Canadian Optometrists Research Articles

Comparing paediatric optometric vision care in Canada over a 14-year period.

In Canada, teaching in paediatric eye care has increased in the past decade both within the optometry curriculum and as continuing education to optometrists. Paediatric vision care guidelines have also been established by North American optometric associations. This study examined whether this exposure was associated with changes in paediatric eye care in Canada over a 14-year period. Canadian optometrists were invited to participate in an anonymous 35-item survey in 2007 and 2021. The surveys sought to investigate optometrist's recommendations for first eye examinations, the number of paediatric patients seen in a typical week and preparedness to provide eye examinations to children. Response frequencies were determined for each survey item. Across Canada, 133/1000 (13.3%) and 261/~6419 (~4.1%) optometrists responded to the survey in 2007 and 2021, respectively. No significant difference was found in the number of years practicing, days per week in practice and total number of patients seen per week. The modal age optometrists recommended children be seen for their first eye examination changed from 3-4 years in 2007 (53%) to 6-12 months in 2021 (61%). In 2007, 87% of respondents provided eye examinations to children <2 years, increasing to 94% in 2021 (p = 0.02). Despite a reduction in the recommended age between the two survey years, the most frequent age children were seen for their first eye examination was 3-4 years (30% in both surveys) and the most common age seen in a typical week remained unchanged (4-6 years-56% 2007; 66% 2021). Although optometrists' willingness to provide paediatric eye care increased over the past 14 years, the number of children seen in a typical week did not change. Barriers to determine why more children are not being seen at an earlier age need to be investigated.

Efficacy of Traffic Signal Indicators

Surveys were conducted to determine if there is a problem with motorists determining the direction indicated by traffic light signal arrows. Canadian optometrists were asked if their patients report this problem during a visual examination. Drivers were queried about difficulty with the arrows and under what circumstances the difficulties occurred. Traffic engi­neers were requested to comment on the use of traffic light arrows in their jurisdictions and whether or not they perceive a problem with visibility. The results indicate that many Canadians, and Manitobans in particular, reported difficulty with the arrows.

2020 CAO Clinical Practice Guideline: Optometric Low Vision Rehabilitation FULL GUIDELINES

The purpose of the Low Vision Clinical Practice Guideline for Canadian Optometrists is to assist them in providing the best level of care in the management of patients with low vision. The guideline is based on current best evidence regarding optometric low vision rehabilitation as interpreted by an expert panel. The writing group includes optometrists from academia and private practice, representing various regions across Canada. This guideline will aid optometrists in identifying patients who require low vision rehabilitation and recommends appropriate assessment and management.&#x0D; As primary eye care providers, optometrists are optimally trained and qualified to identify and manage patients who would benefit from low vision rehabilitation. Optometrists, based on their geographical presence in local communities, are also well positioned to provide initial rehabilitation in a timely, effective manner, and to initiate referral for more comprehensive rehabilitation if required.

2020 CAO Clinical Practice Guideline: Optometric Low Vision Rehabilitation Executive Summary

The purpose of the Low Vision Clinical Practice Guideline is to assist Canadian Optometrists in the provision of the best rehabilitative care for patients with low vision. The guideline is based on current available best evidence, interpreted by an expert panel. The writing group includes optometrists from academia and private practice, representing various regions across Canada. The guideline will aid optometrists to identify patients who require low vision rehabilitation and recommends appropriate assessment and management.

