Optometry's fundamental importance in global health

This year, World Optometry Week (17–23 March) has focused on the role optometry plays in global health.

Through the theme of Eyes to the future: Optometry improving global wellness, the World Council of Optometry (WCO) has highlighted the ways in which the role of optometry will become increasingly important in addressing the challenges facing global healthcare systems.

In a statement recognising the awareness week, Dr Sandra Block, president of WCO, said: “WCO envisions the future of eye care as one where optometry plays a central role in global health systems to meet this demand.”

The WCO has highlighted how the optometry profession is uniquely positioned to lead the way in preparing for the challenges that face healthcare by expanding its role as a primary eye care provider.

Dr Cindy Tromans, president-elect of the WCO, shared her reflections on this year’s theme with OT.

She said: “Eye health is of fundamental importance to all health care systems, with unaddressed vision impairment constituting a major public health challenge.”

Globally, at least 2.2 billion people have a near or distance vision impairment, and in at least one billion of these, it could have been prevented or is yet to be addressed. Refractive error is one of the world’s leading causes of vision impairment and blindness.

Eye health is of fundamental importance to all healthcare systems

Other eye conditions which are increasing in prevalence, such as glaucoma, age-related macular degeneration and diabetic retinopathy, remain undiagnosed due to poor accessibility and affordability, especially in low-income countries, Tromans said, adding that correction and prevention are easy and cost-effective.

Highlighting the role of the profession in meeting these needs, she said: “Optometrists are the key provider of refractive error correction through the provision of spectacles and contact lenses. They are university educated, autonomous, and easily accessible to the community, and therefore well suited to addressing the burden of eye diseases and conditions.”

“Optometry should be at the forefront of any eye care related public health initiative. The scope of optometry can be integrated into all levels of the healthcare system by recognising the profession, providing strong educational support, enhancing legislation and regulations, expanding the workforce through increased graduate numbers, and investing in additional care pathways,” she explained.

Making this investment can increase overall productivity and the efficiency of the eye care model, producing better healthcare outcomes and stronger economies, she said.

Optometry should be at the forefront of any eye care related public health initiative

A unified framework

OT was interested to hear how the optometry profession around the world could be equipped to take a leading role in shaping eye care.

The World Report on Vision, published by the WHO in 2019, identified the challenges in eye health and care delivery, and emphasised a need for an increase in eye care personnel.

Tromans said: “The report demonstrates the magnitude of vision-related conditions affecting the global population and how these negatively impact on health, wellbeing and productivity outcomes, especially in vulnerable and isolated communities.

“Due to changing global demographics, such as an ageing population and the increasing prevalence of myopia, eye health challenges will increase dramatically in the coming years.

“A lack of coordinated response and insufficient eye care workforce will see continued gaps in the diagnosis and treatment of vision impairment, leading to a variety of societal repercussions,” she said.

The UN General Assembly has also recognised the importance of eye care in achieving the sustainable development goals of no poverty, zero hunger, good health and wellbeing, quality education, decent work and economic growth, and sustainable cities and communities.

“Optometry needs to demonstrate that the profession has the relevant competencies not only in the detection and management of refractive error but also in the detection and management of ocular diseases,” Tromans said.

She continued: “A unified global framework for optometric education is therefore needed to ensure the minimum standard for those that use the title optometrist and to make clear to policy makers the competencies of optometrists that support the role of optometrists in eye care teams.”

Eye health challenges will increase dramatically in the coming years

Demonstrating competencies

In 2022, the WHO produced an Eye Care Competency Framework (ECCF) describing the required skills, knowledge, and competencies for eye care workers, including optometrists.

This was followed last year by the WCO Competency Framework for Optometrists, based on the ECCF, which outlines essential competencies in optometry to act as a guide for developing curricular for optometry programmes.

Tromans said: “This enables providers and educators to reference the required skills and competency levels for optometry to ensure that optometrists can participate at their fullest scope in healthcare delivery systems at national and international levels.”

Scope of practice

The WCO Competency Framework for Optometrists identified that the current eye care workforce can be enabled to work at the full scope of their training to meet immediate eye care demands, while the skills of the profession can also be more widely utilised within healthcare systems.

Tromans commented: “There is an abundance of evidence that shows the scale of unaddressed visual impairment whether that is avoidable, such an uncorrected refractive error or presbyopia, or treatable such as diabetic retinopathy, glaucoma, dry eye, and cataract.”

There is also ample evidence of a lack of eye care workers to address these needs, Tromans continued, adding: “It is therefore vital that optometrists use their full scope of practice within their healthcare systems.”

There are discrepancies in scope of practice of optometrists around the world, the WCO has found, and educational levels are not supported by appropriate legislation in many countries, such as regarding the use of diagnostic drugs.

To enable this, there must be a legislative framework that allows optometrists to work to their educational level, and allow progression in scope of practice, such as in the use of therapeutic agents, Tromans said.

Models of care will need to change and evolve to meet increasing demand and the challenges of accessibility

Innovation for accessible care

Writing in the WCO Competency Framework for Optometry, the body identified how the profession needs to consider the “use of current and future technologies, and their impact on the equitable, accessible, affordable and efficient delivery of eye care.”

Tromans highlighted that access to eye care is a major barrier in delivering services, and that technology, digital health, and artificial intelligence, could provide solutions to scale up and increase eye care services.

This could be perceived as a threat to established optometry practice, she acknowledged, but emphasised: “Models of care will need to change and evolve to meet increasing demand and the challenges of accessibility.”

Optometry could be at the forefront of developing “easily accessible health systems,” Tromans suggested: “We have to evolve and position optometry within the wider healthcare team.”

The WCO is involved with the WHO Specs programme, as well as the International Agency for the Prevention of Blindness, which advocate for the role of optometrists in the changing eye care environment, Tromans added.