Remote refraction in the spotlight at AOP Council

The ethical conundrums posed by financial incentives within eye care and issues surrounding remote refraction were discussed at the latest AOP Council meeting (1 November, London).

AOP chief executive, Adam Sampson, outlined AOP external affairs activity – including attendance at the Conservative, Labour and Liberal Democrats party conferences.

He highlighted that the AOP is supporting The Eyes Have It campaign and calling for a National Eye Health Strategy for England.

Sampson added that former Under-Secretary of State for Primary Care and Public Health, Neil O’Brien, had committed to a standard national contract for extended eye care services.

AOP policy adviser, Kathy Jones, led Councillors in a discussion of standards for individual practitioners – with a focus on ethical behaviour.

She shared that the General Optical Council (GOC) is conducting a review of the professional standards for registrants in 2024.

Jones added that the standards were last reviewed by the GOC in 2016.

The GOC is now examining how practice has changed and what this means for how individuals standards should change, she said.

Topics relevant to the review include social media behaviour, professional and personal behaviour online, maintaining professional boundaries and where responsibility will fall in the context of digital developments.

Jones highlighted that there are also issues of financial probity around the appropriateness of financial incentives within eye care.

“We are taking a fairly firm line because we know that we will have to defend our members at the GOC, potentially,” Jones shared.

Remote sight testing

AOP clinical and professional director, Dr Peter Hampson, led a workshop discussion on the general issues raised by remote sight tests – and Councillors’ views on whether the legislative requirements can be met when a sight test is conducted remotely.

AOP Councillor, Paul Chapman-Hatchett, shared that remote sight tests may not be appropriate within domiciliary practice.

However, he noted that there is consumer demand for this mode of providing care and some companies are already offering remote care.

“It’s here, so how do we manage it?” he said.

“How do we prepare our members and students to be educated and ready for this new technology?” Chapman-Hatchett added.

AOP Councillor, Josie Evans, observed that the starting costs for establishing remote sight testing can be significant – but the potential savings in the long-term counteract this.

She highlighted that remote sight testing can be more convenient for patients and provide eye care to patients living in areas where it is challenging to recruit locum optometrists.

Evans added that remote sight tests could also provide greater flexibility for practitioners whose circumstances make working in practice challenging, such as those with disabilities or young children.

However, Evans shared the risk that practitioners could end up de-skilling if they are solely performing remote sight tests.

It may also be more challenging for some practices to set up this mode of testing because of substantial start-up costs, with independent practices potentially at a disadvantage when compared to multiple practices.

AOP Councillor, Will Holmes, highlighted that the costs associated with remote sight testing are likely to come down over time.

He also added that a changing skill set is a natural flow-on effect of technological advancement, adding that an optometrist today would not have same skillset as an optometrist who was practising decades ago.

“Over the next 10 to 15 years, we are likely to cease to perform certain tasks and start new ones. This process may well be challenging as it constitutes a change in our professional identity,” he said.

AOP Councillor, Jagdeep Kaur Gill, raised the issue of who will have responsibility for a sight test under a remote model.

Gill also qualified the idea that risk can be mitigated by only offering remote sight tests to patients within a certain age group.

“All of this is assuming that there is a safe patient bracket we can see but we all know that there is no safe patient age range,” she said.

AOP Councillor, Summaya Ali, highlighted her view that there is an inevitability to remote sight tests entering the market.

“My main worry is newly qualified optometrists taking up a remote testing role because of the convenience factor rather than considering the associated risks,” she said.

In terms of mitigating the risk associated with remote sight testing, AOP Councillor, Rachel Hiscox, highlighted that this mode of testing should be offered to patients under the age of 60 with no history of disease who have had a sight test previously.

Patients with potentially concerning symptoms or other co-morbidities should not be offered a remote sight test.

Hiscox added that optometrists should maintain their experience in performing in-person sight tests alongside remote examinations.

An optometrist should be present on site, a minimum standard set for technicians and contingency plans should be in place in the event of technological failure.

AOP director of communications, John White, led discussion around developments within optometry since 100% Optical was established in 2014.

The 10^th anniversary of the UK’s largest optical event will be celebrated at 100% Optical 2024 (24–26 February, London ExCeL.

Myopia management, expanded extended roles, the shift from CET to CPD, the growth in online sales, more practitioners qualifying with independent prescribing and the effect of the pandemic were among developments shared by Councillors.