Survey of Occupational Musculoskeletal Pain and Injury in Canadian Optometry

Objective:&#x0D; A growing concern in optometry is the incidence and prevalence of occupational musculoskeletal (MSK) pain and injury, with no studies assessing Canadian professionals. However, the risk of work-related MSK pain in optometry has become widely recognized by the profession and literature as having a negative impact on the health and careers of optometrists. The goal of this study was to quantify prevalence and location of MSK pain in Canadian optometrists and estimate practices that may be associated with MSK issues.&#x0D; Methods:&#x0D; A voluntary, internet-based survey (SurveyMonkey Inc., San Mateo, CA, United States) was distributed to all optometrists registered with the Canadian Association of Optometry (CAO). Survey questions were adapted from the literature to identify the prevalence and significance of work-related MSK issues.&#x0D; Results:&#x0D; One-hundred-twenty-one optometrists, with a response rate of 2.4%, and 169 ophthalmologists, with a response rate of 17% participated in a voluntary internet-based survey. When asked if they had experienced pain attributed to their work in the last 12 months, 61% of optometry responders said “yes”, compared to 50% of ophthalmology responders (p=0.06). Shoulder pain was reported in 41% of optometry responders, lower back pain in 37% and neck pain in 34%. This was compared to 28% (p=0.02), 36% (p=0.90) and 46% (p=0.04) respectively in ophthalmology responders. Optometry respondents most commonly attributed MSK pain to “performing the same task over and over”, “working in the same position” and “slit lamp exams”.&#x0D; Conclusion:&#x0D; Many of the eye-care responders in our study were impacted by work-related MSK pain. The prevalence, location and severity of pain were similar to findings in other literature. More research is needed to determine best practices for prevention and solution of MSK pain among eye-care professionals.

Top Legal Risks and Regulatory Trends Facing Canadian Optometrists

Doctors of Optometry are subject to many of the same legal risks and trends facing most regulated health professionals in Canada. These legal exposures range in scale from College investigations into an optometrist’s billing practices to seven-figure lawsuits alleging that an optometrist failed to appropriately diagnose andrefer a patient for further investigation and treatment. This article uses information gained through calls made by insured optometrists to the Canadian Association of Optometrist (CAO)’s Insurance Program pro bono legal services hotline along with over 15 years of program claims data to provide an overview of common legal risks and regulatory trends affecting the profession.

Optometric Care of the Patient with Diabetes

The Canadian Association of Optometrists (CAO) is the national voice of optometry and is dedicated to collaboratively advancing the highest standard of primary eye care through the promotion of optimal vision and eye health, in partnership with all Canadians.&#x0D; Optometrists are the front line of eye health and vision care. They are experts in primary eye care and are well-positioned to help combat the vision related complications of diabetes.&#x0D; CAO assembled the Diabetes Guidelines Working Group to create national guidelines on the clinical management of diabetes mellitus in an effort to further educate Canadian optometrists and assist them in the management of this chronic disease. The Working Group consists of optometrists from private practice, research and academia, chosen on the basis of their expertise, experience and representation from across Canada.

Educating smokers about the risk of blindness - insights to improve tobacco product health warning labels.

BackgroundHealth warning labels (HWL) on tobacco products help educate smokers about the health effects from smoking; however, there is a need to improve HWL content including images and text to increase effectiveness. In Canada, a HWL was created that communicates smoking’s causal association with “blindness” from age-related macular degeneration (AMD). This study surveyed Canadian optometrists about their opinions regarding the image and text used in the “blindness” HWL.MethodsAn online survey was sent to all 4528 registered Canadian optometrists. Respondents were asked if the HWL conveyed important and believable information, and if the picture was appropriate. Optometrists were invited to make open-ended comments about the label which were analyzed using a qualitative analysis framework suitable for health policy evaluation. Frequency distributions were calculated for closed-ended questions.ResultsThe survey was completed by 850 respondents (19 %). Most respondents (90 %) reported the message was believable/somewhat believable; while 35 % felt the picture was “too graphic”. Some respondents reported in their open-ended comments that they were concerned the HWL was internally inconsistent because it reports there is “no effective treatment in most cases” for AMD but the image depicts someone undergoing surgery. There was concern that this may discourage patients from seeking needed treatment.ConclusionThe majority of Canadian optometrist respondents were in agreement that the new, “RISK OF BLINDNESS” pictorial HWL includes important, believable information. Some optometrists had concerns that the HWL included a confusing message or a message that may discourage some patients from pursuing treatment for AMD. Future development of blindness-related HWL should seek practitioner input.

