Ireland's model of eye care is outdated

More services can be provided by optometrists

Deborah Condon

May 13, 2022

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  • Ireland’s hospital-centric model of eye care is outdated, resulting in unacceptably long waiting times for patients, Optometry Ireland has warned.

    It is calling for a new contact for public eye care and an expansion of services in the community – an approach already used in other European countries.

    According to Optometry Ireland President, John Weldon, patients are being diagnosed too late and waiting too long for treatment. This is damaging to their health and quality of life.

    Waiting list figures from the National Treatment Purchase Fund show that at the end of March 2022, over 38,500 people were waiting for outpatient appointments, while 8,500 people were on the inpatient waiting list.

    However, Mr Weldon insisted that these waiting lists could be addressed by looking at how public eye care services are provided in other European countries.

    “A lot more diagnosis, treatment, prescribing and monitoring of eye diseases and conditions can be provided in the community by optometrists under public contract. We can learn from other European countries who have adapted this model of care. This can be done without much difficulty and is more cost effective,” he explained.

    He pointed out that if more routine services were accessible at local optometrists, hospital ophthalmology departments could focus on specialist and complex care.

    “Other member countries across Europe are already applying this model. We are asking Health Minister, Stephen Donnelly, and his officials to take notice and commit to implementing a similar model of care here,” Mr Weldon said.

    He made his comments at a European Council of Optometry and Optics (ECOO) meeting in Dublin on May 13, which was hosted by Optometry Ireland.

    Minister Donnelly provided a video message to the meeting in which he said that community optometrists were pivotal to the delivery of core eye care services and have the potential to play an even greater role.

    “My officials are working with their counterparts in the HSE with a view to contracting more services to community optometrists. Embedded in communities, local optometry practices ensure access to care near people’s homes and reform in eye care must build upon those foundations,” he commented.

    Responding to this, Optometry Ireland CEO, Seán McCrave, said that the need for a new public services agreement has previously been acknowledged by Minister Donnelly and senior department officials at meetings and now is the time to progress this issue.

    “There have been major changes in optometry. Techniques have changed and treatments have expanded. Equipment and technology have transformed. Our 23 year-old contract does not recognise these changes and so doesn’t provide a meaningful reference for what optometrists can and should provide,” he noted.

    Optometry Ireland highlighted six priority changes that could be included in a new contract that would help to achieve earlier diagnosis and treatment for the public. They are:

    -National roll out of the award-winning Sligo Cataract Scheme where optometrists refer cataract patients directly to public hospitals and review post-cataract patients. This would reduce the costs incurred by the National Treatment Purchase Fund and cross border schemes

    -Nationwide rollout of a children’s eye care scheme where eye examinations and care for children aged over six is led by optometrists. They could manage cases where medical examinations and treatments are not required, and refer those who do require treatment

    -Authorising optometrists to directly refer medical card patients to EDs without GP involvement. This would reduce the need for patients to be redirected to GPs, leading to cost savings and less burden on GPs

    -Sanction optometrists to provide the public treatment of additional conditions such as stable glaucoma, dry eye and dry macular degeneration. Doing so is within the scope of optometrists training and would reduce hospital waiting lists

    -Remove current restrictions on optometrists’ prescribing of medications and enable them to do so to the full extent of their training and qualifications

    -Sanction short hospital rotations as part of the training of undergraduate students of optometry. This would help to better integrate hospital and community services.

    “A new optometrists’ contract, which follows the community-led model of our European partners, would significantly improve outcomes for our population. With relatively little intervention or overall change to costs, these improvements can be readily implemented. We are calling on Minister Donnelly to progress work on a new contract and to provide more care in the community by engaging with our profession,” Mr Weldon added.

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