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HomemifeatureOptometry in the Next 20 Years

Optometry in the Next 20 Years

We look at the anticipated changes to optometry in Australia over the next 20 years and the perceived local impact to optometric education, changes to the theory and practical side of the profession, therapeutic drugs, the impact of an ageing population upon the eye care industry as a whole and the maldistribution of optometrists in rural areas.

Future Trends in Optometry Education

Optometry education in Australia typically follows the American trend. In 2006, the University of New South Wales started its new Bachelor of Optometry/Bachelor of Science1 program which allows optometrists to graduate with a therapeutic license for the first time in NSW. This was a very significant step in advancing the scope of optometry practice in NSW.

In the future, optometry education will evolve even further. Starting in 2011, the University of Melbourne is replacing its Bachelor of Optometry course with a new four-year postgraduate Doctor of Optometry (OD).2 This program requires the candidates to have completed a bachelor degree, preferably a bachelor in science. The programme will include on-campus teaching combined with clinical placement and is thought to allow for emphasis on the teaching of optometry at a more sophisticated level.

The University of Melbourne is the first university in the southern hemisphere to follow other countries such as the USA and Canada to offer the OD.2

In the future a greater number of practices will try to differentiate themselves from others by the type of services they offer, rather than competing with each other solely on price.

In the future there will be more emphasis on equalising the optometry practice in all states of Australia. National Registration is already underway and allows for standardised education and expansion of the therapeutic drug list.

Another change to optometry education will be decreased dependency on campus-based facilities for clinical training. Private practice externships will become a part of clinical training for future students, allowing for practice in management skills and clinical training.3

There will also be a greater emphasis on the expansion of clinical education in low vision, ocular therapeutics and systemic disease, allowing for better management of patients and a closer affiliation between the optometry school and ophthalmology and the medical school.4 This allows for:

  • Hospital privileges for optometrists
  • Increased access to patients with eye disease who also have systemic conditions
  • Earlier exposure to pre and post-ophthalmic surgical cases
  • Increased interaction with other health care professionals
  • More effective management of surgical patients
  • Opportunities for sharing equipment, people and resources4

Therapeutic Drug List and Procedures

The very limited list of drugs available to optometrists prevents them from independently treating all ocular conditions. Currently, Australian optometrists have no access to oral medications which are required in some cases for optimum patient care.7 In the U.S., optometrists can prescribe oral antibiotics, antivirals, anti-allergy, analgesics, and corticosteroids. However in Australia, optometrists must refer the patient to an ophthalmologist or a GP for such medications.6,7, It is very likely that in the future Australian optometrists, like their colleagues in the U.S., will have greater access to topical and oral therapeutic drugs.

Evidence Based Optometry

Like other healthcare disciplines, the practice of optometry is shifting more towards evidence based practice, particularly when it comes to giving advice to patients on the preventative measures as well as managing sight-threatening eye diseases.8 Ongoing research is being carried out to investigate ways to prevent or better manage ocular conditions such as age-related macular degeneration, cataract, diabetic retinopathy, pterygium, myopia, strabismus, near point stress and many other conditions.

It is expected that in the future more clinical trials will be conducted on unanswered topics, revolutionising the way optometry is practiced. Greater financial support will be made available from the profession as well as the federal and state government to enable further research so that optometrists can provide better evidence based care to the public.8

Impact of Technology

In the near future we can look forward to devices that are capable of providing greater assessment and diagnosis of ocular conditions.

The technological advancements predicted will allow for: analysis of the retinal blood vessel calibre; evaluation of hypertensive and diabetic vascular changes in the retina; imaging of the photoreceptor mosaic, retinal microvasculature and RPE; and imaging of retinal physiological and metabolic functions.9

The majority of patients presented to optometric practices are still in need of a quick and accurate refraction. With advancing technology, autorefractors are becoming more accurate and reliable.10 This may allow for a much quicker refraction, thus enabling optometrists to concentrate on examining ocular health and function in greater detail.

An Ageing Population

It is predicted that the number of people aged over 65 will double between the now and the year 2050, most of this occurring over the next 20 years.11 The ageing process results in the degradation of visual function even in healthy eyes and is also a major risk factor in many ocular conditions such as cataract, age-related macular degeneration (AMD) and glaucoma.12 It stands to reason then that in the future we can expect to see a large increase in the number of these ocular conditions, and subsequent increased demand on the optometry profession.12 We may see the scope of the optometry practice change in response to this demand. This change may include a greater emphasis on the prescription of low vision aids and an increased need for more ‘low vision specialists’. Optometrists may perform more domiciliary visits due to a greater number of people that are immobile.

