Milestone Moments in Australian Optometry

Dr Kate Gifford, Andrew Hogan and Joseph Chakman

In 1918, Australia’s population was just over five million. That year, and just one month after the end of World War I, the Australian Optometrical Association (AOA) was born at the first interstate conference, with 11 delegates. A new journal called The Commonwealth Optometrist appeared in March 1919. The journal, a continuation of a publication put out by the Institute of Optometrists of NSW (now O NSW/ ACT), was published by the Institute for the newly formed national organisation.

Across the country, optometrists formed societies and associations, and advocated for registration. Their belief was that registration would signify Government and community recognition of optometry as a profession. It would also mean recognised qualifications would be required to practice optometry, that optometrists would have to conform to clinical and ethical standards in their practices, and that ‘quacks’ would no longer threaten the sight of the public.

1975 brought the profession’s formative moment when optometrists were included in the brand new national health scheme, called Medibank (later Medicare)

Optometrist Newham Waterworth was responsible for getting registration of optometrists in Tasmania in 1913. This was the first optometrists’ registration Act in the whole of the British Empire, and a remarkable achievement because the legislation was so aggressively opposed by the medical profession. Tasmania was followed by Queensland in 1917, South Australia in 1928, New South Wales in 1930, Victoria in 1935 and finally, Western Australia in 1940.

FROM THE 20s

During the 1920s, medical graduates were being trained as ophthalmologists who spent much of their time performing refractions. Later, in 1932, OPSM was formed to concentrate dispensing activity. At the time there were also proposals that ophthalmologists should give free glasses with consultations, refuse to give prescriptions and promote the sale of readymade spectacles. Optometry had organised itself across the country, but with no national health scheme, sat outside the public health domain. The promise of a national health scheme in the late 1930s saw advocacy to government increase, but World War 2 delayed this policy.

THE 50s

By 1952, optometrists outnumbered ophthalmologists by eight to one and provided 90 per cent of primary eye care. Despite this, along with determined and sustained advocacy from the profession’s leaders, when the Menzies’ government introduced the Australian National Health Act in 1953, it excluded optometry.

Optometry’s exclusion saw its refraction services ineligible for benefit while ophthalmologists were able to claim a benefit for refraction as part of an examination for eye disease. Things got worse when, in 1953, all refraction services were excluded from receiving benefits. With other benefit options available to ophthalmology, the share of primary care patients between the two professions swung dramatically against optometry.

Despite these setbacks, the role of optometry began to be taken more seriously and the education standards required to practise as an optometrist were increased to university status. Barry Cole, Jon Nathan and Geoff Henry set up the first course in optometry at the University of Melbourne. Josef Lederer was instrumental in the development of the optometry course at the University of New South Wales.

In the words of Tasmanian optometrist Eric Padman, an influential figure in optometry throughout the 1950s and 60s, the profession had “learned the value of a united Australian Optometrical Association (AOA), a Federal body to be respected – every Australian government now respects optometry’s place in the professional field and our intention to preserve it”.

THE 60s

Vision science research began to shine in the 60s. The first optometry PhD in Australia was awarded to George Amigo in 1962 and the second to Barry Collin in 1970. Lloyd Hewett published a growing body of Australian research in the Australian Journal of Optometry (previously edited by W.G. Kett for 42 years). The monthly publications reflected changing professional and educational standards and saw Australia’s research recognised internationally. Today Optometry Australia’s journal, Clinical and Experimental Optometry has continued this heritage and grown more in impact.

THE 70s

The 1970s was a huge decade for Australian optometry. 1975 brought the profession’s formative moment when optometrists were included in the brand new national health scheme, called Medibank (later Medicare). A formidable team comprising National President Arthur Ley, Bruce Besley, Brian Layland, and Damian Smith (recently appointed as the Association’s first Executive Director), brought optometry’s case to the government with confidence, clarity and conviction. The Hon. Bill Hayden who developed Medibank as Minister for Social Services in the Whitlam Government, was open to optometry’s recognition as a primary health care profession. Optometry’s scope of practice was defined by State Registration Acts and the Government began paying benefits for consultations with optometrists during which a range of procedures were performed.

This moment was critical to the survival of optometry as a profession in Australia and to supporting the eye health of all Australians in the decades since. Today, more than nine million people access subsidised eye examinations annually.

In 1977, optometry was further cemented in the health system by inclusion in the Veteran Affairs scheme. Australia’s population was about 12 million and there were around 1,000 optometrists.

THE 90s

In 1993 the Keating Labor Government sought to remove optometry consultations from Medicare and the future for the profession of optometry was uncertain. This period, which some refer to as ‘the original Mediscare’, led to wide spread campaigning which successfully overturned the decision.

THE NOUGHTIES AND BEYOND

Legislation allowing optometrists to prescribe therapeutic drugs passed in Victoria in 1996 due in large part to David Southgate, who was President of the Victorian division at the time. Unfortunately, the Victorian Government did not implement the legislation for a few years and Tasmanian optometrists became the first to prescribe therapeutic drugs in Australia in 2002. Tasmania was followed by NSW in the same year, Queensland in 2003, ACT in 2005, the Northern Territory in 2006, South Australia in 2007 and finally, Western Australia in 2010.

