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What is an optometrist?

Just what is an optometrist? According to the American Heritage Dictionary, he or she is “a person who is professionally trained and licensed to examine the eyes for visual defects, diagnose problems or impairments, and prescribe corrective lenses or provide other types of treatment.” Surely, this does not describe a 2004 American optometrist? A more appropriate definition would be more substantial and dynamic. The World Council of Optometry’s Concept of Optometry (WCO) is as follows: Optometry is a health care profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are primary health care 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. This is probably closer to a useful working statement, but it, too, includes some contentious issues. Can there be optometry without licensing and registration and what if a jurisdiction legislates that optometry is something quite different? An alternative way to view an optometrist is to look at a two dimensional array of an optometrist’s actual performance. The first dimension would be that which is the legal scope of practice in a particular jurisdiction, whereas the second would outline capability or competency in a task. Each individual competency has three parameters: its definition, its measurement, and its standard. This approach is now the basis of the model favored by regulating authorities to the extent that at a meeting of international regulatory bodies in conjunction with the U.S. Association of Regulatory Boards of Optometry (ARBO) and WCO (Dallas, December 2003) it was tentatively agreed to develop an internationally accepted set of optometric competencies based on the Australian Competency Document, which has evolved since its original version in 1991. This document confines itself to the definitions of competency. Europe and Canada 5 have also begun the process of definition and measurement of individual competencies. A possibly more important issue is the process by which standards are set, or to put it more colloquially: “Who examines the examiners?” It seems to us that a reasonable system already exists. On the one hand, registration boards are charged by their governments to protect the public by maintaining appropriate standards. On the other hand, many boards either alone (e.g., the General Optical Council in the United Kingdom) or in concert (e.g., the states of Australia and New Zealand, the states of the U.S.A., and the provinces of Canada) have already well established accreditation methods. Mutual recognition by these accrediting bodies or, better still, an international accrediting body would be a significant step toward standardization. By using the competency approach, regulating authorities will be able to determine the skills and knowledge of any internally or externally trained optometrist applying for registration in a justifiable and objective way. A further benefit is that educational institutions can be accredited against an accepted set of standards that is comparable around the globe. It should therefore be possible to define optometry in any jurisdiction as a subset of the full matrix of competencies. This should amount to a potentially greater ease of mobility for optometrists to move around the world, not only to practice but also to receive continuing education and to help developing nations in the pursuit of better eye care for their people. Ironically, an American optometrist would then be able to register and practice optometry in another country, such as Australia, which has just signed a free trade agreement with the U.S.A., far more easily than in another state of the U.S.A. Mutual recognition of registration as a concept already exists among the Canadian provinces, the states of Australia and New Zealand, and slowly but conditionally in Europe. One perception often used to counter this process is the protectionist argument. That is, a horde of optometrists will flood into a country, thereby reducing the standard of eye care and threatening the quality of life of the existing optometrists. Optometry legislation is rarely concerned with human power or quality of life issues. However, to a certain extent, the quality of care issue is politically legitimate because many laws enabling changes in scope of practice have been gained as the result of bitter legislative battles. Once additional privileges are gained in a jurisdiction, boards are required to ensure that entering optometrists have equivalent or similar credentials as those of the local optometric practitioners. The WCO has facilitated the development of competencies as an objective measure as a potential precursor to any governmental action within the General Agreement on Trade and Services initiative. The World Trade Organization is actively encouraging professions to establish international standards to facilitate the free flow of professionals throughout the world. Optometry now has the tools to participate in this movement if required. Optometry’s scope of practice differs dramatically between jurisdictions; indeed, there are many who would term the work of some practitioners more accurately as opticianry than optometry. Recently, Gavzey and Masnick, through the Legislation and Regulation Committee of the WCO, set out to compile an international database of current optometric practice with the aid of an elementary questionnaire. The survey results show a snapshot of optometry in 30 countries and are available on the WCO Web site. A review of the country profiles shows that optometry has a wide 1040-5488/04/8105-0289/0 VOL. 81, NO. 5, PP. 289–290 OPTOMETRY AND VISION SCIENCE Copyright © 2004 American Academy of Optometry DOI: 10.1097/01.opx.0000134897.45038.e4