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Thread: Has sight testing been harmful to optometrists in BC?

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    Has sight testing been harmful to optometrists in BC?

    Hi folks

    I believe back in May 2010, BC permitted sight testing by opticians. Was this change in any way a game changer for ODs? What is the work/job scenario for optometrists in the province these days? Is there less work now available for ODs compared to before the new law was implemented? Or are ODs basically "equally" busy now, as before the rule change? Would an OD moving to BC from another province find it difficult to find adequate work?

    Thanks in advance.

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    Redhot Jumper “The main issue we have is that asymptomatic eye disease will go unchecked,” she says

    Kirsten North, president of the Canadian Association of Optometrists, says that automated sight tests aren’t comprehensive. “The main issue we have is that asymptomatic eye disease will go unchecked,” she says.

    For some eye diseases, such as glaucoma, early detection is the only way to prevent permanent damage. Symptoms occur late and lost vision cannot be recovered.Sight tests are also unable to detect problems such as retinal tears, corneal scars and eye tumours.

    Automated Sight tests, alone, aren’t an adequate basis on which to generate prescriptions, says North. Factors other than refraction, such as age and health status, must be considered. “Even something as simple as how tall someone is can affect a prescription,” she says.


    see all of it:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882486
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    Of course there are factors related to health, but much of that is scare tactics, Chris, and not really what the OP was asking. Has it affected ODs in BC? I have not seen any indication it has but would be interested to hear from those affected on both sides of the issue.
    Last edited by wmcdonald; 12-28-2017 at 08:16 PM.

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    Eyeglass and contact lens prescribing and dispensing regulations by province

    Quote Originally Posted by wmcdonald View Post

    Has it affected ODs in BC? I have not seen any indication it has but would be interested to hear from those affected on both sides of the issue.

    It for sure is affecting ODs as well as opticians because the sale of glasses is totally deregulated and opticians can test vision.

    PROVINCE/TERRITORY, GLASSES, CONTACT LENSES, British Columbia.
    A patient may obtain an eye glass prescription from an optometrist, physician or ophthalmologist. A patient may also obtain specifications for eye glasses from a sight testing optician. Both the optical prescription and sight test results must include a measurement of the interpupillary distance.

    The patient can either use the eye glass prescription or the sight test specifications to purchase eyeglasses anywhere that eyeglasses are available. Dispensing is deregulated in British Columbia.


    A patient must have an optical prescription or specifications from a sight test to initiate a CL fitting. A patient must have an initial CL fitting done by an optometrist, physician, ophthalmologist or optician.

    Initial CLs may only be dispensed by the above regulated professionals. Replacement CLs can be dispensed indefinitely by anyone including internet CL sites.


    source:
    https://opto.ca/sites/default/files/..._version_2.pdf
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    Thanks, Chris. I knew of those details, but I wonder if it has hurt the bottom line if the ODs. Are they seeing less patients? I have not been able to find detailed evidence of that anywhere in the literature. Are Opticians seeing an increase? Has there been an increase of significant ocular events due to this change. And I don't mean individual instances of something that should have been caught but was not.........that has always happened. I mean significant evidence of issues. Based upon the typical scare tactics, one would think half of BC was probably blind by now.

    As always, I appreciate your insights.

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    Quote Originally Posted by Chris Ryser View Post
    It for sure is affecting ODs as well as opticians because the sale of glasses is totally deregulated and opticians can test vision.
    I walked into a Vancouver Lenscrafters recently in a busy Cadillac Fairview mall and asked for the price of an eye exam. $125. I walked by 3 times on different days and not once did I see a single patient waiting in the waiting area. I don't think this qualifies as even an anecdote, much less data though.

    Internet dispensing is everywhere, not just in BC. But BC regulations are almost devised to encourage people to buy online, so you'd imagine online dispensing would affect brick/mortar stores there "at least as much or even more" than in other provinces. So I wonder how brick/mortar opticals have been affected. I was last in BC about 14 years ago, and I recall seeing more optical stores in malls then, compared to now. I recall seeing the stores of a lot more optical chains that I had never encountered in Ontario, that I didn't really notice this visit. At the time, seeing Pearle and Iris was new to me as they hadn't entered the Ontario market yet. And there was at least another "smaller" chain or two that I recall too, that I didn't notice this visit. But my survey isn't scientific of course.

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    the BC health minister was a principle in clearly.com before Lux bought them. Talk about a conflict of interest.

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    Dig deeper, to see the bigger picture, not just the provincial picture. Look at all the stakeholders, as well as all the shareholders.

