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Thread: Ontario Opticians refracting?

  1. #1
    Master OptiBoarder mike.elmes's Avatar
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    Ontario Opticians refracting?

    Just noticed this has been posted on the COO website. Any thoughts from members in Ontario regarding this next step.

    http://www.ontario-opticians.com/OOA...y_Nov_2007.pdf

  2. #2
    registeredoptician Refractingoptician.com's Avatar
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    Quote Originally Posted by mike.elmes View Post
    Just noticed this has been posted on the COO website. Any thoughts from members in Ontario regarding this next step.

    http://www.ontario-opticians.com/OOA...y_Nov_2007.pdf

    Yeah, gives me a headache reading it . The nuts and bolts of the whole thing indicate that a plan is in motion and is about to be played out in accordance with some master plan , which has not been revealed in it's entirety ... and won't be .

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    bilateral peripheral scotoma LandLord's Avatar
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    Optician refracting is likely to happen. It's one of those issues that has an underlying human rights feel to it. It reminds me of the gay marriage issue here. Many powerful groups may fight vigorously against it. Some say it's evil. But in the end, how can you stop it?

  4. #4
    Excalibur
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    To better answer the direction the Ministry of Health in Ontario is heading with opticians and refraction, please refer to the following document (specifically pages 292-293):

    http://www.hprac.org/en/reports/reso...il_2006_EN.pdf

    HPRAC has effectively advised the Minister of Health that opticians refracting without direct OD or OMD supervision and independent of a complete ocular assessment is a no-no.

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    I'm personally against it. I point to things like this when we wonder to ourselves why Optometrists fight so hard to keep their non-licensed people. Why are we pushing for this? You want to refract? Become an optometrist. Why do some think this is ok for us to do, then cry bloody murder when an Optometrist has joe blow off the street adjusting a pair of glasses? :\

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    Then Don't.......

    If you are against it, simply don't do it. No one is making you take the courses, etc. to learn to refract. For those who wish to do so, keep in mind it is not a free ride. It will require additional education and training, but it is a reachable goal if we work together with the other two Os to develop a model acceptable to all. ODs heard much of the same "I am against this" and "if you want to prescribe drugs, go to med school" baloney, but they studied for years and made things happen. It should not discourage those who want to do more. Learn and expand your mind. That is the way Opticians regain some lost ground. There will be a place for those who do not wish to participate, nuch like many older ODs did not take the theraputetic courses to allow them to utilize prescription pharmeutucals.

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    ATO Member HarryChiling's Avatar
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    I have said it before and I will say it again, I don't want to refract, but I do want our profession to have the ability too if we choose. I would also take a class on refraction even though I don't feel my time is better spent doing other things int he practice.

    I congratualte the Canadians for pushing the envelope. Here in teh states we worry about weather we are going to lose another licensed state or not while up north they are gaining ground, I envy our neighbors to the north.
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  8. #8
    Excalibur
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    I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    I don't see any problems in patient care if an optician refracts as long as it is part of a complete assessment under the supervision of an OD or OMD.
    I think that's the model, it makes sense to me too.
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  10. #10
    Excalibur
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    the conduct of Bruce Bergez (discussed elsewhere on Optiboard) is hurting the political position of opticians with the Govt of Ontario. In Canada, health legislation is largely dictated at the provincial level, and Mr. Bergez is not making things easier for his peers.

  11. #11
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Excalibur View Post
    the conduct of Bruce Bergez (discussed elsewhere on Optiboard) is hurting the political position of opticians with the Govt of Ontario. In Canada, health legislation is largely dictated at the provincial level, and Mr. Bergez is not making things easier for his peers.
    He is a bad example for an optician, didn't he get his license pulled?
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  12. #12
    Excalibur
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    I think he is still licensed in Ontario. Perhaps a fellow board member can clarify his status.

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    Quote Originally Posted by wmcdonald View Post
    If you are against it, simply don't do it.
    I cannot agree more!!
    British Columbia took the Alberta 'refraction' model, tweaked it a bit, added public protection notice(s) and refraction exemptions, and then made education in refractometry mandatory for those engaged in this area.
    Proper 'Errors & Omissions' liability insurance is in place and the whole process is a credit to College of Opticians of BC, the Alberta Board of Opticianry and the Opticians Association of Canada, all of whom collaborated with the BC government to achieve something truly grand for Opticians. And the public interest is maintained.

