Regulation of optometry in Australia

Optometry in Australia is regulated by legislation in each of its six states and two territories, with the result that there are eight optometrists registration acts. Different legislation again regulates optometry in New Zealand, making a total of nine registering authorities in Australia and New Zealand, each working under a different regulatory regime.     

Competency standards for entry-level to the profession of optometry 1993

Competency standards for entry-level to the profession of optometry in Australia were established after a process of interview, observation of optometric practice, workshops and consultation with the profession. The standards developed consisted of eight units to represent the skills and attributes expected of an optometrist who is to be registered for the first time. The units were broken into 37 elements to illustrate the components of each area and the elements were accompanied by performance criteria which, when observed, can provide evidence of the ability of the person to perform to a degree necessary for the appropriate practice of optometry. The standards were developed for the profession as it exists in 1993 and will be updated progressively as required.     

The Australian optometric workforce 2005

Background: This paper presents the findings of the Optometrists Association Australia 2005 optometric workforce study. Methods: Data from the association’s database, the Australian Bureau of Statistics, Medicare and the Department of Veterans Affairs were applied to create a profile of the optometric workforce in Australia, including the number of equivalent full‐time optometrists (EFTOs), population to optometrist ratios and workloads. Results: In February 2005, 2,866 (76.7 per cent) of the 3,738 optometrists registered to practise in Australia were in clinical practice. Adjusting for the number of hours worked, there were 2,712 EFTOs in Australia. The ratio of population to EFTO for Australia was 7,016. Ratios were higher in the states without schools of optometry (South Australia 9,413, Western Australia 8,810 and Tasmania 8,172) and in the remote and lightly populated Northern Territory (10,521). The lowest ratio was in New South Wales (6,053). The proportion of women in clinical practice has gradually increased since 1977 and was slightly more than 41 per cent in 2005. The percentage of the profession under the age of 40 years was 48.6. The percentages of female and male optometrists under the age of 50 were 89.3 and 72.5, respectively. On average, female optometrists worked approximately 82 per cent of the hours worked by male optometrists. The average time per week spent on Medicare and Veterans Affairs consultations was 25.8 hours. Conclusions: The profession of optometry in Australia is undergoing considerable change in age and gender make‐up. In 2005, the number of optometrists was adequate for the needs of the Australian population. Further analysis is needed to determine whether the supply of optometrists meets community needs at local levels.     

New Zealand optometrists 2006: demographics,working arrangements and hours worked

Background: Optometry is a regulated health profession in NZ, with limited student places. With 650 registered optometrists in 2005, the optometrist to population ratio was 1 : 6,291 with no apparent national shortage. If optometrists registered in NZ do not actually live there, a workforce shortage is possible. This paper presents findings from the New Zealand Association of Optometrists 2006 workforce survey of members, which aimed to profile the NZ optometric workforce and to explore factors relating to workforce capacity, job stress and future planning. Methods: A questionnaire was developed to collect information on employment status, hours worked and gender distribution of optometrists in New Zealand. It was circulated to 530 active members of the NZ Association of Optometrists representing 86 per cent of the available optometrists. Direct comparisons with the Australian optometric workforce numbers were also undertaken. Results: Of the 243 respondents, 129 (53 per cent) were male. The median age of all respondents was 39 years (46 for males and 34 for females) and 75 per cent of the respondents were aged younger than 50 years. Fifty per cent had practised 15 years or less. Ten per cent of respondents had ‘time‐out’ during their career and this was significantly more likely for females. Nearly half the respondents were self‐employed (46 per cent) and eight per cent worked as locums. Part‐time employees were more likely to be female and males were more likely to be in full‐time self‐employment. Half the group was under 40 (51 per cent), which accounted for 86 per cent of the full‐time salaried arrangements. Those aged 30 to 39 included 52 per cent of the total part‐time salaried workers. The average working week was 34 hours for women and 39 hours for men; the median was 40 hours for both groups. In the typical working week, 80 per cent of an optometrist's time was spent consulting with patients and five per cent was patient‐related paperwork. The distribution of work arrangements was remarkably similar among New Zealand optometrists, New Zealand GPs and Australian optometrists. In 2006, there were 619 optometrists assessed as working in New Zealand. This equated to 544 EFTOs and a ratio of EFTO to population of 1 : 7,517. Conclusions: The New Zealand optometric workforce in 2006 was sufficient to meet the overall population needs. One‐third of optometrists chose to work part‐time and the proportion of female optometrists has increased over the past 15 years. In the face of expected increasing demand for optometric services, a targeted expansion of the workforce appears desirable.     

The mobility of optometrists practising in Australia in 2005: Do optometry graduates move to states without schools of optometry?

