The NHS’s limited optometry specialists don’t know best. That’s a system problem | Deirdre Tynan

When 12-year-old Brandon Nichol was diagnosed with a rare and aggressive type of astrocytoma, an inoperable tumour in his eye, his family began to worry about the risk of second- and third-degree burns. But…

The NHS's limited optometry specialists don't know best. That's a system problem | Deirdre Tynan

When 12-year-old Brandon Nichol was diagnosed with a rare and aggressive type of astrocytoma, an inoperable tumour in his eye, his family began to worry about the risk of second- and third-degree burns. But no one was ever prepared for what that would do to his vision.

Fortunately for Brandon and his family, a line for surgery was made available by a surgical consultant trained in Canada. “Just to think about being able to go and get my eye fixed … but I can’t have eye surgery because of the risk,” Brandon said. “I love watching things on TV. And to get this [operation] could mean all of those things would be taken away. That’s why I like it.”

Still, by the time Brandon’s eye was operated on, its fluid had sunk into his retina and the surgeon was able to successfully remove it. But Brandon knew he could never see like that again.

So in 2016, Brandon’s family turned to Ontario’s optometrists, whose agency, the Optometrists Branch of the Ontario College of Optometrists, came to the family’s rescue, offering the use of an artificial lens, expected to be at least as effective as the one they lost in the cancer surgery.

Because the lens would require the use of water, Brandon and his family moved to a warm, dry location in the middle of the Ontario summer. After months of painstaking work, a custom-made lens was painstakingly inserted into Brandon’s eye. It took months for the lens to fuse properly, but after more than a year of obsessive cleaning Brandon’s eye and extra measures to preserve the lens’ thickness, Brandon now sees like any other child his age.

Such assistance is available only in Ontario because, even though the Ontario health authority finances optometrists, the work of the optometrists branch in the province is voluntary. Brandon and his family now hope that the Ontario government will allow the optometrists branch to act more like a statutory agency, so that it can provide free glasses and surgical assistance as of right.

The Ontario health minister, Christine Elliott, announced a review of the optometry branch in early 2018. She allowed herself to be wooed by a group of optometrists who were concerned that the potential switch to statutory status would endanger them. That closed the door on the public discussion of Brandon’s case.

Disadvantaged patients may need optometrists to attend to their need for free surgical aid, but beyond that, what do people actually get for their money? Photograph: Kateline Houde/Alamy Stock Photo

Instead, the Ontario government agreed to keep the optometrists branch as it is. And although it was quick to cut funding to the college of optometrists that looks after its relations with the branch, the government has not allowed the optometrists branch to prove that it can provide the same quality of service free of charge as the college.

The government is now being lobbied to make that change, but it’s unclear when, or even if, it will. The fast pace of economic and technological change means that hospitals around the country have been trying to drop charges for their patient services to supplement funding by governments. Without optometrists, hospitals would be forced to do so. It’s not just Ontario’s hospitals that depend on optometrists for patient care – in some provinces, optometrists are the sole or even sole provider of those services.

But research has shown that fees charged for patient services are not much more efficient, providing enough financial incentive to drive eye doctors to work on an hourly basis instead of full time. Moreover, such measures do not even address the needs of the poorest or most vulnerable members of the population, those who would benefit most from free surgical services.

The insistence of Ontario’s optometrists that their agency be left to stand by itself is not only unfair to doctors, it’s not the science. The common wisdom that the future belongs to private care should be challenged in Ontario and elsewhere. In a world where treatment has no cap and millions of dollars are spent annually for potentially medically unnecessary cosmetic eyewear, the obligation to provide as much patient care as possible has never been more urgent. The public has a right to an optometrist who will not hold patients hostage just to stay alive.

Kairos College of Optometry

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