About 1000 years ago, production and sales of optical reading glasses were reported to be going on in ancient China by Venetian Marco Polo and by a British historian, Sir John Needham . Dr Gross (OD, PhD) of the school of Optometry Indiana in the United States noted that by 1300s Italy, Netherland and Germany were documented to have started manufacturing optical spectacles for commercial purpose.
Between 1850-1900 the first school of Optometry was established.
In 1901, Minnesota state became the first to regulate Optometry practice with the use of "License to practice". Viz:
"Over 110
years ago, on April 13, 1901, Minnesota Senate Bill 188 was signed into law
establishing the first optometry practice Act. That first scope of practice was
defined as:
“An
act to regulate the practice of optometry.
Be it
enacted by the Legislature of the State of Minnesota:
Section I. The practice of optometry is
defined as follows, namely: The employment of subjective and objective
mechanical means to determine the accommodative and refractive states of the
eye and the scope of its functions in general.”" [1]Ever since then Optometry has been evolving into a medical practice. This could be observed in the trend of Optometry advancement in the USA. DPA (Diagnostic Pharmaceutical Agent) was allowed to be part of the Optometry scope of practice in Rhodes Island in 1971. Prior to that time legistative fisticuff in Indiana saw the Optometric practice recieve approval for DPA in 1935 but was fully affirmed by the Attorney General of the state by July 17th 1946. Today all Optometry practice in the USA are allowed to use DPAs in their practice, the state of Maryland became the last state to approve DPA into Optometric practice by January 13th 1989.
Nigerian Optometrists are allowed to use DPA in practice inferentially:
"Optometry” means a health-care profession specialising in the art and science of
vision care and whose scope of practice includes—
(a) eye examinations to determine refractive errors and other departures
from the optimally healthy and visually efficient eye;
(b) correction of refractive errors using spectacles, contact lenses, low
vision aids and other devices;
(c) correction of errors of binocularity by means of vision training
(orthoptics);
(d) diagnosis and management of minor occular infections which do not
pose a threat to the integrity of the occular or visual system; and(e) occular first aid;[2]
[See the part (d) above to throw more light on DPA approval for Nigerian Optometrists].
But it remains to be fully introduced into the main stream Optometry practice in Nigeria especially in Public hospitals. Rumor mills making rounds have it that most Optometrists in our government facilities are restricted to refraction, depriving them of the flexibility of the 21st Century Optometry practice. DPA includes topical anesthesias, mydriatric/cycloplegic agents and ocular dyes.
Optometry practice in Europe is not as harmonized as it is in North America, Canada and in Australia. For example, in 1938 the first drug for diagnosis in Optometry was inserted into Worshipful Company of Spectacle Makers (SMC)- one of the two bodies of Optometry in the UK. It was not till 1968 that it became a legal requirement as passed by law for the optometrist to use Diagnostic agents in the UK.
In other European countries like in Italy, Optometry is not legally recognised as a profession. Norway has been regulating Optometry practice since 1988 and was legally allowed to use DPA medications in a regulated framework since 2004. In Ireland, Optometry has been regulated since 1953, but was legally allowed to use cycloplegia as a DPA in their amended Act of 2003.
In Asia, Optometry practice is evolving into a model eye care profession. In Philipines for instance, the first refraction centre was opened in 1902 and Optometry came under a body known as the Board of Optical examiners in 1913. Optometry became regulated by law in 1917 and in 1919 it was amended. Professional Optometry in Philipines had an upward review of their regulation and came up with Ethical codes for Optometry in 1957 Amendment Act.
The Revised Optometry Law in the Philipines of 1995 updated and modernized many aspects of optometry including the use of diagnostic pharmaceuticals (DPA).
In Japan Optometry is yet to be fully recognized by the government and hence no proper regulation is been in place. China does not recognise Optometry as a profession either.
On the flip side, Malaysia has a body of Optometry formed in February 1984 known as Association of Malaysian Optometrist. In 1985, Malaysian Association of Practicing Opticians was formed but it was in 1991 that a legislation to regulate Optometry was put forward.
It defined Optometry as,"
The employment of methods for the measurement of the powers of vision, or the adaptation of ophthalmic lenses or prisms for the aid of the powers of vision, or both." [3]
The Act allows the use of Diagnostic Drugs for refraction.
