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World Optometry Day is upon us again, and this time during a global pandemic. A lot has changed in the last 12 months and the eyecare sector is no exception. We have an opportunity to reflect upon the role of optometrists in this ecosystem of identification, prevention and treatment of global blindness.
The World Report on Vision reported staggering numbers for the magnitude of vision impairment and eye health conditions. And the Lancet Commission of Global Eye Health provides us with a foundation, as optometrists to think about the future of our profession.
A large proportion of the cause of visual impairment is due to uncorrected refractive errors and cataracts – both preventable. In previous years, we’ve recognised the need to train more practitioners, but The Commission highlights to us that optometrists need to be innovative in how we contribute to the human resource need. Training alone is not the solution, integration within the different models of practice that may be more efficient, working in teams, remotely supporting health workers and tele-optometry are areas that we should focus on. Community based primary care services is a strategy that optometrists need to be a part of – at the same time strengthening and connecting private sector optometry with primary and secondary care.
As optometrists we must recognise and accept that the private sector model alone is not going to address all the issues. Services must be provided as a part of the public health system and national eye care strategies. Optometry needs to think about how it can work to improve the services and outcomes for those groups that are disadvantaged and don’t access or receive care e.g., those that are in rural areas, socially or economically disadvantaged, women, indigenous populations. Services should prioritise equity by design and be regulated and monitored to ensure they are of good quality and affordable.
Refractive errors feature in the top five Grand Challenges in Global Eye Health. Optometry should take advantage of this to advocate for change and gain a stronger political voice. We need to strike a balance here, where refractive errors are not seen as a separate issue. Integrated person-centred care at the community level, looking beyond refractive errors is crucial. Regions where uncorrected refractive errors is a major cause of visual impairment, and where population growth is the highest, there is a lack of services (quality and affordable) and comorbidities such as diabetes and glaucoma will be high in the future. Integrated services with optometry involved at the community level will ensure that referral pathways are mapped out correctly.
The Lancet Commission recognises the three types of people needing eyecare, (i) those who need ongoing care, (ii) those who with early-stage disease and (iii) those with symptomatic conditions that don’t cause vision impairment but require services. Optometry services can support all three groups, and this can be further enhanced with a team approach between ophthalmology and optometry with each providing care to their full scope of practice.
Optometry needs to improve its role in public health by recognising the social determinants of eye health and visual impairment and the link with quality of life and mental health. We need to embed data collection and evidence-based decisions within our practice to ensure services are needs driven. At the same time tackling the challenge of building quality services and standardising the care we provide. We need innovative approaches to education programmes and continuing professional development, especially in countries where optometry is a young profession.
An enormous challenge for us as optometrists for the next decade, is to find an equilibrium in a sector that has large financial returns but provides an assistive technology/device and primary eye care services. At the same time keeping in mind that during the life course most people will experience a visual impairment and eye care is no longer an option but needs to be a part of basic health care.
Image credit: Priya Morjaria