Eye care muddle not helping patients
Optometrists, ophthalmologists, opticians all doing each other's jobs
by Nicosia Smith
Business October 8, 2004
Stabroek News
October 8, 2004
A number of eye care providers are coming under the microscope for providing treatment not in keeping with their training and qualifications.
Dr. George Norton, an ophthalmologist and head of the Georgetown Public Hospital's eye clinic, says there are different categories of workers in the provision of eye care and these need to be better defined.
As an ophthalmologist Dr. Norton is clinically trained and state licensed to examine the eye and vision system; diagnose vision problems and eye diseases, and provide medical and surgical treatment. To obtain his certification Dr. Norton, apart from attending medical school, has an intern and residency background that involves understanding and managing eye disease and vision problems.
Dr. Norton says optometrists(OD-Doctor of Optometry) in Guyana who treat eye conditions are not licensed to do this, regardless if they are trained in its use, since the laws only allow medical doctors to prescribe medication. They are not licensed to use pharmaceutical agents for therapeutic purposes. An optometrist is trained to examine the eye and vision system, diagnose vision problems and some eye diseases, prescribe glasses or contact lenses, and provide referrals. An optometrist is the first line of defence and in some instances during the course of their studies are trained in treatment use. Under the health care provider laws, a person upon presentation of their certification of training, for which they are acknowledged in the country of training, is entitled to be registered locally.
Stabroek Business spoke with one optometrist who asked not to be named(but whose qualifications are known) who noted that he does remove foreign bodies from the eyes, he gives drops for infections, prescribes over-the-counter drops and anti-infective drops. He also prescribes glasses. But serious eye diseases such as glaucoma which require surgery are referred to an ophthalmologist. This optometrist noted that if their customers can obtain the same drugs they are prescribing over-the-counter, then there is no reason why they should not be allowed to give the same treatment if they are trained in its use.
A reliable medical source told Stabroek Business that optometrists are certified to address refractionable errors of the eye and to offer primary health care that involves therapeutic treatment. It is understood, the medical source explained, that for certain treatment that surrounds primary health care, such as drops or over the counter therapy, optometrists can provide this.
But treating ailments such as glaucoma are not allowed, says the source. The medical official noted that an optometrist can detect glaucoma but must refer such patients to a specialist. Stabroek Business understands that the Medical Council is in the process of drafting clear guidelines for health care providers.
Spectacles are now being provided by ophthalmologists, optometrists as well as from opticians.
An optician is actually trained to grind, fit and dispense corrective lenses and low-vision devices prescribed by an ophthalmologist or an optometrist.
Some opticians are also said to be examining the eyes and giving drops when they are not qualified to do this. Another reliable source noted that this practice is spiraling out of control and the opticians are now competing with the optometrists.
The source is concerned for the health of patients 10 to 15 years after they are prescribed treatment by opticians who are not qualified. The problem, says one source, is that there is"a whole set of people piggybacking" on the qualified. Even opticians are being called optometrists and ophthalmologists by patients who do not know better.
Others say it is the perception that the opticians are qualified to examine the eyes and prescribe spectacles which is leading them to have a large number of customers and not necessarily because their spectacles are cheaper.
The National Insurance Scheme (NIS) offers a $10,000 voucher to contributors who qualify for the benefit. Depending on your choice or need, spectacles can be $16,000 and more.
Dianne Baxter from the NIS public relations office says there is a list of eye specialists but she understands that this needs some modifications.
Baxter says once the person is registered with the government as an eye care medical practitioner the NIS can refer contributors to them.
While ophthalmologists are selling spectacles privately, Dr. Norton noted that optometrists believe ophthalmologists should concentrate on eye treatment and surgery only.
"The risk is so low, that you can venture into the business. Simply because the lenses [are] duty-free," says Dr. Norton explaining why so many spectacle shops are opening.
He also notes that many Guyanese unfortunately believe that having spectacles will end eye problems when in fact a spectacle may not be needed. There is also a perception that when you are wearing a spectacle, it is a sign of intelligence.
At the GPHC the work load is so high for the two ophthalmologists that four nurses were trained in refraction (testing for spectacles) through the GPHC, the Pan American Health Organization and by Sightsavers, a United Kingdom group.
Each nurse selected for the refraction course had an average of 10 years experience as a nurse and for the past three years has been conducting refractions. Dr. Norton says the training is adequate and is an ongoing process since the nurses provide the prescriptions which are counter-signed by the ophthalmologists and are then filled out with lenses and frames. Every aspect of the nurses' work is discussed with them, he says.
The training of the nurses was designed to provide low cost spectacles and was not intended to compete with optometrists who are qualified to offer this service. The GPHC does not have plans to train any more nurses as refractionists but rather as optometrists. This training may take place in Cuba or the Dominican Republic.