Regulatory Bodies define the scope of the profession and what is needed to be done to be included in the register for optometrists. They additionally detail the competencies that fall within the regulated scope that an optometrist performs in practice. These are used to control what the optometrists do in practice. The scope of practice may be periodically reviewed and expanded if needed.

The optometry profession in many countries have not included the use of ocular diagnostic or therapeutic pharmaceutical drugs in the original scopes of practice. In recent years, most have realized that to adequately address the fight against preventative blindness and provide comprehensive eye health and vision care to all those in their countries, there is a need to amend the scopes of practice to include ocular diagnostic and therapeutic medications.

DEFINITIONS

SCOPE OF PROFESSION:

Legal, regulatory, and professional framework define the scope of the optometry profession in each country.

SCOPE OF PRACTICE:

The scope of practice defines the actual procedures and processes that an optometrist is allowed to perform as part of their licensure category and specific training, per the scope of profession in their country.

Practitioners may undergo further training and wish to practice additional clinical skills which were not part of their original scope. This expanded scope of practice must be approved by the Regulatory Body who will have to engage in a series of legal steps to have the scope of practice formally expanded. Practitioners who undergo further training will also have to change the licensure category that they are currently registered in.

The Regulatory Body may need to follow these steps recommended below:

STEP 1:

DETERMINE IF ANY OTHER EYE CARE PROFESSIONALS ARE PEFORMING THE PROPOSED EXPANDED SCOPE. IDENTIFY THE CURRENT GAPS IN EYE CARE SERVICES IN THE COUNTRY IN RELATION TO OCULAR DIAGOSTIC/THERAPEUTIC SERICES. COMPILE A RATIONALE FOR OPTOMETRISTS TO INCREASE THE SCOPE OF PRACTICE TO ADDRESS THE UNMET NEEDS.

STEP 2:

LIST THE SPECIFIC ADDITIONAL COMPETENCIES THAT WILL BE ADDED TO THE CURRENT SCOPE OF PRACTICE. YOU MAY CHOOSE TO SHARE THESE WITH OTHER RELEVANT EYE CARE PROFESSIONALS  FOR INPUT.

STEP 3:

APPROVE A COURSE THAT NEEDS TO BE UNDERTAKEN BY OPTOMETRISTS IN ORDER TO MEET THE EXPANDED SCOPE OF PRACTICE.

STEP 4:

PRESENT THE RATIONALE, REQUIRED TRAINING, AND PROPOSED AMENDMENTS TO THE SCOPE OF PRACTICE TO THE RELEVANT AUTHORITY FOR APPROVAL AND LEGISLATION. THE REGULATORY BODY MAY NEED LEGAL ASSISTANCE TO DRAFT THE AMENDMENTS TO THE SCOPE OF PRACTICE BEFORE IT IS PROMULGATED INTO LAW.

STEP 5:

SET UP SEPARATE REGISTERS FOR THOSE OPTOMETRISTS WHO SUCCESFULLY COMPLETE THE ADDITIONAL TRAINING. IF A LICENCE CARD/CERTIFICATE IS ISSUED ANNUALLY TO PRACTITIONERS, THEY MUST REFLECT THAT THE PRACTITIONER IS REGISTERED TO PRACTISE THE EXPANDED OPTOMETRY SCOPE.

When the regulation is amended and new scope for optometry is defined, it may be best that the Regulatory Body engage with universities in the country offering optometry training to include relevant scope of practice advancements in their undergraduate programs. This may mean that the number of years to complete an optometry degree be extended to include the additional competencies. Ideally, schools should also include specific additional clinical training at hospitals/community clinics for students to get exposure a wide range of ocular diseases.

CASE STUDIES

Case studies, from different countries across the globe, are included in this section.  The areas addressed are: 1.) developing a professional association, 2.) lobbying for formal recognition of the profession, 3.) developing a regulatory body, and 4.) introducing legislation to change the profession or expansion of the scope of practice.  These real-life cases can give insight into a process that has been successful for other countries. Every country has a unique process so you will be able to read and understand the many different approaches to issues.   These case studies can help advocates/countries better understand what may work and use the Legislative toolkit as a reference for the issue(s) that need to be addressed.

• Asia Pacific region
• Saudi Arabia
• South Africa
• Switzerland
• United States

Standards of practice means a document embodied in a healthcare code, which is usually determined by the Regulatory body/College, which defines all aspects of professional service.   Defined as the applicable standards in a traditional healthcare setting overseeing the care, skill and learning associated with the practice of the profession.  Some examples include: accountability-takes responsibility for actions, confidentiality-keep all information private and away from those who should not have access, fiduciary duty-place needs of patient first and honesty-always tell the truth.  This will lead the ethics of the profession as being practiced in the country.  The profession, if it follows the ethics as set by the Regulatory body/College, optometrists will practice at the highest standards.

The profession of Optometry varies in scope of practice around the globe.  Optometry has a history of providing care to individuals at varying levels of care.  Optometrists, through their clinical education, training, experience, and possible broad geographic distribution, have the means to provide primary eye health and vision care.  So besides refractive care, different issues requiring primary ocular care may be addressed depending on the country’s health law. They have the aim of guiding decisions and criteria regarding the specific areas of the profession.  Having advanced clinical guidelines, which will cover many different diseases and proper treatment, will inevitably provide a uniformity of care across the profession for a country that accepts and implements practice guidelines.  Advanced clinical guidelines, which are evidenced based, are published as a reference guide for individual practitioners and educational institutions to implement.  These are usually written by a committee of educated optometrists appointed by the National association and very well referenced to be accepted by the profession.