State of Optometry in British Columbia

[Smooth Operater]

Hey guys!

Someone posted this on a Canadian medical school forum when there is a discussion regarding optometry as an alternate career path. And his post really worries me as I may practice in BC in future, since I am BC resident right now.

"Optometry is vastly different in the US versus Canada. I don't know about other provinces but in BC at least, the government has decided to stop reimbursing for optometrist visits. Thus optometrists are starving for business and has since started a major ad campaign urging people to come in for routine eye check-ups.

I recently went to visit my optometrist in BC. I can tell you that it's a sad state of affairs right now. He wanted to check my eyes for glaucoma, a disease that usually does not usually manifest in people my age. When I asked why he wanted to screen me (and charge me) even though he admitted it was rare for someone my age to have glaucoma he said that it was because he once saw a 22 year old who had it and almost went blind because of it. This is just bad medicine to want to test everyone that comes into your office when the pre-test probability of a disease is virtually nil. Anyway, my point is, his office used to be a bustling practice. Now, he has free time to see me almost anytime during the week.

I respect optometrists a lot. They know a lot and can do a lot of good things. But you have to wonder where in the health care niche they fit in, when you have opthalmologists doing the major procedures, and you have opticians in places like Lens Crafters doing corrective lenses. For example, my dad has cataracts and my mom has age related macular degeneration. They don't see our optometrist, but our opthalmologist. "


I have few questions about the statements above.


is it true that some provinces in Canada won't reimburse for optometrist visits ? Does this also hold true in US that some states won't reimburse for optometrist?

And the words that more people start seeing opthalmologists really worries me.

What do you guys think? esp. the Canadians.

---

Members don't see this ad.

 

[acurael]

well in BC eye exams are not covered for ppl 19-64
plus now there is those sight tests...which they are going to allow (most likely)

the profession of optometry is not lookin too good right now in BC...but they may allow TPA's which could help
I'm worried that sight testing will become common all across Canada..only time will tell

I'm thinkin of stayin in the US after i finish my OD degree now...with all thats is going on in BC......wonder where optometry will be in 4 years

 

[Potato!]

I'll throw my opinion into the mix.
1) Currently, in B.C. the government does not reimburse ppl for routine eye exams. They only get reimbursed if the eye exam is for a medical reason (pink eye, diabetes, AMD, cataracts, etc.). So the majority of ppl pay for their eye exams out of their own pocket in B.C. I'll honestly say I have no idea how it works for provinces outside of B.C.
2) In the states, they don't have universal health care...you're either well-off and have complete private insurance coverage, or you're poor and you have no insurance (yes a simplification, I know). From what I gather, most ppl who go in to the optometrist to get an eye exam have some kind of insurance that pays for it, so it is not out of their own pocket.
3) People seeing opthalmologist: In city areas, yes ppl will go see opthalmologist. In Vancouver, there are so many opthalmologist, that you can get in to see one with only a 2 day wait. In other areas, where opthalmologist are more sparse and the wait time is longer, then often it is the optometrist that will be the first to see the ocular problem. In terms of treating ocular disease, often ppl are more comfortable going to opthamologists compared with optometrists...so it doesn't surprise me that the kid's parents both see ophthamologists.
4) General comments: Optometry is constantly changing; it evolves with the times. Optometrists as a group have a lot of power, so they will always fight to expand the scope of their practise. I believe that the profession will survive throughout your lifetime, but may be a lot different in 40 years then it is now.
5) One thing that Canada has going for it, is the fact that we do not have the crazy oversaturation of optometrists that the US does. Job prospects might be better in general in Canada then the states.
6) You've probably read some of my previous posts, so you know that I used to be pre-optometry. Given everything I've read and heard in the past year, I have personally decided to pass on pursuing a career in optometry. There were just too many issues, like those brought up by the above post, that I was not comfortable with.

My 0.02, everyone has their own opinions.

 

[JennyW]

Hey guys!

I recently went to visit my optometrist in BC. I can tell you that it's a sad state of affairs right now. He wanted to check my eyes for glaucoma, a disease that usually does not usually manifest in people my age. When I asked why he wanted to screen me (and charge me) even though he admitted it was rare for someone my age to have glaucoma he said that it was because he once saw a 22 year old who had it and almost went blind because of it. This is just bad medicine to want to test everyone that comes into your office when the pre-test probability of a disease is virtually nil. Anyway, my point is, his office used to be a bustling practice. Now, he has free time to see me almost anytime during the week.

