OPTOMETRY IN SPAIN: AN UNSTOPPABLE · PDF fileOPTOMETRY IN SPAIN: AN UNSTOPPABLE EVOLUTION GENERAL COUNCIL OF OPTOMETRY of SPAIN Jesús García Poyatos, D.O.O.,

OPTOMETRY IN SPAIN: OPTOMETRY IN SPAIN: AN UNSTOPPABLE EVOLUTIONAN UNSTOPPABLE EVOLUTION

GENERAL COUNCIL OF OPTOMETRY of SPAINJesús García Poyatos, D.O.O., M.Sc.

International Affairs Advisor

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SummarySummary• NATIONAL COLLEGE OF OPTICIANS-

OPTOMETRISTS OF SPAIN• OPTICIAN-OPTOMETRIST PROFESSION• OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE

– Optics-Optometry in Spain: The role of the Optician-Optometrist

• THE SPANISH OPTOMETRIST IN PRIMARY CARE• THE LATEST POLITICAL AND LEGISLATIVE

ADVANCES IN SPANISH OPTOMETRY

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NATIONAL COLLEGE OF NATIONAL COLLEGE OF OPTICIANSOPTICIANS--OPTOMETRISTS OF SPAINOPTOMETRISTS OF SPAIN• The National College of Optics, was

created by Royal Decree on 1964• Statutes were approved by agreement

of the Labor-Union Organization on 1964.

• Regional Offices were brought together and recognized.

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NATIONAL COLLEGE OF NATIONAL COLLEGE OF OPTICIANSOPTICIANS--OPTOMETRISTS OF SPAINOPTOMETRISTS OF SPAIN• New Law about Professional Colleges

on 1974• On 1977 is complemented regarding

the National College of Optics• Our relationship with the Administration

shall be done through Government Department of Public Health.

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NATIONAL COLLEGE OF NATIONAL COLLEGE OF OPTICIANSOPTICIANS--OPTOMETRISTS OF SPAINOPTOMETRISTS OF SPAIN• The new Statutes of the National

College of Optics are approved on 1979.

• Regulations of Internal Rules appear structured.

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NATIONAL COLLEGE OF NATIONAL COLLEGE OF OPTICIANSOPTICIANS--OPTOMETRISTS OF SPAINOPTOMETRISTS OF SPAIN• University Degree in Optic and

Optometry is established on 1990.• New members of the College shall be

qualified opticians-optometrists.• The National College of Optics

becomes the National College of Opticians-Optometrists on 1997.

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OPTICIANOPTICIAN--OPTOMETRIST OPTOMETRIST PROFESSIONPROFESSION

• Optic profession in Spain is being performed from time immemorial

• Daza de Valdés wrote the work “Use of glasses for all kind of eyesight”on 1622.

• 3 books dedicated to the nature and properties of the eye and the remedies for eyesight by the use of glasses.

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• The first Spanish Optics Association is created on 1918 with its Statutes.

• The profession is, beside a commercial activity, a scientific profession serving the eyesight health.

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• First issue or the professional magazine, “Spanish Magazine of Optics” on 1932.– Need of an Official Professional College.– Defend the commercial, professional and

scientific interests.– Legislation which regulated the practice of

the profession.

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• Trained in the daily practice, courses, seminars, conferences, and reading publications.

• Until 1956 when the Degree in Binocular Optics is created.

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• The Degree demanded several practical knowledge useful, not only for being a glasses dealer, but for the practice of Optometry.

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• The Daza de Valdés Institute starting organizing courses on 1956 for obtaining the Degree in Binocular Optics.

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• 1961 regulation of the profession of optics.– demanding a holder of diploma in optics for

all establishments of Opticians´

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• Creation of the National College of Optics on 1964– structuring the professional community– looking alter the quality of professional

tasks– fighting against the illegal practice of the

profession

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• 1972 was created the School of Optics at the Complutense University of Madrid.

• After three courses of higher education – diploma in optics

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• 1990 - official university degree in Optic and Optometry Diploma.

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OPTOMETRY IN SPAIN: OPTOMETRY IN SPAIN: A UNIVERSITY DEGREEA UNIVERSITY DEGREE

• First University College of Optics and Optometry created in 1972.

• Nowadays, 11 University Colleges:– 9 Public Universities– 2 Private Universities

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• More than 4000 students.• Same basic core subjects.• Complemented with compulsory and

optional subjects.• Offering basic and a professional

training:– Highly qualified opticians-optometrists.

• Contributing to eye healthcare.

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• Qualify them for:– Optometric examinations.– Lens prescriptions.– Preserve and improve sight.– Visual training.– Cut, make up, adjust and supply any

optical systems.– Refer patients to appropriate specialist.

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• Great demand for this university degree.