Eye on Denver

The annual American Academy of Optometry (AAO) meeting had another record-breaking year in Denver this past november. A total of 6,323 attendees made this meeting the largest on record, despite the sub-zero temperatures and biting winds. Among the attendees were 218 Canadian optometrists and 71 students, residents, and librarians from both Canadian schools. Overall student attendance hit a record high this year, with 995 optometry students attending in total. the faculty and students from the two Canadian schools were once again very involved in the meeting, presenting posters, research talks, and Ce lectures and being honoured with awards.

Low-vision service provision by optometrists: a Canadian nationwide survey.

To document the degree to which Canadian optometrists are involved in the provision of low-vision (LV) care and their referral patterns. To investigate the barriers to providing optometric low-vision services (LVS). Practicing optometrists across Canada were randomly sampled and invited to participate in a questionnaire that included questions on personal profile, primary practice profile, levels of LV care offered, patterns of referral, and barriers to provision of LV care. Questions included a combination of multiple choice and open-ended formats, and included hypothetical cases. A total of 459 optometrists responded (response rate, 24.8%). Optometrists estimated that 1% (range, 0 to 100%) of their patients were LV patients yet also estimated that 10% of their patients had acuity equal to or worse than 20/40. Thirty-five percent of respondents indicated that their primary practice offered LV care, 75.6% would manage a patient with minimum disability and simple goals themselves, whereas 10.7% would manage a patient with more than minimal visual disability who needed more specialized LV devices (e.g., telescopes, electronic aids, and custom-designed microscopes); 84.3% of optometrists would assess for basic magnification and lighting in a hypothetical patient with early age-related macular degeneration, whereas 15% would undertake full LV rehabilitation in advanced age-related macular degeneration. Optometrists commonly referred to CNIB (formerly the Canadian National Institute for the Blind), yet only 10.7% of respondents almost always received a written report after referral. Those who would not undertake LV assessment stated that they lacked the knowledge, equipment, or experience; that LV assessment is too time consuming; and that the cost is too prohibitive. This is the first comprehensive study of LVS provision by optometrists in Canada. In order for optometrists to become more involved in LVS, there is a need for more LV education, provincial health coverage of optometric LVS, and better collaboration communication between LV providers.

Smoking Cessation Referrals in Optometric Practice: A Canadian Pilot Study

The current pilot study sought to understand optometrists' attitudes toward addressing tobacco use within the scope of their practice, and to identify opportunities within Canada to integrate optometrists as health care partners into the national tobacco cessation network. A descriptive qualitative design was used to conduct this pilot study. Five focus groups were conducted with 29 informants, including 11 practicing community optometrists and 18 senior Doctor of Optometry students from the University of Waterloo. Rationales, barriers, and opportunities to practice patterns were identified. Optometrists and optometry students knew the association of smoking with eye diseases such as age-related macular degeneration and cataract; however, some informants selectively asked patients about smoking behavior based on patient age or visit type. Most informants indicated that they did inform their patients who smoke of their increased risk of developing certain eye diseases; however, very few informants assessed whether their patients wanted to stop smoking and no informants reported that they had ever provided a patient with explicit support for tobacco cessation. This limited role in smoking cessation support for patients due, in part, to insufficient: financial incentives, training and educational tools and materials, knowledge of community resources for cessation treatments, and time during appointments. Several opportunities were identified to better integrate optometry into tobacco control efforts such as optometrists' access to patients, patients' fear of blindness as a tool to motivate behavior changes, and practitioners' openness to change. Optometrists can be a helpful addition to a smoking cessation healthcare network that already involves more than a dozen health care professions including medicine, nursing, pharmacy, dentistry, and dental hygiene. The findings of this study will be used to develop a national survey of Canadian optometrists' practice patterns regarding tobacco use prevention efforts and cessation supports for their patients.