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    I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?

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    Blue Jumper I wonder if someone can define "sight testing" for me................................

    Quote Originally Posted by rbaker View Post

    I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?


    Sight testing is a new definition on the new optical world market, and part of the revolution just about making its official start in 2 month by the Essilor/Luxottica merger.

    The USA is more than halfway deregulated and in Canada, BC and Quebec are done and they are working to do the same in Ontario.

    see the latest trend:
    https://health.economictimes.indiati...erjee/58744572
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    Quote Originally Posted by rbaker View Post
    I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?
    This is actually a good question. I imagine it is legally defined in the jurisdictions where it exists (i.e. BC). I'm assuming the BC optician governing body has outlined what constitutes a sight test. What I don't believe it is, is simply the results of an autorefraction used as the basis for an eyeglass prescription. Although speaking to pro-refracting opticians in the past (these folks took the optician refracting course offered in Barrie back in the day, like in 2005), my understanding is that that an auto-refraction --> eyeglass prescription was all they wanted from their lobbying efforts.

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    Blue Jumper This is actually a good question..............................

    Quote Originally Posted by optio View Post

    This is actually a good question. I imagine it is legally defined in the jurisdictions where it exists (i.e. BC). I'm assuming the BC optician governing body has outlined what constitutes a sight test. What I don't believe it is, is simply the results of an autorefraction used as the basis for an eyeglass prescription.

    The BC opticians website at http://www.opticians.bc.ca does not exist and is automatically diverted to the Canadian Dispensing Opticians Association.
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    In lieu of a formal definition I guess that I will just have to file "sight test" under "monkey business," "shenanigans" or "hankie-pankie" until something better comes along.

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    Blue Jumper

    Quote Originally Posted by rbaker View Post

    In lieu of a formal definition I guess that I will just have to file "sight test" under "monkey business," "shenanigans" or "hankie-pankie" until something better comes along.

    Welcome to the new age of deregulated optical retail operations in North America, South America, Europe, The Far East and Africa.

    Unless you make a living from direct service to the customer, which is a highly needed commercial activity, retail sales prices will be more and more influenced by online sales.


    Walmart’s (WMT, -0.22%) massive e-commerce investments are starting to pay off.

    The discount chain reported on Thursday that U.S. online sales rose a staggering 63%in the first fiscal quarter of the year, following last year’s overhaul of its online marketplace and a series of acquisitions of e-commerce companies since then, most notably its $3 billion purchase of Jet.com.

    http://fortune.com/2017/05/18/walmart-online
    Welcome to Anno Domini 2018, and its coming surprises
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    Quote Originally Posted by wmcdonald View Post
    Thanks, Chris. I knew of those details, but I wonder if it has hurt the bottom line if the ODs. Are they seeing less patients? I have not been able to find detailed evidence of that anywhere in the literature. Are Opticians seeing an increase? Has there been an increase of significant ocular events due to this change. And I don't mean individual instances of something that should have been caught but was not.........that has always happened. I mean significant evidence of issues. Based upon the typical scare tactics, one would think half of BC was probably blind by now.
    As always, I appreciate your insights.
    Ontario opticianry programs were teaching 'sight-testing' since 2005, until stopped by the Ontario government in 2009. BC was following Alberta's lead, and both produced tens of thousands of successful sight-testings until BC formally deregulated Dispensing in 2010, and permitted formally trained Opticians to sight-test. Optometrists were permitted to dispense certain TPA and BC Opticians were permitted to sight-test under certain conditions. Both were considered expansions of each professions' scope of practice. In BC, the fitting of Contact Lenses remains a regulated act, but not the sale of CL lenses.
    Optometrists are still found in abundant numbers in BC and Alberta, over ten years after sight-testing by Opticians was first introduced. So I too would like to hear some views from some BC Optometrists.

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    Also thanks to the fact that the BC health minister had a financial interest in Clearlycontacts (now Clearly) at the time.

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    Quote Originally Posted by optical maven View Post
    Also thanks to the fact that the BC health minister had a financial interest in Clearlycontacts (now Clearly) at the time.
    Would you kindly provide what facts you rely upon for this financial interest allegation?

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    The way I heard the conflict of interest allegation (back in 2004, regarding their eventual right to refract) was that the BC Health Minister's sister was an optician.

