Europe and optometry

It’s unlikely that anyone will make their decision on European Union (EU) membership based on optometric issues alone. It is also hard to predict what the impact of leaving the EU might be on optometry in the UK. So, ahead of the approaching referendum, instead of putting forward a position on whether we should stay or leave, we’re offering an overview of optometry within the EU, and a review on some of what EU membership has meant for the UK and the impact it has had.

Optometry in the EU

The way optometry is defined and regulated varies across Europe, it also operates differently. This variation is captured in the European Council for Optometry and Optics (ECOO) Blue Book 2015, which compares optometry and optics across a number of European countries.

When it comes to workforce, the numbers vary greatly as does the split between optometrists and dispensing opticians. France has just 2,000 optometrists, but 25,000 opticians for its 64 million population. For a slightly lower population, the UK has over 14,000 optometrists and more than 6000 dispensing opticians. In fact, the UK has the largest optometric workforce in the EU. Spain has the highest number of optometrists per 10K of population (3.64 compared to 2.27 in the UK), but this figure is most likely because there is no separation between optometry and dispensing optics in Spain, while the UK categorises them as two separate professions.

	Highest	Lowest	UK figures
Number of optometrists per 10K of population	3.64 (Spain)	0.03 (Serbia)	2.27 (5th)
Number of opticians per 10K of population	3.91 (France)	0 (Norway and Netherlands)	1.01 (15th)
Number of retail optical outlets per 10K population	2.44 (Belgium)	0.3 (Hungary, the only EU country where practices do not refract, examine eyes, and prescribe and sell products)	1.15 (18th)
Percentage of refractions/ primary eye examinations carried out by ophthalmologists	75-89% (Belgium & Bulgaria)	Less than 25% (Denmark, Estonia, UK, Ireland, Norway, Portugal, Sweden)

The following table gives an indication of the differences across Europe

How has free movement of labour affected optometry in the UK?

The principle of free movement of labour across the EU has not had a sizeable impact on optometry, between June 2014 and May 2016 the GOC registered just 65 nationals of member states of the European economic area.

Practitioners with optical qualifications from outside the UK can apply to the GOC to work in the UK. Their application is reviewed by the GOC’s overseas qualifications sub-committee (apart from Irish optometry graduates who are automatically legible to work in the UK). The sub-committee assesses qualifications and practical experience to and decides whether the individual is eligible to practise here. Applicants may be asked to undertake an additional year of training, an ‘adaptation period’, if their competence is not sufficient.

Perhaps the biggest reason for low mobility across borders is the differences in the professional scope of practice. Optometrists in the UK have the largest range of permitted competence of any EU countries, even though practitioners in some countries regularly carry out functions less common in the UK. Many functions we see as part of standard practice are restricted in several countries, for example the use of therapeutic and diagnostic drugs is prohibited in most countries, while France does not grant any prescription rights. 

Regulating optometry

The Blue Book also shows the wide range of approaches to regulation of the optical professions across Europe. There is legal protection for the professions in all EU countries except Bulgaria and Poland. In most countries the professions are regulated directly by government or by law, while the UK and Latvia are the only two countries that have separate national regulatory authorities, in the UK’s case, the GOC. The EU has not influenced the way regulation works in the UK.

In order to ensure that professionals are not being unfairly excluded from practising in other EU countries, the European Commission (EC) has been undertaking an exercise called the Mutual Evaluation of Professions to establish how all professions are defined and regulated in each of the member states. The range of scope of practices in member states can make understanding optometry and optics difficult at the EU level. For example the EC defined ‘opticians’ as part of retail practice. To improve the understanding, ECOO submitted evidence to the EC and supported its member organisations in presenting their evidence to their national associations.

The GOC was consulted by BIS as it drew up the UK’s response to this exercise, which held to the position that the optical professions were considered by the UK Government as health professions rather than retail professions and that they would continue to be regulated accordingly.

From time to time EU regulations impact UK optical practices, the regulation on fluorescein strips is a good example.

Education and training

ECOO have developed a European Diploma in Optometry to ensure a uniformly high standard of education and practice across the EU. For an individual optometrist, there have been means to undertake examinations to achieve the European Diploma for the last 16 years and a number of UK optometrists have sought and achieved this qualification. However, more recently, an accreditation system for the European Diploma in Optometry has been introduced and universities and schools can benchmark their programme against the Diploma. A number of institutions have successfully gained full accreditation of the European Diploma, including Switzerland, Norway and Sweden. For UK institutions, there is growing interest to ensure UK optometry is recognised at this high level, too.    

A European framework called the Qualification in Optics has also been recently developed to recognise the need for a common standard for dispensing opticians.

AOP involvement in EU matters

The AOP is one of five UK members of the European Council of Optometry and Optics (ECOO), the others being the College of Optometrists, the General Optical Council (GOC), the Association of British Dispensing Opticians (ABDO) and Federation of Ophthalmic and Dispensing Opticians (FODO).  

ECOO has members from twenty three countries, not all of them EU nations.The five UK members meet together as the Joint Optical Committee for the European Union (JOCEU) and develop joint positions in preparation fortwice-yearly meetings.  

The AOP maintains its membership of JOCEU in order to keep abreast of developments that might affect the profession in the UK and intervene when necessary to support and protect its members.

While the EU has not had profound impact on optometry in the UK, it is important to understand the differences between the countries and to explain and protect the high standards of education and regulation of the UK. Whether or not the UK remains in the EU following the referendum, the AOP will remain involved in ECOO, the membership of which goes beyond the EU.