    Ontario's COO would do well to emulate BC in this matter rather than try to re-invent the wheel. :cheers:

  14. #14
    Excalibur
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    does the BC model permit self-standing/independent refraction by opticians, or does the OMD or OD have to see the patient at the same time the optician is conducting the refraction?

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    I work as an OD in BC and opticians conduct "sight-tests" without any direct or indirect supervision by an OD or MD. Essentially a refraction is performed without any ocular health assessment. Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received. They were NOT refered by the "sight-testing optician, but came of their own accord.

    I completely aggree that opticians can and should be trained to refract. I think it's inevitable, and a reasonable scope expansion. I however, do not agree with the concept of fragemented eye care, and I think a refraction should always be in conjunction with an ocular health assessment by an OD or OMD.

  16. #16
    Excalibur
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    Stonegoat-- great post. Thanks for the clarification.

  17. #17
    Excalibur
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    which brings me to another observation....

    refraction-only visits were the 'norm' decades ago. Going to this sort of scenario is regressive patient care.

    If you haven't looked inside the patient's eye, how can it be called an assessment? This is certainly is not in the patient's best interest.

    There are many, many patients I see monthly that would be far worse off if all I counted on was refractive data to judge their eyehealth/visual prognosis.

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    Exactly.....I would not sleep at night if a did refractions all day without assessing ocular health. It is a rare day where I don't have at least one patient that presents to me thinking they only require new glasses, when the underlying etiology of their decreased vision is not refractive, but rather previously undiagnosed pathology. What worries me is that many of these patients are correctable to 20/20.

    Unfortunately, money is the underlying motivation for wanting to independently refract, and money is a powerful motivator.

  19. #19
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    [quote=Stonegoat;215026]Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received. /quote]

    What a canard!! Don't be mislead Optiboarders. Stonegoat and his OD colleagues already tried this gambit with the BC government, but government was not fooled.

    Refracting BC Opticians have various mandatory refraction protocols in place... no patients under 19 and over 65 allowed, and they reject patients suffering from glaucoma, diabetes, etc. These they DO refer to OD's/MD's (but obviously not Stonegoat) for proper eyehealth assessment and patients sign a Card indictating that they know they are not receiving an eyehealth assessment. Also, anyone who can't be refracted to 20/20 is automatically sent to a Doctor. See www.cobc.ca for Sight-Testing Protocols mandated by the regulatory College of Opticians of BC.
    A simple 'sight-test' refraction is not and has never been presented as a medical assessment or eyehealth diagnosis. Mandatory three (3)-million ($3,000,000.00) Errors & Omissions liability insurance is still only $75.00/year, only because of the paucity of caselaw on this issue. Three (3) years ago it was 10,000 patients who received a free sight-test in BC. Today that figure is probably 15,000 satisfied BC's who haven't had any problems.
    But Stonegoat is correct about one thing... it is about the money.

  20. #20
    Excalibur
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    [quote=tmorse;215039]
    Quote Originally Posted by Stonegoat View Post
    Is pathology missed?? Absolutely. I have had patients with everything from glaucoma, diabetes, cataracts, brain tumours, etc etc, who were "sight-tested" and came to me for a second opinion, because they were not happy with the glasses they received. /quote]

    What a canard!! Don't be mislead Optiboarders. Stonegoat and his OD colleagues already tried this gambit with the BC government, but government was not fooled.

    Refracting BC Opticians have various mandatory refraction protocols in place... no patients under 19 and over 65 allowed, and they reject patients suffering from glaucoma, diabetes, etc. These they DO refer to OD's/MD's (but obviously not Stonegoat) for proper eyehealth assessment and patients sign a Card indictating that they know they are not receiving an eyehealth assessment. Also, anyone who can't be refracted to 20/20 is automatically sent to a Doctor. See www.cobc.ca for Sight-Testing Protocols mandated by the regulatory College of Opticians of BC.
    A simple 'sight-test' refraction is not and has never been presented as a medical assessment or eyehealth diagnosis. Mandatory three (3)-million ($3,000,000.00) Errors & Omissions liability insurance is still only $75.00/year, only because of the paucity of caselaw on this issue. Three (3) years ago it was 10,000 patients who received a free sight-test in BC. Today that figure is probably 15,000 satisfied BC's who haven't had any problems.
    But Stonegoat is correct about one thing... it is about the money.
    Perhaps it's time for pharmacists to be permitted to dispense HBP meds on the basis of an automated BP measurement?

