OPTOMETRY IN SPAIN

1. OPTOMETRY IN SPAIN Member of: Ignacio Costa, Grad.O-O, M.Sc., PDG IESE,

2. THE SPANISH OPTICIAN-OPTOMETRISTS SYSTEM History of how has been regulated “A Metamorphosis from Optics to Optometry” Parallel progress in professional organization with education evolution First Education for: Existing Opticians New Optician-Optometrists Then legislation Optics-Optometry in Spain: The role of the Optician-Optometrist The Spanish Optician-Optometrists in primary eye care An opportunity to advertise our practice The latest political and legislative advances in spanish optometry

3. First Spanish Optics Association created with Bylaws, defining the profession as a commercial activity and scientific profession serving primary visual health. Regulation of the profession of optics holder of diploma in optics for all establishments National College of Optics, created by Royal Decree with Bylaws, structuring the professional community, looking alter the quality of professional tasks, fighting against the illegal practice of the profession. New Law about Professional Colleges. The new Law is complemented regarding the National College of Optics relationship with Government through Department of Public Health. The new Bylaws are approved and regulations of Internal Rules appear structured. New University Degree in Optic and Optometry. New members of the College shall be qualified opticians-optometrists. The National College of Optics becomes the National College of Opticians-Optometrists. • History of how has been regulated: Parallel progress in professional organization with education evolution • “A Metamorphosis from Optics to Optometry” 1918 1961 1964 1974 1977 1979 1990 1997

4. 2006 2010 NATIONAL COLLEGE OF OPTICIANS-OPTOMETRISTS OF SPAIN SPANISH GENERAL COUNCIL OF OPTOMETRY

5. Parallel progress in professional organization with education evolution for: • Existing Opticians • New Opticians-Optometrists • Trained in the daily practice, courses, seminars, conferences, and reading publications. • Until 1956 when the Degree in Binocular Optics is created. • The Degree demanded several practical knowledge useful, not only for being a glasses dealer, but for the practice of Optometry. • 1972 was created the School of Optics at the Complutense University of Madrid. • After three courses of higher education • University degree in optics • 1990 - official university degree in Optic and Optometry. • First University College of Optics and Optometry created in 1972. • Nowadays, 13 University Colleges: • 9 Public Universities • 4 Private Universities 1956 1972 1990 OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE

7. DEGREE DIPLOMA For Professional Practice For Professional Practice 1 LEVEL 2 LEVELS MASTERS For Specialization POSTGRADUATE POSTGRADUATE MASTERS Research PhD Teaching OPTOMETRY IN SPAIN: A UNIVERSITY DEGREE

8. 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 or another Oficial Regional College if created in that territory of practice. Primary healthcare professional who specialises in poorly functioning visual systems. Independent primary healthcare profession not depending of other professions. 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. • Optics-Optometry in Spain: The role of the Optician-Optometrist • The Spanish Optician-Optometrists in primary eye care

9. Trained and legally authorized to: Determine the health condition and functional assessment of the components of the visual system. Examine, treat and prescribe preventive and corrective devices to compensate visual anomalies. Detect ocular and systemic signs of pathologies. Refer patients to the appropriate healthcare professional. • Optics-Optometry in Spain: The role of the Optician-Optometrist • The Spanish Optician-Optometrists in primary eye care • Because the Spanish Optician-Optometrists were legally recognized as healthcare professionals in primary eye care we found a great opportunity with our authorities to advertise our practice and get social recognition of our important role in public health care.

10. Free and universal national health system. offered throughout primary, secondary, tertiary or specialized care. Complete network of outpatients´ departments and hospitals throughout the country. Acceptable healthcare system but problems of overcrowding and waiting lists Private medical companies provide less crowded and more personalised system so many Spaniards complement healthcare with a private insurance option spending more money. 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. Optician-optometrist practices are defined by law as a healthcare establishment. Must meet at least the following conditions: The permanent and ongoing presence of the Optician-Optometrist (university graduate and practising member of the professional organisation). 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. Our opportunity with the authorities to advertise our practice and get social recognition of our important role in public health care.

11. BECAUSE OF: Increased life expectancy Improved quality of life Surgical and pharmacological advances BECAME THE PROBLEM: Saturated national health ophthalmology services. Alarm and social dissatisfaction. 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 We generated a system with the authorities with the following 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”. The integration of the optician-optometrist as a primary sight carer in the national health system with common protocols and to inform and advise the public of changes in visual capacity. Allows general practitioners, when seeing a patient with visual problems with no pathology, to refer this patient to an optometrist.

12. Significant agreements for collaboration has been reached In seven autonomous Spanish regions.

13. These agreements have entailed many political benefits for the Spanish General Council of Optometry. Great opportunity to form a part of the Spanish Public Health Service. These agreements are the first step towards the total integration of the Spanish optometrist into the National Health System in primary care. 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. GREAT OPPORTUNITY WITH OUR AUTHORITIES TO ADVERTISE OUR PRACTICE AND GET SOCIAL RECOGNITION OF OUR IMPORTANT ROLE IN PUBLIC HEALTH CARE.

14. To establish the general bases for the authorisation of health centres, services and Healthcare establishments understood as: “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”. Optician’s are considered healthcare establishments, defined as: “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”. This Royal Decree came into force on 24 October 2003. The latest political and legislative advances : Royal Decree On Health Care Establishments

15. The latest political and legislative advances : Royal Decree On Health Care Establishments To regulate: Basic aspects of qualified healthcare professions, General structure of professional training, and Professional development. Applicable in public or private healthcare services. Qualified Healthcare Professions are shown as: 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. 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....” “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.”

16. Advertising of services must rigorously respect the scientific basis of activities and prescriptions. Objective, careful and true, so as not to raise false hopes. Also in our professional organization we have regulated that it is forbiden to advertise discounts in any professional service like refraction. Information given must be true, discreet, careful and shown in a comprehensible manner. Failure to comply shall result in sanctions. Obligation to take out the appropriate liability insurance. Professional colleges may adopt the necessary means to enable their members to fulfil this obligation. Public registers of healthcare professionals in order to ensure that patients may exercise their rights with regard to clinical information and documentation. The latest political and legislative advances : The law on regulating healthcare professions

17. OPTICIANS-OPTOMETRISTS DO NOT INVADE THE COMPETENCES OF OPHTHALMOLOGISTS RULING REJECTS AN APPEAL LAUNCHED BY THE COLLEGE OF PHYSICIANS The latest political and legislative advances : New sentences in favor The Supreme Court Rules Against Ophthalmologists

18. 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”. • 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. The Supreme Court Rules Against Ophthalmologists

19. “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.” “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”. The Supreme Court Rules Against Ophthalmologists

20. “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” “This does not affect the specific competences of ophthalmologists with regard to eye and vision pathology.” The Supreme Court Rules Against Ophthalmologists

21. 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. The latest political and legislative advances : New sentences in favour The Andalusia High Court of Justice

22. 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”. 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. The Andalusia High Court of Justice

23. “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” The Andalusia High Court of Justice

24. Thank you! Ignacio Costa, Grad.O.O., M.Sc., PDG IESEConsejo General de Colegios de Ópticos-OptometristasPrincesa, 25, 4ª plantaEdificio Hexágono28008 Madrid (Spain)+ 34 91 5414403 / 4 Phone+ 34 91 5422397 Fax+ 34 609 085250 Cellphonejgarcia@cgcoo.es www.cgcoo.es