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WORLD OPTOMETRY DAY – Hindsight, Insight & Foresight

“Next to life itself, God’s most precious gift is sight; and to the ministry of this great gift, the profession of Optometry dedicates itself”

This great ministry of sight has developed and continues to develop differently and at different rates throughout the world. The profession of optometry differs from country to country in definition, historical evolution, the scope of practice, recognition, regulation, training and status among the other healthcare professionals. 

In this article, we would look at Optometry in Nigeria in relation to other parts of the World under three levels of sight:

  1. Hindsight (Past)
  2. Insight (Present)
  3. Foresight (future)

 Hindsight

Charles F. Prentice

The history of optometry can be traced back to the early studies on optics and image formation by the eye. The term “Optometry” is derived from two root words, Opto, a shortened form derived from the Greek word ophthalmos meaning, “eye”  and metron; “something used to measure”1. Literarily Optometry means “measuring the eye”.

Although the term optometry appeared in the 1759 book A Treatise on the Eye: The Manner and Phenomena of Vision by Scottish physician William Porterfield, it was not until the early twentieth century in the United States and Australia that it began to be used to describe the profession1.

In Europe, early civilization in spectacle wear designs, led to the formulation of Spectacle makers’ guilds in many cities across Europe, as part of each city’s government, the earliest of which was that in Antwerp, Belgium. The Worshipful Company of Spectacle makers chartered in London by King Charles I, was among the most prominent of guilds ever. By the 19th century, only the Worshipful Company of Spectacle makers survived and played a prominent role in the development of the optometric profession in Britain. In 1891, a London School of Optics and Sight Testing was established by the optical industry in the UK but it was not until some years later, under the direction of the newly established British Optical Association, that the Worshipful Company of Spectacle Makers introduced national examinations for ophthalmic opticians. The British Optical Association was formed by a dissident group of opticians in 1895 and they held the first examinations in 1896, thus setting a national standard for ophthalmic opticians (known today as optometrists) in the UK.

In the United States during the 19th century, spectacle-makers who came from Europe began to distinguish themselves as “dispensing opticians” and “refracting opticians”. The refracting opticians eventually evolved into what is now known as “Optometrists”. The first U.S. training school was started in 1892, and the first University-based school opened in 1910. The first national professional association started in 1897. In 1896 the first battle to pass an optometry law was fathered by Charles Prentice in New York; however, the first state license law was passed in Minnesota in 1901. By 1924 all states had some form of basic Optometry law2.

The development of Optometry in Canada followed a nearly parallel path with Optometry in the United States. The first Canadian Provincial Optometry Acts were passed in Ontario and Manitoba on March 9th and 10th respectively in 1909. By 1925 all the Provinces had passed their Optometry acts. The creation of a National Optometry Association in Canada started as early as 1896 with a series of organizational attempts often interrupted by wars, depressions and regional disagreements, but finally formed a unified voice for Optometry in Canada in 1948, the Canadian Association of Optometrists (CAO).2

In Latin America, the evolution of Optometry has followed a similar direction but has varied in pace, scope and degree from country-to-country. It is not uncommon today in Spanish speaking countries to hear the public still refer to an eye care provider as an “oculista” just as the oculists existed in the USA in the 19th century. This signifies that the public is generally not fully aware of the distinction between an Ophthalmologist, Optometrist, or Optician.2

The practice of Optometry in Africa has a relatively recent history when compared to those of America and Europe. Nigeria and South Africa are well ahead in Optometry development in Africa. Documented evidence shows that Optometry practice started in South Africa (1890) and Nigeria (1912). The early practitioners were either immigrant from Europe or Africans who had trained in Britain and registered with the then British Optical Association (BOA). Early practices on the continent centred on spectacle prescription/supply.

Optometric education in Africa originated in South Africa in 1924 when 24 British-trained Optometrists formed the South African Optometric Association (SAOA). The first ever training institute for Optometrists in Africa was at the WITS Technikon in South Africa in 1937. The first degree-awarding training programme for Optometry was established at the University of Benin in 1972. The development of the Optometry programme in the University had its root from the Department of Physics- Faculty of sciences; the then dean of the faculty Prof. Raymond H.W. Wright saw the need to start the first University-based Optometry training programme in black Africa. Dr Paul O. Ogbuehi (an associate professor of Physics) was sent to undertake a special 2-year Accelerated Degree Programme (AODP) from the College of Optometry in Boston, Massachusetts, USA. He returned in 1974 to assume directorship of the programme.