Background: Three schools of optometry in the eastern states of Australia provide optometrists for the entire country. Concerns have been expressed about attracting optometrists to practise in the other states. This paper analyses the source of optometric qualification of optometrists practising in each state, to assess the proportion who have chosen to practise in a state different from that in which they qualified and to determine whether there are gender differences in preparedness to move to a different state. Method: Data on year and school of qualification, primary professional activity and current state or territory of practice were extracted from the Optometrists Association Australia database to determine a profile of place of qualification of optometrists in each state or territory of Australia in 2005. Results: More than 77 per cent of practising optometrists from Australian schools practised in the state where they graduated. The majority of optometrists for the Australian Capital Territory (ACT), South Australia (SA) and Western Australia (WA) were New South Wales graduates; the majority of Tasmanian optometrists were Victorian graduates. Optometrists from overseas accounted for 17.3, 24.6 and 19.9 per cent of optometrists in practice in SA, Tasmania and WA, respectively, but less than 7.5 per cent elsewhere. The highest number of optometrists who had qualified outside Australia practised in NSW. Female graduates from 2000 and later were more likely to move interstate than their male counterparts. Discussion: Approximately 14 per cent of practising optometry graduates practised in states without schools, where 21 per cent of the population resided. This indicates some degree of mobility but the market needs to work further to match supply of optometric services to demand at state level. Further analysis is necessary to determine patterns of graduate movement in the years following graduation, to determine whether movement to different states is short‐ or long‐term.     

The Australian optometric workforce 2009

Background: This paper presents the findings of the Optometrists Association Australia 2009 optometric workforce study. Methods: Data from the Association's database, the Australian Bureau of Statistics, Medicare Australia and the Department of Veterans Affairs were applied to create a profile of the optometric workforce in Australia, including the number of optometrists in clinical practice, the number of equivalent full‐time optometrists (EFTOs), population to optometrist ratios and workloads in the states and territories and Australia overall. Results: In July 2009, 3,719 (87.4 per cent) of the 4,255 optometrists registered to practise in Australia were in clinical practice. Adjusting for the number of hours worked, there were 3,664 EFTOs. The ratio of population to EFTO was 5,944:1 overall. Ratios were higher in the states without schools of optometry (South Australia 8,631:1, Western Australia 7,687:1, Tasmania 7,615:1, Australian Capital Territory 7,635:1) and highest in the remote and lightly populated Northern Territory (9,367). The ratios were fewer than 6,200 people per EFTO in states with optometry schools: New South Wales (5,247), Queensland (5,723) and Victoria (6,126). Women comprised 45.3 per cent of the profession, while 45 per cent of the profession was aged under 40 years. The majority of the female (80.7 per cent) and male (60.7 per cent) optometrists were aged under 50 years. On average male and female optometrists worked 40.3 and 32.9 hours per week, respectively. The average time per week spent on Medicare and Veterans Affairs consultations was estimated to be 22.2 hours, varying from 20.1 hours in NSW to 30.6 hours in SA. Conclusions: Population to optometrist ratios indicate that the number of optometrists in 2009 was more than adequate to meet the needs of the community. Further analysis is needed to determine whether the supply of optometrists meets community needs at more local levels.     

The development of competency-based assessment for the profession of optometry

Background : In 1993, the Australian Optometrical Association developed competency standards for entry-level to the profession.¹ These competencies were the basis for the development of an assessment process to determine suitability for entry to the profession. Methods : The competency standards were ranked in order of importance for assessment. Methods were developed to assess the competencies with a number of methods used to assess more highly ranked competencies. A pilot examination was conducted to test the process. Passes were awarded if the performance of the candidate was suitable for entry-level to the profession. Results : The final examination consisted of: Two written papers (six hours), containing a number of case histories and requiring short answers, were used to assess knowledge in basic and clinical science and application of this knowledge clinically. A ‘diagnosis and management’ paper (two hours), containing photographic information accompanied by case histories, was used to assess ability to interpret information and offer diagnoses and management options. Skills station assessment (three and one-half hours) was used to assess the performance of 21 clinical skills. Clinical examinations were used to assess the performance during a full optometric examination, with the interpretation of results and determination of management plans.     

World optometry: the challenges of leadership for the new millennium.

The World Council of Optometry has developed a mission and organizational strategies to improve the delivery of eye and vision care around the world, as well as to advance the profession of optometry. Its growth over the past several years is a tribute to the early pioneers in international optometry who unselfishly volunteered their time and expertise to improving the profession and eye and vision care. It also underscores the continued spirit of global volunteerism that energizes the recent leaders who have sustained this growth. Over the past decades, optometry has seen the steady growth of its educational infrastructure, scope of practice, and professional image. It has faced adversity and seized opportunities. Throughout, the overarching raison d'être has been optometry's responsiveness to the public health needs of society. The future growth of optometry within the global health community will depend on expanding this professional growth at an international level, and forging durable strategic alliances that address the significant prevention of blindness imperatives of our generation.     