Smoking and Blindness What Optometrists Want their Patients to See

Most smokers are not aware that their tobacco use is a preventable cause of blindness. Despite the important role optometrists can have impacting patient health choices; their voice has been largely silent in the development of tobacco cessation practice guidelines and health promotion strategies. In this study, we use the International Tobacco Control Policy Evaluation Project (ITC) Four Country Survey to describe the level of Canadian smokers’ knowledge of the association of smoking with blindness and we use focus groups to elicit ideas from Canadian optometrists and senior optometry students about blindness-related graphic warning labels.

“Eye-T”: Information technology adoption and use in Canada’s optometry practices

Background While information technology (IT) is playing an increasing role in the delivery of optometric services, little specific information is available about how IT is changing the practice of optometry in Canada or whether optometry schools are adequately preparing their students to use this technology when they graduate. Methods Quantitative data on how IT is being used, as well as related barriers and potential benefits, were obtained in a survey of Canadian optometrists (N = 474). Three site visits were made to geographically dispersed Canadian optometry practices identified as exemplars of IT adoption. Results More than 96% of Canadian optometrists use computers in their practices, but fewer have integrated computers into their examination rooms. Optometrists are regularly using computers to manage their practices and medical record keeping. The automated perimeter is the clinical assessment technology most used (88.4%), followed by the autorefractor (83.9%) and the autokeratometer (72.2%). The anterior segment camera is the technology most likely to be acquired within the next 5 years (36.9%), followed by the scanning laser ophthalmoscope (26.8%). Major benefits of IT for optometrists include being better able to provide patients with images and information to explain results and to inspire greater patient confidence that the practice is state of the art. Perceived barriers include the need for frequent updates, lack of resources for training, and cost. There is support for increased exposure to IT as part of training in optometry. Conclusions Use of IT in optometry practices is widespread and likely to continue to increase in the years ahead. IT may be a key element in the future success of optometry practices in an increasingly competitive marketplace. Perceptions of high investment and training costs are barriers to further adoption. Optometrists may benefit from increased exposure to IT as part of their training.

New eyewear regulations draw ire of optometrists

Changes to eyewear regulations in British Columbia have drawn praise from some opticians and consumers, but most Canadian optometrists consider them a poke in the eye. Two amended regulations in particular have become topics of debate (see sidebar for a more complete list). One allows opticians to

Competency Corner, Part Three: Practice-based Weightings of the CBPS

The first two articles in this series outlined the task, research, terminology and processes the Competence Committee used to develop the Competency-based Performance Standards (CBPS). These standards were designed as a framework for revision of the Canadian Standard Assessment in Optometry (CSAO) to directly link the exam and practice requirements of Canadian Optometrists. This linkage required determination of the relative weight to be assigned to each of the various competencies. Working groups of practising optometrists rated the frequency and criticality of performance of each of the competencies using a standardized rating system. Results indicated that the majority of a revised CSAO would focus on providing comprehensive eye and vision care (78%), followed by management (11%) and collaboration (10%). The ratings also allowed calculation of the appropriate weighting of the underlying general attributes. The heaviest weighting was assigned to candidates’ professional optometric knowledge and the ability to apply this knowledge (41%), followed by communication (27%), planning (13%), ethics (11%) and self-directed learning (8%). The last article in this series will describe work to evaluate the competence-based weightings of the current CSAO and to describe plans for future versions of the CSAO.

A Seven Year Survey of the Contact Lens Prescribing Habits of Canadian Optometrists