I respect optometrists a lot. They know a lot and can do a lot of good things. But you have to wonder where in the health care niche they fit in, when you have opthalmologists doing the major procedures, and you have opticians in places like Lens Crafters doing corrective lenses. For example, my dad has cataracts and my mom has age related macular degeneration. They don't see our optometrist, but our opthalmologist. "


I have few questions about the statements above.


is it true that some provinces in Canada won't reimburse for optometrist visits ? Does this also hold true in US that some states won't reimburse for optometrist?

And the words that more people start seeing opthalmologists really worries me.

What do you guys think? esp. the Canadians.

That's not bad medicine at all.

Even though it's rare, the testing for glaucoma is simple and non invasive. A simple "air puff" has no risks associated with it. Even applanation tonometry has virtuall no risks.

What are the odds that a 22 year old has hypertension? Very very small. But when you go to your doctor, they still check your BP, because even though the chances are low, the consequences are dire. The same with glaucoma.

Jen

 

[Smooth Operater]

well in BC eye exams are not covered for ppl 19-64
plus now there is those sight tests...which they are going to allow (most likely)

the profession of optometry is not lookin too good right now in BC...but they may allow TPA's which could help
I'm worried that sight testing will become common all across Canada..only time will tell

I'm thinkin of stayin in the US after i finish my OD degree now...with all thats is going on in BC......wonder where optometry will be in 4 years

hey EL, may I ask what is TPA?

 

[cpw]

TPA is the license you get as an OD to prescribe medications.

 

[cpw]

Smooth ---


checking the pressure inside your eyes is normal and routine for ANY exam at ANY age. Yes, it's screening for glaucoma but it's also just testing your eyes overall health. Like another poster said if you go to your PCP they check your blood pressure even though at 22 the likelihood of you having hypertension is very very slim. It's required for a regular eye exam. I know in Texas at least it's required by law to be in a "comprehensive exam ". This does NOT make your doctor incompetent.... just thorough. 🙂 In most places in the US they do not charge extra for the pressure test.. it's part of the complete eye exam. I'm not sure the difference up there in Canada. I'd be nervous of any eye doctor I went to who DIDN'T do a pressure test !!

 

[Potato!]

JennyW,

In my mind, the OP was not talking about using a tonometer (puff test), when he was talking about an additional test for pre-screening glaucoma. The post says "When I asked why he wanted to screen me (and charge me) even though he admitted it was rare for someone my age..."

Usually, before an eye exam with an optometrist, a tech does the pre-testing. Pre-testing almost always involves using an autorefractor and a tonometer to take measurements of the eyes. These 2 tests are part of the "complete eye exam" and never cost anything extra. I believe that the OP is saying that he had these tests done, then went in to speak with the optometrist who offered him an additional test at a price. (My guess is that it was a visual field test). If my assumptions are correct than I sort of agree that this is bad medicine.

If physician's tested a patient for every possible disease, it would cost their insurer or the governement an insane amount of money. Physician don't test for a disease unless they have a reason to: symptoms, family history, etc. The fact that the optometrist is doing it for a price, is a little sketchy in my opinion. I agree, that the non-invasive "air puff" that goes along with every complete eye exam is so simple that they may as well include it...but the visual field test just shouldn't be neccessary in a young person, with no history of glaucoma in the family and good pressures in both eyes.

Whether this type of story can be generalize to the state of optometry as a whole, who knows?

 

[MrsJiggaman]

Im from BC too...where are you all going in September?

 

[acurael]

Pacific over here

 

[Andrew_Doan]

I believe that the OP is saying that he had these tests done, then went in to speak with the optometrist who offered him an additional test at a price. (My guess is that it was a visual field test). If my assumptions are correct than I sort of agree that this is bad medicine.

I agree with the above. We don't charge for checking the IOP. It's the visual field test that costs $$$.

My colleague had an optometrist who checked her HVF yearly since the age of 5. His rationale was that he wanted to make sure things were "normal". She had a HVF yearly until age 18. This is bad medicine.

 

[Richard_Hom]

I agree with the above. We don't charge for checking the IOP. It's the visual field test that costs $$$.

My colleague had an optometrist who checked her HVF yearly since the age of 5. His rationale was that he wanted to make sure things were "normal". She had a HVF yearly until age 18. This is bad medicine.

Dr. Doan,

Was the test a "central 40" screening test on the HVF or the full 30-2/24-2 threshold tests?

Regards,
Richard_Hom

 

[JennyW]

I agree with the above. We don't charge for checking the IOP. It's the visual field test that costs $$$.

My colleague had an optometrist who checked her HVF yearly since the age of 5. His rationale was that he wanted to make sure things were "normal". She had a HVF yearly until age 18. This is bad medicine.

I would agree with that if it was a threshold field. A c-40 screening would not be unreasonable.

IMHO, of course.

Jen