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

Thank you!

info@ocog.nl

DISCUSSION

•Setting goals

•How to start

•International differences