The Nigerian law defined Optometry as the art and science of vision care and it has over time developed both in training, scope, recognition and regulation.

It is worthy of note, In some countries, the political power of the medical profession has placed a limit to the advancement of the Optometric profession, and in conjunction with the limitations in training Optometrists to the highest standard of competency in the region. For example, in Chile, the profession of Optometry does not technically exist and it is against the law to practice Optometry. In Argentina, the medical code specifically states that only medical physicians can write prescriptions, thus limiting Optometrists to optician duties.

 

Insight

Professor Brien Holden

Optometry has forcefully advanced in spite of the opposition it has faced since inception. The contemporary Optometric practice has moved from spectacles dispensing to being a healthcare profession. Modern-day optometry has evolved through time so that the educational curriculum additionally includes intensive medical training in the diagnosis and management of ocular disease. Optometrists now known as Doctors of Optometry are medical professionals who provide primary eye care through comprehensive eye examinations to detect and treat various visual abnormalities and eye diseases.

The World Council of OptometryWorld Health Organisation and about 75 optometry organisations from over 40 countries all over the world adopted the following definition, to be used to describe optometry and optometrist.

“Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and Optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system”

Optometry has made a sharp transition from being an optical profession to a medical profession. The International Standard Classification of Education (ISCED 1997 of UNESCO) includes Optometry in the Medical Services, section 72, of the broad groups and educational fields. This indicates that optometric education is internationally recognized.

The scope of practice in America has also broadened to include medical eye care services. Different states have progressed differently in obtaining the required legislative permits. Optometrists are licensed to diagnose and treat many common diseases of the eye through oral, topical, diagnostic, and therapeutic medications.         

Optometric practice in the United States has grown by leaps and bounds as an overwhelming majority of Americans rely on optometrists for primary eye care. It is amazing to know that ODs perform as much as 85percent of all comprehensive annual eye exams.

 Currently, ODs in Oklahoma, Kentucky, and Louisiana are able to perform certain types of laser surgery.

Excitedly, the image of Optometry has greatly improved as Optometrists are also known as Optometric Physicians (O.D.), and held to the same standard as other government regulated health care practitioners participating in Medicare.

In Canada, a similar level of advancement has been recorded. The profession is represented by the Canadian Association of Optometrists. Optometrists in Canada are licensed to prescribe topical and oral medications; however, the exact medications that they are licensed to prescribe varies province by province. In Ontario, Optometrists are able to prescribe drugs to treat normal tension glaucoma, transient intraocular pressure elevations, acute glaucoma crisis, and dacryocystitis. In Alberta, Optometrists will soon have their scope of practice increased to include prescribing certain oral and topical drugs, ordering lab tests, ordering and applying ultrasound tests, and treating certain types of glaucoma.

In the UK, Ophthalmic Opticians have gained acceptance and recognition even among other medical experts. In 1990 a survey of the opinions of British medical practitioners regarding the services provided by British optometrists was carried out by Agarwal3 at City University in London. A majority of respondents were in favour of Optometrists extending their professional role by treating external eye conditions and prescribing broad-spectrum topical antibiotics through additional training and certification.

Since 2009, optometrists in the UK have been able to undertake additional postgraduate training and qualifications that allow them to prescribe medications to treat and manage eye conditions. Currently, three registerable specialities exist:

  • Additional supply specialty– to write orders for, and supply in an emergency, a range of drugs in addition to those ordered or supplied by a normal optometrist.
  • Supplementary prescribing specialty– to manage a patient’s clinical condition and prescribe medicines according to a clinical management plan set up in conjunction with an independent prescriber, such as a GP or ophthalmologist or qualified optometrist.
  • Independent prescribing specialty– to take responsibility for the clinical assessment of a patient, establish a diagnosis and determine the clinical management required, including prescribing where necessary