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    I took this photo at the Richmond Centre (6551 No 3 Rd, Richmond, BC V6Y 2B6) in BC. It's a high end mall with the Cadillac Fairview chain.
    https://www.cfshops.com/richmond-centre.html

    They had an LC with a side-by-side optometry office, an Iris (though I can't say I identified the location of the OD office when I walked by it), and an Eyestar Optical (they have a locations in the Scarborough Town Centre and (IIRC) Square One as well, and probably others). I didn't notice any other "opticals or optometrists" in the mall, though there may have been. I took an image of a sign in front of Eyestar. As you can see by the image, they offered "Sight Testing".

    One observation: In the sign, they use an image of someone being examined using a slit-lamp, which implies an ocular health check rather than a refraction. A more appropriate image would be of someone being examined using a phoroptor. I would normally be suspicious that the choice of the slit-lamp image was deliberately intentional, but I think they use the same image in the Scar TC location advertising eye exams, so it's probably more of a chain-store-same-sign-is-used than an attempt to mislead customers (patients) into thinking the sight test they are getting is an eye exam, but nonetheless, it deserves scrutiny.

    One personal query: Iris and LC use optometrists. This store uses sight testers. I wonder if that is a "choice" by the store to use ST as opposed to offering optometrist examinations? I'm curious if some opticals prefer the use of ST over ODs because they think an ST will make them more competitive than an OD would (e.g. perhaps they don't charge for the ST). Or do such opticals use STs because they don't have easy/reliable access to an OD?
    Attached Thumbnails Attached Thumbnails IMG_20171230_092801.jpg  

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    Quote Originally Posted by rbaker View Post
    I wonder if someone can define "sight testing" for me. I'm confused. Is it a refraction, a screening or eye exam or is it some sort of new procedure?
    Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer. It is done by a trained technician, using computer aided software. The final results (subjective) are compared to the clients existing glasses prescription.
    The whole procedure uses Snellen charts to determined visual acuity. The final results are sent via fax to an eye doctor for final approval by an ophthalmologist. This system works nearly flawlessly. I have used mine for almost 10 years. Redo rate is maybe 1%. It is explained to the potential client as being a non medical exam. No determination of eye health. The client must sign a waiver stating that the procedure is strictly used to determine a prescription for eyeglasses or contact lenses.

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    Quote Originally Posted by mike.elmes View Post
    Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer. It is done by a trained technician, using computer aided software. The final results (subjective) are compared to the clients existing glasses prescription.
    The whole procedure uses Snellen charts to determined visual acuity. The final results are sent via fax to an eye doctor for final approval by an ophthalmologist. This system works nearly flawlessly. I have used mine for almost 10 years. Redo rate is maybe 1%. It is explained to the potential client as being a non medical exam. No determination of eye health. The client must sign a waiver stating that the procedure is strictly used to determine a prescription for eyeglasses or contact lenses.
    Well said. It's a beautiful accurate system. And having an optician do the entire process is why it is 1% error vs. 10% coming from the OD offices.

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    Blue Jumper Well said. It's a beautiful accurate system.........................................

    Quote Originally Posted by Lab Insight View Post

    Well said. It's a beautiful accurate system. And having an optician do the entire process is why it is 1% error vs. 10% coming from the OD offices.


    ........................just like to add one more thing on the subject.


    This system is and has been used all over the world, just about forever, and is nothing new, and has worked fine just about forever.

    The North American Continent is lagging behind the world in this field.
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    Quote Originally Posted by Chris Ryser View Post
    ........................just like to add one more thing on the subject.


    This system is and has been used all over the world, just about forever, and is nothing new, and has worked fine just about forever.

    The North American Continent is lagging behind the world in this field.
    Correct, and the lag is caused by the same group of innovators that are currently trying to take on the largest lens manufacturer in the world.

    The legislation and policies need to change to better serve the public.

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    Quote Originally Posted by mike.elmes View Post
    Sight testing is an evaluation of refractive error of the eye. It is accomplished as a refraction done with an autorefractor, autophoropter, and lensometer.
    I understand that this is how "you" have sight tested these last 10 years, but is this how "sight testing" is defined in BC? What is permitted in BC as sight test? Or does it require all the apparatus you describe? Or can it simply be an optican who uses a mechanical phoroptor (or even just an autorefractor?) to refract?


    Edit: I ask these questions because my understanding of the intent of sight testing has always been to simply "eliminate" the optometrist from the sale of a pair of glasses. It wasn't intended to replace the him/her.
    Last edited by optio; 02-09-2018 at 10:16 AM.

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    The question isn't how it affects ODs in Canada, but the public health.

    Statistics take a while to compile, but there will be an increase in prevalence of eye disease, guaranteed.

    What's more immediate is the decrease in visual efficiency, which is more than guaranteed to happen.

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