• Important role in country’s health, technological and economical development.

• Future graduates are becoming more flexible and adaptable.

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• European Association of Optometry Schools and Colleges (AEUSCO) was created in 1978.

• The University of Madrid chair AEUSCO from the start.

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OpticsOptics--Optometry in Spain: Optometry in Spain: The role of the OpticianThe role of the Optician--OptometristOptometrist

• Independent primary healthcare profession.• Clinical application of ocular physiology.• Prevention and correction of disorders of the

visual system by:– examination.– diagnosis and treatment of visual anomalies.– discovery of any systemic and pathological signs.

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• Optometry in Spain covers: – refractive error measuring– visual development and learning– binocular dysfunction– visual ergonomics– referral to a specialist– adapt and supply aids to compensate, treat

or relieve visual defects

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• Optometry only practiced by a university qualified professional in optics and optometry:– Official valid degree in optics and

optometry– Registered in the National College of

Opticians-Optometrists of Spain

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• Primary healthcare professional who specialises in poorly functioning visual systems.

• Trained professionals in:– normal and abnormal eye physiology– vision psychophysics– perception processes

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• Trained and legally authorized to:

– Determine the health condition and functional assessment of the components of the visual system.

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– Examine, treat and prescribe preventive and corrective devices to compensate visual anomalies.

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– Detect ocular and systemic pathologies. – Refer patients to the appropriate

healthcare professional.

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• Also can specialize in:– contactology– paediatrics– geriatrics– low vision– ergonomics - vision at the workplace– sports vision– visual training / re-education– neuro-optometry and – optical instrumentation.

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• Importance of Optics-Optometry in primary visual healthcare.

• The first contact in the detection of unsuspected systemic disorders.

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• Detection of glaucoma, cataracts, retinal haemorrhage, optic atrophy, blocked ophthalmic artery and so on.

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• Work in public or private healthcare centres and visual rehabilitation organisations.

• Carry out primary healthcare, training, research, and the rehabilitation of low vision anomalies.

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2 LEVELS

DEGREE

POSTGRADUATE

Professional Practice

MASTERS

PhD

Specialization

Research

Teaching

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PhDPhD

MASTERS

DEGREE

G1

G3

G2

G1

G4

G3

G2

M2

M1

M1

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THE SPANISH OPTOMETRIST IN THE SPANISH OPTOMETRIST IN PRIMARY CAREPRIMARY CARE

• Free and universal national health system.• This care is offered throughout:

– primary, secondary, tertiary or specialized care.• Complete network of outpatients´

departments and hospitals throughout the country.

• Acceptable healthcare system – problems of overcrowding and waiting lists

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• Prescription of drugs from the National Health Service (INSALUD) is practically free.

• Funded by company taxing and compulsory percentage (6%) on the monthly earnings of employees.

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• Private medical companies have made notable progress.

• Less crowded and more personalised system.

• Complement healthcare with a private insurance option.

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• Optician-optometrist practices are defined by law as a healthcare establishment.

• Must meet at least the following conditions:

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– The permanent and ongoing presence of the Optician-Optometrist.

– Minimum set of instruments and protocols on proceedings.

– License, prior membership of the National College of Opticians-Optometrists of Spain.

– Inspection by the regional health authorities.

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• 63% of the Spanish population go to the optician-optometrist.

• 37% visit an ophthalmologist:– 26% under the National Health Service – 11% attend private ophthalmologists or

those of private health insurance.

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– Increased life expectancy– Improved quality of life– Surgical and pharmacological advances

• Saturated national health ophthalmology services.

• Causes alarm and social dissatisfaction.

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• INSALUD has approached the National College of Opticians-Optometrists of Spain.

• Optometrist’s help in reducing waiting lists– Relieve ophthalmologist of everything to do

with primary visual care

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• Significant agreements for collaboration has been reached.

• In five autonomous Spanish regions:– Community of Andalusia– Basque Country– Community of Aragon– Community of the Canary Islands– Community of Madrid

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• Collaboration agreements have been set up:– Regional health authority of the Andalusian Health

Service– Basque Health Service– Department of Health, Consumption and Social

Services of the Aragon General Deputation– Canary Island Health Service– Health Council of the Autonomous Community of

Madrid

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• Objectives:– “To establish the mechanisms for the

prevention of visual problems, the correction and promotion of vision, aimed at patients, referred by the different health services of the various autonomous regions, via family doctors or general practitioners”.

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– The integration of the optician-optometrist as a primary sight carer in the national health system.

– The publication of common protocols.– To inform and advise the public of changes

in visual capacity.

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• Allows general practitioners, when seeing a patient with visual problems with no pathology, to refer this patient to an optometrist.

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• Optometrists must meet several requirements.

