Clinical Discussion 2: Primary Eye Care Introducing Optometry in a Tri-Border Area Maurice M.T.H. Heunen, MSc
Aug 17, 2015
Clinical Discussion 2: Primary Eye Care Introducing Optometry in a Tri-Border Area Maurice M.T.H. Heunen, MSc
Conflict of Interest Co-owner Optometrisch Centrum Oud-Geleen
Location
Location Belgium 7km Germany 7km
Höhere Fachschule für Augenoptik Köln (DE) 100km
Optometrie en Optiek Hogeschool Universiteit Brussel (BE) 120km
Optometrie Hogeschool Utrecht (NL) 170km
Box 1 Greece Turkey
Box 2 Belgium France Iceland Italy
Box 3 Austria Denmark Finland Germany Spain Sweden Switzerland
Box 5 Australia Canada New Zealand UK USA
dispensing refraction prescription diagnosis of eye disease using DPA’s (diagnostics) treatment of eye disease using TPA’s (therapeutics) eye surgery using laser
dispensing refraction prescription diagnosis of eye disease using DPA’s (diagnostics) treatment of eye disease using TPA’s (therapeutics)
dispensing refraction prescription diagnosis of eye disease using DPA’s (diagnostics)
dispensing refraction prescription screening for eye disease
dispensing refraction prescription
dispensing
© Feike Grit 2007
Box 4 (Andorra) Ireland Netherlands Norway
Box 6 USA (1 state)
Optometry in The Netherlands after November 2000
Main advantages: Diagnostic drugs allowed Allowed to make an optometric diagnosis
NL Optometry early 2000s: Hospital
Use diagnostic drugs Working as ophthalmic assistants
NL Optometry early 2000s: Optical
Optometrists are allowed to use diagnostic drugs Offering optometry as a problem solver
NL Optometry early 2000s: Optometric
Optometric practices without optical sales -> went broke within 3 years
Setting goals
WCO concept of optometry: Optometry is a healthcare profession that is autonomous, educated and regulated (licensed / registered). Graduated in Utrecht (BOptom, 2004) Registered (KP nr 49907883787) Private practice
Setting goals
WCO concept of optometry: 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 in the visual system.
Starting an optometric practice
2004 joined a contact lens practice Advantages: reduced investment Existing patient base Disadvantages: difficult to change a “winning team”
Already available Immediately necessary Auto-refractometer 90D, 20D, gonio lenses Retinoscope Indirect ophthalmoscope Phoropter + trial frame Goldmann appl. tonometer Distance + near vision tests Binocular vision tests Slit lamp Colour vision test Direct ophthalmoscope Amsler grid Corneal topographer Tropicamide Non contact tonometer Phenylephrine Fluorescein Oxybuprocain Lensmeter Cyclopentolate
Implementing optometry
Offer a comprehensive optometric exam to everyone Clear distinction between optical sales and health care Don’t offer optometry for free
Hard choices
Quit offering contact lens fittings and refractions Convince colleagues and patients of the benefits of a comprehensive eye exam “Forbid” my colleagues to use the non contact tonometer
Different mindset
Traditionally: Product based I want new glasses -> 10mins refraction I want contact lenses -> contact lens fit New: Problem based Always start with a thorough examination of the eyes and visual system
Refraction
Traditionally: History, refraction, binocular vision, non contact tonometry.
BUT Pts equal good tonometry to good eye health Explain importance of tonometry, offer a comprehensive eye exam.
Contact lens fit
Traditionally: History, topography, refraction, anterior segment.
BUT Why not adding: binocular vision, tonometry and fundus examination? It adds ~10 minutes Makes people familiar with optometry
Collaborate with General Practitioners
Visited all local GPs Explained optometry Referral letters
Collaborate with Ophthalmology
Visited the local ophthalmology departments Give the information they want Ask feedback in return
Collaborate with Optometrists
Group with other optometrists:
Do’s: case reports and referral schemes Don’ts: competition / commercial subjects
Spread the word: What didn’t work
Free sight tests at a drivers refreshment course. Sponsoring Fashion shows Sponsoring Athletes
Spread the word: What did work
Word of mouth www.ocog.nl
Spread the word: What did work
Advertisement in local news paper: “Something’s wrong with my eyes…”” Comprehensive eye exam on regional TV
Belgium
Ophthalmology Advantages: shorter waiting lists Good feedback Disadvantages: some struggles with insurance companies. Optometry School HU Brussel Foreign experience mandatory
Germany
Language border Excellent manufacturers Technical courses
Acknowledgement
Thanks to Dr Wolfgang Weseman Optometry School Cologne for providing information
DISCUSSION
•Setting goals
•How to start
•International differences