The 75th anniversary of the World Council of Optometry: Seventy‐five years of advancing eye care by optometrists worldwide

SUMMARY Over 75 years, the World Council of Optometry has developed as an organisation with the mission and appropriate strategies to improve the quality of eye and vision care around the world, especially by advancing the delivery of that care by educated, regulated, primary care optometrists. However, WCO is unknown to most optometrists and ‘international optometry’ is not part of the optometric curriculum in our schools, just as it is rarely on the agenda of our professional associations. As a consequence, many optometrists do not understand the difficulties faced by their colleagues in other countries, in both clinical and political challenges. Australian optometrists are regulated by law, educated at state universities, eligible for service coverage by universal health insurance, able to detect disease in the eye using diagnostic agents and, in increasing numbers, able to treat disease in the eye with therapeutic drugs. However, this community standing and professional privilege, taken for granted by most Australian optometrists, cannot be exported. In fact, an Australian optometrist would be jailed in many countries around the world just for doing the ordinary clinical procedures that he or she does on every patient, by routine, day in and day out. All optometrists should feel ownership of WCO and all should have a commitment to its mission to facilitate the enhancement and development of eye and vision care by optometrists worldwide. Australian optometrists are already linked to WCO through their membership of Optometrists Association Australia, which is itself a longstanding and valued member of WCO. To prosper for a further 75 years, WCO needs continued global volunteerism and from those unable to directly participate, financial support through donations and sponsorship.     

The role of optometrists in India: An integral part of an eye health team

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.     

The unification of European optometry: how the profession will change after 1992.

The economic integration of the European Community (EC) targeted for 1992 has the potential to change the course of the development of the optometric profession in Europe. One of the goals of this integration is to create within Europe an environment free of professional barriers, such that European professionals will be able to practice their skill anywhere within the Community. Because optometry is practiced so differently among the 12 EC countries, the development of a system of reciprocity for optometric credentials in Europe will be a difficult task. Currently, there exists a strong movement, headed by the Association of European Schools and Colleges of Optometry (AESCO), to unify the profession by creating a European-wide examination for optometry. The implications of such an examination are tremendous in that it will establish a standard for the delivery of optometric care not only for the 320 million people within the EC, but also world-wide. The purpose of this paper is to examine the current status of optometry in Europe, to review efforts by both the EC and AESCO to unify the profession, and to discuss the impact of recent developments on the future of optometry not only in Europe, but throughout the world.     

The accreditation of university teachers: an optometric viewpoint

The issue of whether university teachers should be required to gain a formal teaching qualification is currently under debate. In the United Kingdom, the development of an accreditation system for university teachers is well advanced. In the future, Australian university teachers may be required to either:

• 1 prove their teaching competency
• 2 undertake teaching courses as part of their induction program.

Of the current full-time academic staff of the optometry schools in Australia and New Zealand, about 15 per cent have undertaken university courses on higher education teaching: two of 10, one of 12, one of six and one of six for the optometry schools at the Queensland University of Technology, The University of New South Wales, The University of Melbourne and The University of Auckland, respectively. In terms of undergraduate optometry students' views, of those who responded (43 per cent of QUT third and fourth year students) to a survey on a range of teaching and learning issues, 20 out of 26 thought that a teaching qualification should be a requirement, while only six thought that it was not necessary. It has been suggested that an accredited training system is one way of ensuring that university teachers have the skills to deal with a dynamic teaching environment and the challenges of the future. The quality of teaching in universities has particular relevance to the optometric profession both in terms of undergraduate students and postgraduate experiences.     

Critical incidents described by new optometry graduates

Background : In the process of developing competency standards for entry-level to the profession of optometry, the critical incident technique was used with new graduates to ensure that there were no omissions from the standards developed in workshops. The information gained from these incidents also provides insights into the experiences and difficulties of new graduates as they make the transition from student to optometrist. Methods : The critical incident technique was used to obtain information from recent optometry graduates by means of telephone interview and questionnaire. Thirty per cent of 1991 Australian optometry graduates were interviewed. Optometrists were requested to provide details about a demanding incident for which the outcome was clearly satisfactory or unsatisfactory or one which captured the ‘essence’ of optometry. The incidents were then considered for the systems involved (for example, retina, lens), the problems experienced by the patient and the optometrist, the skills required by the optometrist, the attitude of the optometrist and what was learned from the incident. Results : The incidents that caused the greatest concern to new graduates were those which involved referral of the patient particularly with respect to the urgency of the referral. Other frequently occurring incidents involved some degree of vision loss, difficulties with the behaviour of the patient, choice or availability of ophthalmologist and issues relating to communication. Conclusion : Critical incident interviews and questionnaires can assist in determining the difficulties experienced by new optometrists and can provide useful information to employers and educators. The incidents showed that the major area of concern was the urgency of referral, reflecting the inexperience and lack of exposure of new graduates to ocular conditions. (Clin Exp Optom 1995; 78: 6: 227–235)     