Distribution of Health Care Professionals

A huge issue for the future of Australian health is the severe maldistribution of health care professionals. Rural Australia, which comprises about 30 per cent of the population, is starved of health care professionals including optometrists.13 Students enrolled in universities today mainly live locally and tend not to leave the city in which they gained their education, particularly without financial incentive.13 Another reason for the maldistribution of optometrists is the increasing feminisation in optometry.26 Women tend to have a shorter working life and appear to be less likely to travel to a rural area.13 There are also problems in the retention of optometrists who work rurally, mainly due to the lack of financial support for travel to rural or remote areas.13

A suggested solution to these problems is a change in the student recruiting systems.13 That is, offering scholarships to university to students from states that don’t have schools of optometry and students from a rural or an indigenous.13 Another solution is to offer scholarships or HECS reimbursements to students who agree to a period of rural practice.13

Practice Differentiation

The American supermarket giant Costco, which sells discounted products of all kinds, opened its first warehouse store in Australia, in Docklands Victoria, with an optometry practice on site last year. Costco is expected to introduce further competition to the optometry market as it opens more stores in Australia.

As competition rises in the optical industry it is likely we will see a greater differentiation in the type of services offered by practitioners. Some will continue to offer basic refractions and eye care whilst others will offer more specialised clinical services with the help of advanced technology such as Glaucoma Diagnosis (GDx), Heidelberg Retinal Tomograph (HRT) and Optical Coherence Tomography (OCT).

In the future a greater number of practices will try to differentiate themselves from others by the type of services they offer, rather than competing with each other solely on price.

Sahar Falahati is an optometry student in her fifth and final year of a Bachelor of Optometry & Bachelor of Science at UNSW (expected graduation 2011). She has honours Bachelor of Science – Specialised in Molecular biology: University of Toronto, Canada, 2004. This is her first published work.

Doug Grimson is an optometry student in his fifth and final year of a Bachelor of Optometry & Bachelor of Science at UNSW (expected graduation 2011). This is his first published work.

References:

1. School of Optometry and Vision Science. Program Information [internet]. Sydney: Faculty of Science. 2009 [cited 2009 Aug 21]. Available from:
http://www.optom.unsw.edu.au/future/undergraduate/proginfo.html
2. Mcbrien N. Doctor of Optometry [internet]. Melbourne: Department of Optometry & Vision Sciences; 2009 [cited 2009 Aug 23]. Available from: http://www.optometry.unimelb.edu.au/courses/OD.html
3. Mullen CF. Emerging Trends and Issues In Optometric Clinical Education/Patient Care/ Applied Research [online document]. US: Charle F Mullen website. Available from: http://charlesmullen.com/publications/Trends.doc
4. Mullen CF. Optometry and Medical School Affiliations [online]. US: Charle F Mullen 1986. Available from: http://www.charlesmullen.com/optometry-and-medical-school-affiliations/
5. Texas State Board of Pharmacy. Drugs that may be prescribed by optometrists [internet]. Texas; 2008. [cited 2009 Sep 1]. Available from: http://www.tsbp.state.tx.us/files_pdf/Optometrists.pdf
6. New South Wales Optometrists Registration board. Board requirements for the use of ocular therapeutic drugs in New South Wales [internet]. Sydney: NSW Health; 2009 [cited 2009 Aug 21]. Available from: http://www.optomreg.health.nsw.gov.au/optom_ocular.htm
7. Melton R & Thomas R. How and Why to Use Oral Meds Uncommon cases require different methods: Here’s where oral ophthalmic drugs fit in. Review of Optometry [serial on the internet]. 2001 [cited 2009 Aug 20]; 138. Available from: http://www.revoptom.com/
8. Anderton, P.. Implementation of evidence-based practice in optometry. Clinical and Experimental Optometry. 2007; 90 (4): 238-243.
9. Whatham AR & Pye DC. Imaging into the future of optometric practice. Clinical and Experimental Optometry. 2008; 91(6): 501-503.
10. Isenberg S, Del Signore M, & Madani-Becke G. Use of the HARK autorefractor in children. American Journal of Ophthalmology, 2001: 131 (4); 438-441
14. Department of immigration and multicultural and indigenous affairs. Inquiry into long-term strategies to address the ageing of the Australian population over the next 40 years [online document]. Canberra, 2003 [cited Oct 2009]. Available from: http://www.aph.gov.au/house/committee/ageing/strategies/subs/sub117.pdf
12. Department of health and ageing. Final report – Risk factors for eye disease and injury 2.1 Visual impairment and blindness in Australia [online article]. Canberra 2008 [cited Oct 2009]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-eyehealth-risk-factors.htm~ageing-eyehealth-risk-factors-4.htm~ageing-eyehealth-risk-factors-4-1.htm
13. Main R. Rural optometry in Australia [online document]. National rural conference No 10. 2009. Available from: http://10thnrhc.ruralhealth.org.au/papers/docs/Main_Robyn_C1.pdf