• Must appear on an official list.• Must carry out the following clinical

procedures for all cases:

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– Assessment of the refractive condition.– Assessment of the afferent and efferent

neurological pathways.– Assessment of the individual’s flat fusion ability.– To determine the integrity of the visual field of the

macular region.– To determine intraocular pressure value (IOP)– Refraction– Binocularity– Ocular health

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• Other tests to be carried out:– Ophthalmoscopy– Tonometry– Keratometry– Perimetry– Confrontation visual fields– Slit lamp observation– Retinography, etc.

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• If any pathological abnormality,– the patient should be referred to the

appropriate professional.

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• Optician-optometrists should draw up an optometric report for the Health Services’ epidemiological and statistical studies.

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• These agreements have entailed many political benefits for the National College of Opticians-Optometrists.

• Great opportunity to form a part of the Spanish Public Health Service.

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• Benefits– A universal service. – Geographic dispersion. – Agreement negotiated at corporate level. – Strengthening of the profession. – A challenge for the future. – Experience in primary visual health care.

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• These agreements are the first step towards the total integration of the Spanish optometrist into the National Health System in primary care.

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• If authorities wish to offer general public quality primary visual and ocular health care at less cost, they must consider opticians-optometrists as independent suppliers of this primary care.

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THE LATEST POLITICAL AND LEGISLATIVE THE LATEST POLITICAL AND LEGISLATIVE ADVANCES IN SPANISH OPTOMETRYADVANCES IN SPANISH OPTOMETRY

A. ROYAL DECREE ON HEALTH CARE ESTABLISHMENTS

B. LAW ON THE REGULATING OF HEALTHCARE PROFESSIONS

C. THE SUPREME COURT RULES AGAINST OPHTHALMOLOGISTS

D. THE ANDALUSIA HIGH COURT OF JUSTICE RULING

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Royal Decree On Health Care Royal Decree On Health Care EstablishmentsEstablishments

• To establish the general bases for the authorisation of health centres, services and healthcare establishments.

• To comply with:– Law 114/1986 on General Health– Law 16/2003 on National Health System

Cohesion and Quality

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• To regulate the general bases of the authorisation process by the autonomous regions.

• To establish a common classification, denomination and definition for the creation of a general register.

• To establish the general catalogue and register.

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• To be applied to all health centres, services, healthcare establishments, whether public or private of any type.

•• Healthcare establishmentsHealthcare establishments understood as:

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Healthcare establishmentHealthcare establishment“An organised group of technical instruments and installations where

officially qualified professionals, carry out basic health activities, the

dispensing of drugs or health products adapted to the individual”.

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• Common minimum requirements determined by royal decree.

• Requirements may be complemented in each autonomous region.

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• General register in the Ministry or Health showing any decisions, communications and authorizations of the autonomous regions on health matters.

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• Any advertising should show the register number awarded by the health authority of the autonomous region.

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• Period of eighteen months from the date this Royal Decree comes into force to meet this regulation.

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•• OpticianOptician’’ss are considered healthcare establishments, defined as:

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OpticianOptician’’ss“Healthcare establishments where, under the technical direction of a graduate in optics and

optometry, activities are undertaken involving the assessment of visual ability using optometric techniques; the cutting, making up, adjusting, supply, selling, checking and monitoring of the

appropriate means for the prevention, detection, protection and improvement of visual acuity; help

for low vision and the adjustment of external ocular prostheses”.

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• This Royal Decree came into force on 24 October 2003.

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Law On The Regulating Of Law On The Regulating Of Healthcare Professions Healthcare Professions

• To regulate:– Basic aspects of qualified healthcare

professions.– General structure of professional training.– Professional development.– Their participation in the planning and

regulating of healthcare professionals.

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Law On The Regulating Of Law On The Regulating Of Healthcare ProfessionsHealthcare Professions

• Establishes registers of professionals:– Rights of the public with regard to the

provision of healthcare.– Appropriate planning of the health system’s

human resources.

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• Applicable in public or private healthcare services.

•• Qualified Healthcare ProfessionsQualified Healthcare Professions are shown as:

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Qualified and regulated Qualified and regulated healthcare professionshealthcare professions

those whose undergraduate or specialist training is specifically and essentially

directed at equipping those undertaking it with the knowledge, skills and

attitudes appropriate to healthcare and are organised in officially recognised

professional colleges.

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• Graduates in optics and optometry are shown as healthcare professionals.

“At graduate level: the professions whose practice is enabled by holding the title

of Graduate in...... Optics and Optometry....”

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Healthcare graduatesHealthcare graduates“Healthcare graduates should, within the field of

activity for which they have the appropriate title, personally deliver the care or services of their professional competence in the different

phases of the healthcare process, without undermining the competence, responsibility and autonomy of the different professionals

involved in this process.”.