Most states in the USA have the approval to use Therapeutic Pharmaceutical Agents (TPA) and the first state with TPA approval was in West Virginia, 1976. In 1977, North Carolina became first state to pass a law that requires the Optometrists to use injectable and oral medication for therapeutic purposes. In 1998 the District of Columbia became the last state in the USA to enforce Optometrist right to TPA for treatment and management of ocular diseases.
DPA approval has been in force since 1987 in Canada and recently most Provinces in that country allows the Optometrists to use TPA in practice. Alberta was the first province to grant optometrists with TPA legislation in October 22, 1996. In December 1997 the Optometry Professional Act of New Brunswick was expanded to "the use of pharmaceutical agents" [6], which includes classes of TPAs and all topical pharmaceuticals. The province of Saskatchewan was next in January 2, 1998. Limited use of TPA was incoporated into the legislation. In 1999, Yukon province became next to adopt a TPA legislation similar to Alberta and New Brunswick. In May 2000, Nova Scotia province amended its Optometric legislation to start using TPA in practice with an upward review in 2006 and in 2007. In June 2000, Quebec province made a law to allow Optometrists to use TPAs and it was approved in 2003.
In Columbia Optometry practice enjoys the right to prescribe therapeutic agents (Decree No. 1340, passed on July 14, 1998.). No other country in Latin America or the Caribbean has a law allowing optometrists to use or prescribe pharmaceuticals of any type. Argentina, Brazil and Chile have been struggling to gain recognision while Venezuela and Maxico does not recognise Optometry as a profession. Ecuador remains the second country after Columbia to recieve a legal framework for Optometrist. The first law was passed in 1979 [Decree 3601]. Another legislation in 1994 saw the passage of Law 65 Article 174, which officially recognized the profession of optometry.
In Europe, the use of therapeutic pharmaceutical agents (TPA) is still evolving especially with the formation of a strong unifying body headed by the Association of European Schools and Colleges of Optometry (AESCO), the UK GOC (General Optical Council) and the World Council of Optometry(WCO). In 2000, the GOC rules were reviewed to allow Optometrists enforce their professional jubgements and to use limited TPA for curative/management purposes even though the Medicines Act of 1968 provided the UK Optometrists {Opticians} the opportunity to use DPA and mild prophylactic antibacterial agent for contact lens wearers.
In 2005, another review saw the expansion of therapeutic role for the UK Optometrists, (Titcomb and Lawrenson 2006):
● Update to the list of POMs available to all registered optometrists
● Removal of the 'emergency' requirement for the sale and supply of Pharmacy (P) and General Sales List (GSL) medicines.[4]
In 2008 another review in the Medicines Act allowed the UK Optometrists to prescribe most TPAs. The unification of the European Union and the independent prescribing right won by the UK Optometrists in 2007, it remains to be seen the destination of Optometry in Europe. But for sure the future of Optometry in Europe looks very promising.
In Asia, TPAs are more often than not left for the Ophthalmologists because Optometry is studied as pure Optical science. You can get your degree from a Polythecnic e.g in Singapore, in Hong Kong; or even in Technical colleges e.g. in Korea.
A pattern is emerging from all these. The profession is taking a turn towards inclusive medical eye care as the evolution continues. For instance a law in Kentucky in 2011 authorized the use of surgery and therapeutic lasers by state Optometrists. Before then Optometrists in Oklahoma have been providing laser and non-laser surgical procedures since 1998 (Senate Bill 1192).
As the profession keeps advancing the following steps should be patternized for posterity sake:
1) Becoming organized,
2) Seeking government regulation through education, research and advancement in technology,
3) Developing competence in use of DPA/TPA
4) Developing evolutionary medical eye care that will address secondary and tetiary eye care gaps in the world today.
The trend is progressive. The scope of Practice is expanding. The development, advancement and improvement of professional practice in Optometry globally has become the default. No wonder the world Council of Optometry expanded the frontier of Optometry thus:
"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."[5]Nigerian Optometrists should not be left behind because the onus of proof lies with us to make a paradgm shift towards medical eye care with a view to tackling the burden of blindness locally and globally!
Thank you,
Dr Ezebuiroh Victor Okwudiri
N/B: This is intended for educative purpose and to inform the members of the public and it does not attract any financial obligation