In 2008, optometry’s prescription writing was included for Pharmaceutical Benefits Scheme eligibility as for other primary care providers. Two years later, the Australian Health Practitioner Regulation Agency (AHPRA) became a reality – the profession of optometry joined the National Scheme and became regulated by a national board. Australia’s population had cracked 21 million and there were around 4,000 optometrists.

In January 2015, the Medicare fee cap was lifted. This followed extensive lobbying by Optometry Australia to see self determination of our professional fees recognised by the government as vitally important to the profession’s future, especially in view of rebate cuts and the indexation freeze. Preparation for what was to be one of the most significant historical changes to our consultation billing in 40 years included the development of evidence-based recommended fee guides, patient information, and optometrist support materials. Four years on, though, the majority of optometrists across the country continue to bulk bill.

It’s fascinating to look back on how far the profession, and Optometry Australia, has come in 100 years. While much has changed, the profession of optometry remains committed to achieving the very best visual outcomes for patients.

 

Dr Kate Gifford is a clinical optometrist, peer educator, and researcher in contact lenses, binocular vision and myopia control. Dr Gifford became a director of Optometry Queensland/Northern Territory in 2005 and was elected vice president in 2009, before becoming president for a two-year term from 2010 to 2012. She joined the Optometry Australia national board as a director in 2010 and was elected national vice president in 2013. Dr Gifford was Optometry Australia’s second female National President, serving from 2014 – 2016.

Andrew Hogan was the National President of Optometry Australia from 2016 –2018. Mr Hogan is an optometrist and broadcaster in Hobart, and a former president of Optometry Tasmania. He served as a national director on the board of Optometry Australia for a total of six years, having been appointed from 2007 to 2011, and from 2014 to 2018.

Joseph Chakman was the CEO of Optometry Australia for 35 years and was instrumental in the establishment of Australian Independent Optometrists, now ProVision. He served on the board of ProVision for almost 30 year and continues to contribute to optometry as a member of the Board of O NSW/ACT.

Looking to The Future

Katrina Yap and Cassandra Haines

In early 2018, Optometry Australia launched Optometry 2040, a project which aimed to identify likely and preferred futures for optometry, optometrists, and community eye health.

The project was implemented in response to members’ concerns about increasingly rapid change associated with technological, economic, political, and demographic influences. These changes are already disrupting tried and true optometry practice models, working conditions, patient eye care, and clinician training requirements and communication. Early career optometrists in particular, with many years ahead of them, were uncertain about what their careers would look like in 2040.

Change isn’t always positive, yet it brings opportunity if it can be embraced and channeled, and Optometry 2040 aimed to do just that. Using proven techniques and in partnership with futures studies experts, Optometry Australia consulted optometrists across the country, and key stakeholders who influence the sector. Those key stakeholders included industry suppliers, ophthalmologists, universities, industry associations, and the regulators, who all attended workshops alongside optometrists to identify plausible and preferred futures and the pathways to realising them.

The excitement in the workshops was palpable. It was great to draw on ideas from other colleagues and realise that we have control over our future – if we want our future to look a certain way, we need to make changes now.

SEVEN TRENDS

Seven key trends were identified as shaping the future of optometry:

Consistently Evolving Technology 

Almost all of the trends driving optometry to its future are influenced by emerging technology. The enabling potential of innovative clinical and communicative technologies can seem limitless. New technology, including artificial intelligence applications, will continue to improve the services available for prevention, detection and management in eye health.

Enlarged Scope Of Practice 

Optometry will play an increased role in both eye care and broader health care, establishing the profession as ‘ocular health practitioners’ who are leaders in multiple areas of eye health. Optometrists will have a concrete role as part of a primary health care team and will deliver eye care in ways that best meet community need.

Consumer Centric Care Coupled With High Consumer Participation 

We will see the growth of ‘participatients’, facilitated by digital tools and forms of communication. This trend will be supported by moves towards more integrated and holistic care and will enable more direct and appropriate referral pathways. It will ensure there are many opportunities to provide best quality care to all patients, regardless of location.

Changes To Social Demographics 

Unprecedented changes to social demographics are taking place in health care and well being across the globe. Commonly understood trends include population ageing and escalating rates of mental health and chronic disease, however less well researched factors such as climate change, urbanisation and increased human mobility will also have an impact. The new era of screens heralding in challenges such as wearable technology, and global changes in myopia present new challenges that optometry will be at the forefront of.

Big Data 

There is a significant role for big data in driving decision making. In health care, data driven decision making can improve efficiency and productivity at system and practice level.

Alternative Models Of Funding 

While there is a strong community commitment to the Medicare system, a general lack of sustainability means optometry will need to consider alternative models of funding, especially as healthcare demands and scope increases.

