I have recently completed a post-graduate diploma course in ocular therapeutics through the University of NSW which will enable me to prescribe medications for the eye, including those listed on the PBS. This aspect of optometry’s role in primary eye care is the final piece of the picture which makes up the scope of our profession. We have certainly come a long way from our humble origins as an offshoot of jewellery and frame making.
The full scope of our profession now includes eye examination, diagnosis and treatment of some eye diseases, or referral. We have gone beyond the simple providers of prescriptions for glasses – the perception held by the public in the past, and to some extent currently.
With the amazing imaging equipment available to optometrists now it is possible to make detailed maps and images, and to analyse these compared with normal to make a judgement as to the health of most tissues inside the eye. The most detailed of these measures the thickness of the nerve fibre layer in the retina and around the optic nerve to assess the likelihood of glaucoma, as well as imaging the full thickness of the retina around the macula to check for disease.
The retailing side of optometry is where big business takes over from the optometrist’s role as eye care and prescription provider. Given the proliferation of advertising from the major players it will be no surprise to most people to know that there is serious competition for the consumer dollar in the marketplace, and that most advertising is centred around price. It is also no secret that few consumers pay the actual advertised price – upselling is the name of the game, and in some stores the staff receive more training in upselling marketing than in optics. In any case it only makes it harder for our staff to explain why our products represent good value, even given a price differential, when our apples are nothing like the apples sold by these competitors.
And I haven’t mentioned ready-made reading glasses which were not available before the early 90’s, but are now everywhere. Despite their poor optical quality, and small range of powers they do not pose any risk to vision except in one important regard. Case in point – last year I had an elderly woman come in for a check-up with no real problems. She had been happy to get by with ready-made readers for many years, and was fine in the distance un-aided. She had the worst glaucoma I have ever seen because it was un-treated, and it was un-treated because she had not had an eye check in 20 years because she was happy with ready-made readers. She did not know that glaucoma has no symptoms in most people, and that without treatment steadily progresses to blindness, and is much harder to control in its late stages.
Laser surgery and breathable contact lenses have made their mark over the last two decades, giving an option to glasses for those who want that freedom. Advice on both is part of optometry’s role.
I anticipate further changes in my profession as technology and market forces combine, hopefully for the better. It promises to be as fascinating as the last 40 years has been.