Little is known about the contact lens prescribing habits of optometrists in North America. The purpose of this survey was to obtain data on the types of lenses and solutions prescribed by Canadian optometrists. One thousand Canadian optometrists were surveyed annually over seven consecutive years (2000 to 2006; n = 7000) on their contact lens prescribing preferences. Each survey requested a range of information about the contact lenses prescribed to the first 10 patients after its receipt. Over this time period, 1008 (14.4%) of the surveys were returned, providing data on 9383 fits. During the seven-year period, the ratio of male:female fits was 1:2 (3123:6217, 43 not reported), with a mean age of 31.3 +/- 13.6 years (range 2 to 82 years). The ratio of new fits to refits was 2:3 (3780:5518, 85 not reported), with 91.3% of all fits being soft contact lenses (SCL). Of the SCL fits, 59.5% were spherical, 28.5% toric, 9.7% multifocal, and 2.3% cosmetic tints. Gas permeable (GP) fits were 46.6% spherical, 18.6% toric, 19.5% multifocal, and 6.6% were for orthokeratology (OK). Over the seven-year period, SCL prescribed for continuous wear (CW) increased from 3.2% to 14.3% between 2000 and 2004 and reduced to 8.1% in 2006, for all fits. The use of mid-water content (MWC) materials decreased from 34.6% to 2.7% and the use of silicone hydrogel (SH) lenses increased from 61.4% to 96.2%, for all CW fits. GP lens continuous wear increased from 0.7% to 30.6% of all GP lens fits by 2006. Daily wear (DW) of SH lenses decreased from 49.6% (2000) to 33.7% (2004) and then increased to 86.1% in 2006, for SH fits. MWC SCL fit on a monthly planned replacement (PR) basis reduced in popularity over the seven-year period (75.0% to 39.9%) and in 2006 more patients were fit overall with SH lenses (42.9%). The use of non-PR SCL declined from 20.5% to 4.5% of all fits. Fitting of low-water content lenses also declined (15.1% to 7.0%). High-water content (5.4% to10.2%) and SH lenses (5.4% to 42.9%) both increased. By 2006, the majority of GP lenses fit were with high Dk (HDK) materials (50.3%). The preferred contact lens modality for Canadian optometrists appears to be DW SCL, which are replaced monthly. The proportion of lenses used for CW peaked in 2004, with SH SCL being the preferred material. The market share for GP lenses remains relatively unchanged, with an increasing proportion used for OK and CW. The launch of DW SH lenses in 2004 resulted in a marked increase in their reported fits, with a similar effect following the launch of a HDK GP lens material for CW.

Competency Corner, Part One: Optometrists – What do we do?

In 2001 the Canadian Examiners of Optometry mandated the Competence Committee to describe the competencies required of Canadian Optometrists to provide safe and effective optometric care. The goal of this work was to provide a framework for revision of the Canadian Standard Assessment in Optometry so that questions on this exam could be directly linked to the practise-requirements of Canadian Optometrists. Work from the World Health Organization (WHO) provided an excellent foundation for the Competence Committee’s deliberations, emphasizing that Optometrists have professional responsibilities beyond providing eye and vision care. The Competence Committee followed WHO’s framework and identified four critical roles of Optometrists. These roles relate to: i. providing eye and vision care; ii. collaborating with and referring to other health care providers; iii. managing their practice, and; iv. educating within their profession. A second set of general attributes was also identified. These general attributes are needed to successfully perform the majority of the professional competencies. The Competence Committee identified five underlying general attributes: knowledge, reasoning and skills; planning and implementation; communication; values and ethics; and, selfdirected learning. The next article in this four part series provides the detailed descriptions of these professional competencies and underlying general attributes required of Canadian Optometrists.

The Canadian Optometry Survey: Report on the Utilization of Diagnostic Pharmaceutical Agents by Canadian Optometrists

This study represents the first national survey of optometrists in Canada. A mailed questionnaire was designed and implemented in order to discover how optometrists have reacted to the introduction of diagnostic pharmaceutical agent (DPA) legislation in Canada and to determine what variables are important predictors of DPA use. The data collected were also used to test the null hypothesis that DPA legislation does not affect the use of mydriatic/cycloplegic agents by optometrists. A stratified random sampling procedure was used to select 230 optometrists (roughly 10% of the practicing profession) for inclusion in the study. Over 90% of the subjects completed and returned the questionnaire. A statistically significant and important association was found between mydriatic/cycloplegic drug use and legislation (p less than 0.05 and odds ratio = 2.18). Legislation, type of practice, age, and optometry school attended were all found to be associated with DPA use.