A conversation with study authors: Kovin Naidoo, Pirindha Govender, Priya Morjaria, Sandy Block, Ving Fai Chan, Ai Chee Yong, Luigi Bilotto
The Vision Atlas country dashboards display key national indicator data for eye health services at the country level, including the number of optometrists in each country, along with the number of optometrists per million population. These data have been sourced from a study conducted by the World Council of Optometry, the Africa Vision Research Institute and the Brien Holden Vision Institute. To provide more insight into the methodology and key learnings, we spoke to the study authors.
Question: According to the recent mapping study, how many optometrists are there in the world?
Answer: Our data indicates that 331,743 optometrists are representing 123 countries. The reporting includes optometrists practising at competency levels 2-4 as defined by the World Council of Optometry (WCO).
Question: What trends or patterns have been noticed during this mapping exercise? Are there countries or regions that are underrepresented? Have there been changes over time?
Answer: As we had expected, high-income countries have better practitioner-to-patient ratios than low- to middle-income countries where there are no optometrists in many cases. In some countries, the practitioner to patient ratios may seem adequate to address the refractive needs of the population. However, the maldistribution of the practitioners poses a significant challenge. Future studies will more accurately capture the changes over time.
Question: How can/should this data be used to increase access to eye care services?
Answer: The information from our study will serve as a powerful, evidence-based advocacy tool. It provides the impetus for policymakers and advocates in eye care to ensure that measures to enable equitable distribution of practitioners within countries are activated. Furthermore, emphasis should be placed on human resource development in optometry to ensure that high-quality optometry education is provided for, and made available, especially in the resource-limited countries of the world.
Question: Could you please tell us a little about how many countries were included in the study and how the data was collected?
Answer: The study targeted 200 countries, and 123 countries with reasonably complete data were included in the final analysis.
We used a Key Informant Method to collect data for the mapping. We approached countries where we had one or more reliable key informants or were referred to key informants who could provide reliable data. We worked with various organisations, including the IAPB or national optometry associations, to reach out to countries where we could not find a key informant before concluding that the information would not be available for a given country. We also consulted WCO regional representatives to confirm contacts in certain locations. A survey was disseminated using various methods, e.g. email, online (Survey Monkey) and hard copies to maximise the response rate. We followed up with the key informants if they did not respond, which frequently occurred due to the absence of and the difficulty in gathering the requested data in numerous countries.
Question: WCO established 4 competency levels for optometry, the numbers in the Vision Atlas reflect levels 2-4, could you please explain how this group of optometrists are defined?
Answer: The global competency-based model of the scope of practice in optometry was used as a framework to gather information on the global number of practitioners. The definition of optometry, which encompasses refraction and dispensing, diagnosis and management of disease, and rehabilitation of conditions of the visual system, starts at level 2. Level 1 is limited to dispensing of optical devices, which is insufficient to define optometry. Some scenarios only consider the provision of refractive services as defining optometry, and therefore it is likely there will be variations in data presented.
Optical Technology Services (OT): Management and dispensing of ophthalmic lenses, ophthalmic frames and other ophthalmic devices that correct defects of the visual system
Visual Function Services (VF): OT plus Investigation, examination, measurement, diagnosis and correction/management of defects of the visual system
Ocular Diagnostic Services (ODx): VF plus the investigation, examination and evaluation of the eye and adnexa, and associated systemic factors to detect, diagnose and manage disease
Ocular Therapeutic Services (OTx): ODx plus the use of pharmaceutical agents and other procedures to manage ocular conditions/disease
Question: Are there plans for further mapping studies of optometrists?
Answer: Considering that the global burden of eye disease continues to change, it would make sense to ensure continuous monitoring of practitioner numbers to meet the demands. We intend to do a periodic follow-up on the data, use the learnings from previous mapping efforts to improve data collection and potentially expand the collected data to clarify information gaps. We are also hoping that after releasing these figures, countries will be more forthcoming with the information for the next round since the data has a significant impact in forecasting potential and capacity to meet the local demands in eye care and globally.