A Changing Optometry Workforce 

The Australian optometry workforce is growing, and becoming more female and younger. In general, younger workforces have different attitudes to their work – they want more flexible employment, work that is meaningful, and opportunities to continually learn and develop.

By considering these trends, optometrists and stakeholders across the country identified likely scenarios for optometry’s future. They recognised that with rapid advancements in diagnostic technologies, change in consumer expectations, and potential loss of retail dispensing, the future looked bleak. Change was needed to ensure consumer access to quality care. By embracing and directing change, there is opportunity for a bright future for eye health and optometry.

Katrina Yap graduated with a Bachelor of Optometry from the University of Melbourne in 2013. She practices at Lakkis Optometry and is a clinical teaching instructor at the University of Melbourne Eyecare. 

Cassandra Haines practises at Eyes and Vision Optometry in Unley, South Australia. Ms Haines graduated from Deakin University in 2016. She is the Chair of Early Career Optometrists Committee in South Australia and a board member for Optometry South Australia. 

Step Into the Future

Melanie Kell

At a time when the future of optometry as a profession looks uncertain, Optometry 2040 presents a bold vision.

Within this vision of the future, it’s likely that we will have two ‘types’ of optometry practitioner. Those who continue with a traditional retail oriented shop front, and those who become integrated into a more holistic clinical system of collaborative healthcare. The latter may choose to work in clinical practices alongside ophthalmologists, in health centres that offer audiology, eye health and general practitioner services, or other disease specific centres. A diabetes clinic for instance, may offer access to general practitioners, dieticians, endocrinologists, podiatrists, optometrists and ophthalmologists.

Described as “a major health reform” Lyn Brodie, Optometry Australia’s chief executive officer, says the 2040 plan needs to be instigated now. Significant research is required and major milestones need to be achieved along the way – including new approaches to education, and new funding models to cover the cost of optometry services which are currently subsidised by retail sales of eyewear.

“We can control the future, we can make it happen – if we start now,” said Ms Brodie. “We know where we want to get to, so now we need to determine what it will take – we need to start talking to the Australian Health Practitioner Regulation Agency (AHPRA), the Optometry Board of Australia (OBA), the Royal Australian and New Zealand College of Ophthalmology (RANZCO), and the Universities. And we need to determine specific topics for research in preparation for the future.”

EVOLVING THE SCOPE OF PRACTICE

Ms Brodie said discussions will be necessary with RANZCO, the regulatory authorities and the universities about how optometry’s scope of practice will evolve to meet the growing eye health needs of the community.

“If we see an evolving scope of practice, then we need to understand how teaching for this will be included in courses at universities and in CPD. Typically the universities start to teach a topic before it is introduced and of course, it takes some time to change the curriculum.

“In the future, students at universities might do basic optometry, then if they have a particular interest, they might go into a separate stream, or later in their career they might jump back in (to gain more indepth training in a specific area of optometry practice).

Referred to as ‘micro-credentialing, Ms Brodie said it is already happening in New Zealand and to a small extent in Australia with for example, Civil Aviation Safety Authority credentialed optometrists who are trained to screen pilots’ vision.

The growing pursuit of special interests in eye health will change the way optometrists work together to deliver services. “I think as a result, we will see a lot more referrals between optometrists,” said Ms Brodie.

Rapidly evolving technology will also change the way optometrists are taught at universities, with greater need for counseling skills. “As technology ramps up, optometry will be interpreting findings and communicating with patients about what they’re interpreting,” said Ms Brodie.

There is no doubt that preparing students for a new world of optometry will be a challenge for universities. Associate Professor Nicola Anstice, head of discipline at the School of Optometry, Canberra University believes it comes down to creating life long learners. “It’s impossible to foresee exactly how optometrists will be practicing in 20 years, or the scope of the technology they will have access to, so we have to prepare our students to embrace continuous learning,” she said.

EVOLUTION OF MEMBERS’ SERVICES

Back at Optometry Australia, Ms Brodie believes there is also the need for change in preparation for the future.

“In the next five years we will look at how we start to adapt the services we offer to ensure they remain relevant, so we’re talking to members about the services they really value and the services we are not providing right now that we need to provide”.

Continued professional development is one area the Association is already working on to ensure its provision is in line with anticipated changes to be introduced by AHPRA and the OBA.

“We will launch a clinically focused online Optometry Australia CPD Institute with self directed learning tools allowing optometrists to create their own education plan. We hope to partner with multiple optometry CPD providers so that optometrists can use the Institute to access CPD from a variety of sources – online, face to face etc,” she said.

FULL STEAM AHEAD

With so much to do in preparation for a new future of optometry, and limited resources with which to achieve massive change, the OA team and its members could be forgiven for feeling overwhelmed. However Ms Brodie said that’s not the case.

“The 2040 vision has been embraced by our national Board and the profession – people want to be part of this change. We’ve imagined the future, we’ve identified the most viable plan and we have a clear direction – this plan will not sit on the shelf. At the end of the day, Optometry Australia didn’t write this report, our members – the sector and the industry did – so it’s a really powerful, collaborative plan for the future.