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OpticianOptician--optometristsoptometrists“University graduates in optics and optometry carry out activities for the

detection of ocular refraction defects, by their measurement using instruments, the use of re-education prevention and

visual hygiene techniques and the adjustment, verification and monitoring

of optical aids.”

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Continuing educationContinuing education“The active and permanent process of

education and learning to which healthcare professionals are entitled

and obliged to undertake.”

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Continuing educationContinuing education“This starts at the end of the period of

undergraduate or specialist study and is aimed at updating and improving the

knowledge, skills and attitudes of healthcare professionals with regard to

the scientific and technological evolution in demand from and the needs of society and of the health

system itself.”

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• Protocols must be written for any healthcare action.

• An Continuing education Committee has been created which will include representatives from the professional colleges.

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• Establish procedures for the examination of their professional development and career.

• Supervised, in their implementation and development, by the appropriate health authority.

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• Advertising of services must rigorously respect the scientific basis of activities and prescriptions.

• Objective, careful and true, so as not to raise false hopes.

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• Information given must be true, discreet, careful and shown in a comprehensible manner.

• Failure to comply shall result in sanctions.

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• Demands guarantees of safety and quality in private professional practice.

• Obtain help from quality agencies or the professional colleges.

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• Obligation to take out the appropriate liability insurance.

• Professional colleges may adopt the necessary means to enable their members to fulfil this obligation.

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• Public registers of healthcare professionals in order to ensure that patients may exercise their rights with regard to clinical information and documentation.

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• Registers must be public and accessible to the public.

• Must be at the disposal of the health authorities.

• Show the name, title, speciality and place where the professional practices.

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The Supreme Court Rules Against The Supreme Court Rules Against OphthalmologistsOphthalmologists

OPTICIANS-OPTOMETRISTS DO NOTDO NOTINVADE THE COMPETENCES OF

OPHTHALMOLOGISTS

RULING REJECTS AN APPEAL LAUNCHED BY THE COLLEGE OF

PHYSICIANS

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• The Official College of Physicians of the Balearic Islands:“There is a clear invasion of the professional competences of ophthalmologist physicians, namely the determining of the visual capacity

of the human being and the prescription of corrective ocular prostheses which are not

the legal competence of opticians-optometrists”.

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• The sentence passed by the High Court of Justice of the Balearic Islands was completely overruled.

• The College of Physicians launched an appeal.

• The Supreme Court overruled this.

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“Opticians-optometrists are university graduates in optics and optometry who

carry out activities to detect ocular refraction defects, by their

measurement using instruments, the use of re-education prevention and visual hygiene techniques and the

adjustment, verification and monitoring of optical aids.”

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“There was and is no reserve for the medical profession as alleged by the

appellant with regard to the detection of ocular refraction detection, on the

adjustment, checking and monitoring of visual aids”.

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“It does not appear that public health is put at risk by the recognition of

university graduates in optics and optometry, bearing in mind their

academic training, for their professional function”.

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“The profession of the optician-optometrist was created, a university degree being required for its practice

involving academic training and sufficient knowledge, precisely for determining the condition of sight”

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“This does not affect the specific competences of ophthalmologists with regard to eye and vision pathology.”

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The Andalusia High Court of The Andalusia High Court of JusticeJustice

• The Andalusia High Court of Justice rejected the Medical Association’s appeal against the agreement signed.

• Development of sight prevention and promotion activities does not invade the area of competence of the ophthalmologist.

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• Does not constitute unfair competition to the ophthalmologist.

“an instrument for the Andalusian public health authority to improve health care

by means of rapid client service”.

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• When a patient visits their G.P. with a sight problem, the doctor can refer them to any optician-optometrists to have their sight tested.

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“Assessing patients’ eyesight is one of the functions of an optician-

optometrists, and, therefore, work on information to improve sight, sight

promotion, prevention and hygiene do not constitute any invasion of the area

of activity of ophthalmologists”

Thank you for your kind Thank you for your kind invitationinvitation!!

Jesús García Poyatos, D.O.O., M.Sc.International Affairs Advisor

Colegio Nacional de Ópticos - OptometristasPrincesa, 25, 4ª planta

Edificio Hexágono28008 Madrid (Spain)

+ 34 91 5414403 / 4 Phone+ 34 91 5422397 Fax

+ 34 609 085250 Cell [email protected]

www.cnoo.es

Documents

OPTOMETRY IN SPAIN: AN UNSTOPPABLE · PDF fileOPTOMETRY IN SPAIN: AN UNSTOPPABLE EVOLUTION GENERAL COUNCIL OF OPTOMETRY of SPAIN Jesús García Poyatos, D.O.O.,