Canadian Ophthalmological Society sees ‘significant concerns’ with expanding scope of practice of non-physicians in eye care

The group representing eye doctors in Canada is calling on governments to exercise caution when it comes to expanding the scope of practice for non-physician eye care professionals, warning of a greater likelihood of delayed or incorrect diagnosis.During a press conference in Ottawa on Wednesday, Dr. Nina Ahuja, president-elect of the Canadian Ophthalmological Society, said the organization had “significant concerns” over several proposals across Canada to expand the scope of practice for non-physicians “without engagement of physician specialists extensively trained to provide that care.”“Other professions including optometry play important and complementary roles in care but they are not interchangeable in terms of training scope or responsibility,” she said.During her press conference, Dr. Ahuja shared two stories involving incorrect diagnoses made by optometrists. In one case, a patient was assessed for fluctuating vision by an optometrist who thought it was a localized eye condition.“When the condition didn't resolve, a family member insisted that their loved one be assessed by an ophthalmologist who identified a life-threatening condition underlying the vision loss, a condition that required urgent life-saving medical care,” she said.In the other case shared by Dr. Ahuja, an optometrist referred a patient for a laser procedure for a presumed diagnosis, but upon examination by an ophthalmologist, the diagnosis was not what was initially expected. “Proceeding with the laser treatment would have been unnecessary and could have resulted in irreversible harm to the patient’s vision,” she said. Although Dr. Ahuja did not call out any specific provinces or proposals by name, several provincial governments have put forth proposals to expand the scope of practice for optometrists. Last fall, the Ontario government ran consultations on a proposal to allow optometrists to perform minor surgical procedures, use laser therapy to manage cataracts and glaucoma, and treat open-angle glaucoma without referring patients to a physician.Back in February, British Columbia also held consultations on whether to allow optometrists to prescribe and administer oral drugs and apply laser for the purpose of cutting and destroying tissue for certain procedures.In Alberta, the province’s minister of primary and preventative health services also expressed support for expanding optometry scope of practice last fall. And earlier this month, the Saskatchewan government signed a new six-year agreement with the Saskatchewan Association of Optometrists, which included a commitment for new funding to raise public awareness on how optometrists can treat glaucoma and diabetes care.“We urge policymakers to approach system change with a clear vision of an integrated comprehensive healthcare system rather than addressing gaps through disconnected measures that contribute to fragmentation, delays in diagnosis, and increasing complexity in navigating care across multiple providers,” Dr. Ahuja said.

Canadian Ophthalmological Society sees ‘significant concerns’ with expanding scope of practice of non-physicians in eye care

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