On the African Scale, the Optometric practice has also become very appreciated and relevant, owing to the very short supply of Ophthalmologists and key experts in eye care. In Nigeria, Optometrists are skilled in the art and science of vision care. Upon completion of National service, a typical Nigerian Optometrist is fully ready to fit into the primary health care space either in public or private practice. Sadly, many Optometrists occupy the private space because it gives a wider scope of practice and fulfilment for the practitioner. Optometry hasn’t been properly integrated into the primary health care system in some government centres, most times; the practice is only limited to optical Optometry, making Optometrist in such centres function as ‘refracting opticians’ instead of ODs.

The development in educational qualification for optometrists in Africa has been sporadic. From apprenticeship and part-time (diploma certificates) training programmes, it has developed into full-time Doctor of Optometry (OD) degree programmes in Nigeria, South Africa and Ghana.

Currently, there are about 23 institutions offering undergraduate training programmes in Optometry in Africa. There are also postgraduate and residency programmes for Optometrists in Africa. The Nigerian College of Optometrists offers four-year residency programmes. Currently, there are seven (7) specialty areas in the college-Cornea and Contact Lens Practice, Ocular Health, Orthoptics, Paediatric Optometry, Primary Care Optometry, Public Health Optometry, Rehabilitative Optometry and Low Vision. Also, Post-graduate programmes, leading to the award of MSc and PhD in Vision Science and Ocular Health exist.

 

Foresight

21st Century Optometrist

In spite of the many gains Optometry has made in the last couple of years, the possibilities in the profession are yet to be fully harnessed. In some regions, the practice is still at infancy levels, whereas in some developed settings like the United States, more still need to be done to harmonize and expand the scope of practice across states and the world at large.

In Africa, the development of full scope Optometry is being slowly achieved, as many Optometrists still have measures of identity crisis. There hasn’t been an obvious transition from optical Optometry to medical Optometry. The teaching schools will have to play a pivotal role in preparing graduates for full scope practice.

In Nigeria, Most successful Optometrists are successful in having very beautiful clinics and attracting very wealthy clients. Much of their successes haven’t translated to the advancement of the profession because many are self-centered and careless of the next generation and the future of the profession. Eye health needs to be properly and fully integrated into the primary health care system in Nigeria; with Optometrists occupying their true status in the primary health care block, and the Nigerian Optometric Association must stand up to the task of influencing key policies and providing visionary leadership.

Despite the progress already made with the postgraduate and residency programmes, Optometry Specialty practice in the country is yet to be fully developed. The Nigerian College of Optometrists should raise specialty training to the highest level of excellence and competence. Residency programmes should be made open, accessible and more encouraging for young professionals to participate. The future of Optometry in Nigeria depends largely on the number of young visionary Optometrists that are being mentored and allowed to bring youthful energy and creativity to the profession.

In my popular quote “Professions don’t make people; People make professions”

Optometrists globally should raise Optometric practice to the highest level of excellence and relevance. If we must achieve significance, the practice must go beyond just making a living to making a difference.

To conclude, looking at how it all started, from spectacle makers’ guild, now to an internationally recognized medical profession. It could only have been possible largely because of the visionary labour and sweat of many fathers, who chose to fight even in the face of stiff oppositions. A challenge is before us today, what is your contribution towards advancing the victories of our fathers? It is not enough to just sit and complain. Let’s all be bold for positive change and defend the heritage of Optometry, as we dedicate to this great ministry of sight.

 

Ref:

  1. https://en.wikipedia.org/wiki/Optometry
  2. Optometry in Americas by Leasher and Pike PDF
  3. Agarwal, R. (1996), British optometry: medical practitioner’s opinion survey, British Journal of Optometry and Dispensing, 4(2), 50-52.
  4. Optometry in Nigeria: A history; PUBLICATION OF THE NIGERIAN OPTOMETRIC ASSOCIATION (NOA)
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Dr. Lucky Aziken
Dr Lucky Aziken, a multitalented Optometrist believes health education is key towards achieving a healthy society. He is passionate about knowledge and creatively communicates his thoughts. He loves reading, writing and connecting people.

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