Some History Notes on Optometry's Involvement with the Australian and New Zealand Association for the Advancement of Science

ABSTRACT The histories of the Australian and New Zealand Association for the Advancement of Science and of the Australian Optometrical Association have interacted to the past advantage of optometry. From a fledgling in ANZAAS, optometry has advanced to be a discipline with its own body of knowledge well equippedNo identify and to pursue courses of research to advance the bounds of that body of knowledge. Lacking its own specialist scientific society optometry still seems to need ANZAAS. This paper ends by considering what duties optometry may owe to ANZAAS.     

HALLMARKS OF A PROFESSION

The banquet address delivered at the 1978 meeting of the American Academy of Optometry. A review of the criteria of a profession and an evaluation of optometry in meeting these criteria.     

Practice standards for optometry and optometric practice accreditation

Background: To assist optometrists to deliver care more efficiently and effectively, in 1995 Optometrists Association Australia decided to develop standards that would assist optometrists in better managing their practices. Existing practice management standards for health professionals were thought to be either not specific enough for optometric practice or to have shortcomings in the context of optometric practice in Australia. Methods: Following a literature search, material previously developed by Optometrists Association Australia to assist practitioners with management of their practices and standards from other professions were used to assist with the development of a draft set of standards for optometric practices in Australia. Successive drafts were circulated for comment to optometrists in practice, non‐optometrists with experience in the development of practice standards for other health professions and to Australian General Practice Accreditation Limited. The comments were used to refine the standards and the accreditation guidelines to their final form. Results: Optometric Practice Standards suitable for use in a practice accreditation program were developed. The standards comprise seven sections—Practice administration, Quality assurance, Rights and needs of the patient, Practice services, Practice facilities, Communication and Patient records. These sections are divided into criteria that provide the detail of the requirements of the standard. Indicators describing how criteria can be assessed accompany the criteria.     

Should optometry evolve as a vertically integrated discipline that includes all components of ophthalmology?

Change in the optometric profession is inevitable. Persuasive economic factors will play a great role in shaping the future of optometry and ophthalmology. Optometry is in a position now and into the future to leverage its great strengths to benefit the public in a cost conscious manner.     

Women optometry students: how qualified?

This study compares the academic and personal qualifications of women and men entering the University of Houston College of Optometry (UHCO) over a 6-year period, as well as the performance of these women and men throughout 4 years of optometry school. As predicted, women, as a group, presented somewhat higher grade point averages (GPA's) upon application to optometry, whereas men presented higher scores on science, especially physics, and math sections of the Optometry College Admission Test (OCAT). Women also scored significantly higher on an inventory of positive personality traits generally associated with achievement in higher education. Despite these differences, women and men performed at essentially equivalent levels throughout optometry school, both in the classroom and in the clinic. Women were under-represented as dropouts and over-represented as summa cum laude graduates; men received more clinical performance awards. In terms of personality traits, women were more similar to their male peers and female medical students than to college women in general. Strong motivation to achieve, independence, self-confidence, interpersonal skillfulness, and a sensitivity to others--traits generally associated with leadership--typified optometry students, especially women. These findings suggest that the increasing numbers of women graduates will bring to the profession young optometrists who are well qualified, not only to practice optometry, but also to fill positions of leadership in the profession.     

An overview of the current drugs scene

Ophthalmic drugs, both diagnostic and therapeutic, play a central role in new developments in optometry, particularly as practitioners extend their involvement in primary care. Optometrists now dilate more patients in routine practice, and this brings increasing concern about the risk of provoking acute closed angle glaucoma (CAG) attacks. It would seem that the risk of inducing acute CAG is far outweighed by the potential benefit of examining the eye through a dilated pupil. Driving difficulties, reported subjectively to be the result of glare, are frequently encountered by patients after dilation, and advice from the College of Optometrists is welcomed. The local anaesthetic proxymetacaine 0.5% is now marketed in the UK in preservative-free unit-dose applicators both alone and in combination with fluorescein, and is a more comfortable alternative to existing anaesthetics in unit-dose form. The second half of this paper includes a summary of the background to recent developments, as the UK profession takes its first steps towards the use of ocular therapeutic agents. Finally, some exciting new therapeutic preparations for use in the treatment of glaucoma, allergic eye disease, and dry eye conditions are discussed.