    If a patient is sight-tested for a number of years and never has a retinal or glaucoma assessment... and the asymptomatic condition worsens due to delay, have we improved this individual's situation? Hardly.:finger:

    Sight-testing has not been designed for the greater good of patients, but rather for the greater good of commercial interests. A hundred years ago, the ophthalmic professions moved forward by taking refraction out of the back of jewelery and optical shops and rightly association with a comprehensive oculo-visual assessment. Fragmenting this care into independent sight-testing does little to improve the evolution of eye care for patients.

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    I have seen many patients post "sight-test" who have had problems. I'm sure I'm not the only OD who has. When a patient presents to an optometrist for an eye exam, they are evaluated under the SOAP (subjective, objective, assessment, plan) format. This format, for the most part, ensures optimum patient care. Without an ocular health assessment, the objective, assessment and plan will be incomplete, or completely incorrect.

    I understand sight-testing opticians will never understand what it is an optometrist really does during the course of an exam. I would not expect them to.

    By the way, what is a "canard"??? Is that a term for a well-endowed, highly sophisticated, incredibly handsome man?? If so, when did we meet??

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    bilateral peripheral scotoma LandLord's Avatar
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    Fragmentation or Divergence?

    I hear OD's use the term "fragmentation of eyecare" to describe refraction being performed as a solo service. You also suggest it's a regression of care. Quite the opposite, it's a progression of care if you look at the direction history has taken.

    A better term would be "divergence of eyecare."

    All disciplines diverge into new specialties over time. It's a basic law of the universe.

    In the old days, all medically related disciplines were practiced by general medical practitioners.

    Today we have many disciplines.

    Allergy & Immunology
    Anesthesia
    Cardiology
    Dermatology
    Emergency Medicine
    Endocrinology
    Family Medicine
    Gastroenterology
    Geriatric Medicine
    Gynecology
    Gynecologic Oncology
    Hematology
    Infectious Disease
    Internal Medicine
    Neonatology
    Neurology
    Nephrology
    Neurological Surgery
    Obstetrics and Gynecology
    Oncology
    Ophthalmology
    Orthopedic Surgery
    Otorhinolaryngology
    Pathology
    Pediatrics
    Physical Medicine and Rehabilitation
    Plastic Surgery
    Podiatry
    Preventative Medicine
    Psychiatry
    Pulmonary Disease
    Radiology
    Radiation Oncology
    Rheumatology
    Sports Medicine
    Surgery

    Of course, this is only a partial list that doesn't include sub-specialists like

    Chiropractors
    Dental hygienists
    Dental technicians
    Dentists
    Denturists
    Dieticians
    Hearing aid dispensers
    Massage therapists
    Midwives
    Naturopathic doctors
    Opticians
    Optometrists
    Pharmacists
    Physical therapists
    Podiatrists
    Psychologists
    Nurses

    Of course this is also only a partial list that does not include sub-sub-specialities even within a speciality.


    Within ophthalmology you have

    Cataract specialists
    Retinal specialists
    Lasik specialists

    Within optometry you have

    Low vision
    Pediatric vision
    Lasik center optometry

    Within opticianry you have

    contact lens specialists
    sports vision
    fashion eyewear


    Why is this the case? The more that is learned about the human body, the more specialists are needed to practice the new disciplines. Imagine one medical practitioner trying to provide care in all of the above areas. As ophthalmology branches off into new surgery fields and optometry expands its scope into medicine, there are more new eye-related specialties than there are eye-related specialists. I repeat, THERE ARE MORE NEW EYE-RELATED SPECIALTIES THAN THERE ARE EYE-RELATED SPECIALISTS. We need to add one more specialty to the list. Refracting optician.

  23. #23
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    Quote Originally Posted by HarryChiling View Post
    He is a bad example for an optician, didn't he get his license pulled?
    Yes Bruce Bergez's liscence is has been revoked.

    Regards,
    Golfnorth

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    I agree, I have no problem with opticians refracting. But only with a concurrent eye health assessment. There are many specialties, sub-specialties, etc. However, if a patient has seen an oculoplastics surgeon, the patient has likely been triaged to that specialist by another individual, fully capable of determining the best treatment /referral options for the patient. This is done by an exam under the SOAP format, irregardless of the specialty. Treatment decisions made by an individual that cannot obtain all the neccessary objective data, such as an independent sight-testing optician, leaves an unacceptably high risk of missed pathology.

    Any statement otherwise would be a "canard"....new word of the day!!

  25. #25
    bilateral peripheral scotoma LandLord's Avatar
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    Stonegoat, can you please elaborate on "obtain all the necessary objective data?"

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