c of this case is disingenuous. The judge in this case did not render an opinion on whether or not sight testing is safe. That is not the role of the court in this case.

[tmorse]

If independent refraction was the norm and the right thing to do, we'd all still be refracting in the back of jewellery shops like they did a century ago. We (optometry, ophthalmology) have progressed from this, and you want to go backwards to this again? Shame shame.:finger:

Hey... Rolex watches at wholesale!! And it would solve the slow season between November and February. Excellent idea!!!:D

[Stonegoat]

Tmorse,

The correction of the myopia would have eliminated most of the visual complaints. I doubt he would have returned anytime soon claiming his vision was again "off", until he suffered from significant vision loss from the edema. Why should he have to wait a few more weeks to get a "prompt" referral?? More damage would likely occur while the patient spent time deciding if he just needed time to get accustomed to his new Rx. After all, he was correctable to 20/20.

As an aside, I saw a patienty about a year ago who had recently received a sight-test. She was not happy with her vision, and complained to the optician. He stated her vision is as "good as it gets"?? She came to me, of her own accord, with a 20/50 cataract (easy fix) and advanced glaucoma (not so easy).

There is NO WAY that fragmenting eye care is in the best interest of the patient...it's such an absurd idea it's hard to believe we are even debating it.

[tmorse]

What is Optometry's E&O Liability insuranc premium per year as determined by Actuaries? Not your office insurance premium or lost income insurance, but just the professional negligence coverage portion.

Stonegoat... Now where's my answer. What's your, or if you like, an average OD's E&O liability insurance premium per year?

[tmorse]

The correction of the myopia would have eliminated most of the visual complaints. I doubt he would have returned anytime soon claiming his vision was again "off", until he suffered from significant vision loss from the edema. Why should he have to wait a few more weeks to get a "prompt" referral?? More damage would likely occur while the patient spent time deciding if he just needed time to get accustomed to his new Rx. After all, he was correctable to 20/20.

He 's got a GP, doesn't he? And if more damage is likely to occur, then... my answer is "C'est la vie!" , Tough luck, Charlie, S*it happens... take your choice. Last year I developed an acoustic neuroma and I didn't blame anybody.

If all the protocols were followed, and the sight-tester achieved 20/20, all is well. I would suggest that he should have told his GP that his vision is "off" before attending at your office. How long did he sit on his hands?

I hope your GP puts on the rubber glove next time you present with the sniffles.:D:D