I’m taking a moment’s break from talking about beauty this afternoon to talk about another important thing in my life- my profession. Now it’s a bit of political post so if this type of thing bores you, click to the next post instead.
One of the issues Optometry faces today is the increasing retail focus of the profession. Even though optometry degrees are becoming more and more indepth, longer (Melb uni degree is now 6 years, UNSW is 5 years for a Bachelor of Optometry) and increasingly medical/clinical focused- the industry reality is that optometrists make money not from their clinical skills but from spectacles. Corporate chain stores are doing brilliantly in this environment, and Specsavers have even sponsored a fast-track 3 year course at Deakin University to churn out “optometrists”.
There’s talk of a ‘two tier’ optometry profession- bottom tier consisting of optometrists working in retail who will test your eyes for glasses, and top tier optometry is full scope clinical practice managing eye disease and prescribing ocular medications.
All very controversial stuff not to be talked about over dinner.
My partner (who many of you may know as ‘P’), is also an optometrist and has just written this letter to the Minister for Health, the Shadow Minister for Health, and the local MP. As a beauty and personal blog, My Funny Valentine is probably not the right place to post this letter- but his letter may never see the light of day otherwise so here it is.
I am an independent optometrist practicing in Australia. After a few years in the workforce, I have learnt that Optometry is the only health profession participating in Medicare that cannot determine the fees they charge for their services. Optometrists work under an overly restrictive Medicare remuneration structure where the fee they can charge for their services is capped by the Government. This fee is not reflective of the cost of maintaining proper levels of care with ongoing training and latest equipment costs.
Consider the following example;
On any given day, I could see an average of 15 patients – who are all tested for vision problems and potentially blinding eye disease such as glaucoma and diabetic retinopathy. I also provide therapeutic management of various chronic and acute eye diseases. On top of this, I will also provide spectacles and other visual aids for refractive errors. Some of these consultations can take 45-60mins however Medicare only allows us to charge a fixed amount of $70 for any consultation longer than 15mins duration. About $60 of this is reimbursed by Medicare. This leaves a situation where the only other source of revenue becomes the sale of spectacles or other ocular appliances. Many patients will then request a copy of their prescription to purchase their spectacles elsewhere. We are required by law to provide a spectacle prescription when requested.
Optometrists are the cornerstone of primary eye health and vision care in Australia. We play a key role in preventing, detecting and treating eye disease and vision problems. Their role in preventing vision loss and blindness is increasingly vital as our population ages and as rates of chronic disease like diabetes increase.
Over the years, the role of Optometry in diagnosis and management of eye disease (and ultimately blindness prevention) has increased significantly. This has been achieved via means of extensive training and professional development both at an undergraduate and postgraduate level.
However, due to the Medicare Fee cap; practitioners are forced to subsidise the cost of their clinical expertise via the sale of ocular appliances (glasses, contact lenses etc). While glasses are an important part of a consultation for many patients, it is not sustainable to have a remuneration system that relies heavily on retail sales. Sadly this has been the case for myself and many of my colleagues. This means a reduced ability to make a living and to continue to provide vital clinical services to prevent detect and manage eye disease.
I strongly believe that for a sustainable model where Optometrists can continue to provide a high standard of care, the Medicare cap needs to be lifted to allow practitioners to charge a more appropriate fee for their services. I am not asking for more money from the government, just the freedom to charge a more appropriate rate for my clinical services.
Thank you for taking the time to read this letter, any assistance you can offer in helping realise a fairer and more equitable remuneration system for myself and my colleagues under Medicare would be sincerely appreciated.
My 2c – make specs and contacts cheaper, and have the option to charge appropriately for consultations.
For those who are unhappy about this post, I apologize if I’ve offended- that is not my intention. These are my honest opinions.Posted by myfunnyvalentine on Mar 27th, 2013 in Your friendly blogging optometrist | 69690 comments. Your+friendly+blogging+optometrist%3A+an+open+letter+to+the+Minister+for+Health+2013-03-27+05%3A16%3A57myfunnyvalentinehttp%3A%2F%2Fmyfunnyvalentineblog.com%2F%3Fp%3D6969
Just your everyday beauty blogging optometrist here- thought I would finally put on my health care professional hat on this blog after avoiding it for the last 2 years.
To be completely honest here, I had avoided blogging about anything related to my career because:
a) I wanted My Funny Valentine to be an escape from my day job and kept totally separate.
b) I didn’t want google to connect My Funny Valentine to Jenny (B.Optom UNSW) – although I suppose I’ve really put the nail in the coffin there haven’t I?
c) Giving health advice on the internet is fraught with danger.
I must credit Yishan from www.beautyswatch.com for suggesting this idea, over 12 months ago while we were catching up over coffee. She’s a fountain of wisdom for me, and is always looking out for the best interest of the readers.
The reason I decided to speak out about contact lens related issues now is because lately I’ve had one too many patients come to see me with complications from the inappropriate use of coloured contact lenses and circle lenses- all of them ordered their lenses online and none of them had their lenses fitted by a professional. These girls had no idea what risks they were taking, because no one had ever told them.
The popularity of coloured and ‘circle’ contact lenses has increased exponentially in the last few years, and there is now a mind boggling number of unlicenced online retailers allowing easy access to cosmetic contact lenses without requiring any sort of professional care.
This has been a huge concern among eye care professionals (as well as the TGA and FDA) since we’re seeing an alarming increase in rates of sight threatening complications directly associated with the inappropriate use of these lenses. The danger comes from the fact that these lenses are being used without all the proper fitting, instruction, and regular monitoring from an eye doctor or optometrist- patients are wearing lenses that are potentially wrong for their eye shape, and have not had any education on lens care and hygiene.
This is a recipe for disaster, and the final dish can sometimes look something like this…
This is a case of Pseudomonas Keratitis, a severe infection of the cornea (the clear dome on top of the coloured part of your eye), secondary to inappropriate, unmonitored contact lens wear. Less severe complications include corneal scarring, new blood vessels growing into the cornea (see image below), smaller corneal ulcers, and inflammatory ocular responses from sleeping in lenses.
Glad you asked.
For patients to be fitted into any contact lenses, including non prescription cosmetic lenses, an eye doctor or optometrist needs to do a full eye health and refractive check to determine whether lenses are suitable and what type is required. A proper fitting process, teach, and after care appointments are needed to make sure the contact lenses and solutions are compatible with the eye and performing well. Rather than going into too much detail here, I’ve just linked a PDF copy of the Contact Lens Consultation form that our practice uses for those that are interested in finding out what is involved —> Contact lens consultation info
A review of the literature shows that most, if not all cases of severe eye complications from cosmetic lenses presenting to emergency departments around the world are cases where the patient has not had been to an eye care professional.
As an optometrist, I would never recommend wearing coloured contact lenses more than once a week, and never more than 8 hrs at a time, even when they have been properly fitted. The reason for this is that these lenses are significantly less oxygen permeable (breathable) compared with some of the clear contact lenses available on the market, and if the lenses are worn too much patients will inevitably end up with chronic damage to the cornea due to lack of oxygen.
So the answer is, you can safely wear coloured lenses if you only wear them occasionally and under the guidance of an eye care professional.
First image courtesy of [image creator name] / FreeDigitalPhotos.net