Call to arms for optometrists in Nigeria – A perspective

“Call to Arms”, metaphorically used, represents in the context of this article brain power, professionalism, ethics, possibly submission of complaints and peaceful protests. 

Optometrists, their scope of practice and their right to practice can be found in the Nigerian law. 

There are a lot of misconceptions about the Optometrist; Ironically these misconceptions can be found more profound in the health sector amongst health and medical professionals. 

I have been privy to the loathing, ignorance and the typical intent to suppress and demoralize each other amongst practitioners in the eye care sector and this article will set the records straight; Devoid of sentiments or assumptions but facts, truth and research-based logic. 

The Optometrist can be referred to as an eye doctor, it is a means of identification rather than a title and in the same capacity an Ophthalmologist can be referred to with the same nomenclature as a means of identification. The Optometrist is the only primary eye care provider and the Ophthalmologist is an eye surgeon and a secondary-level eye care provider. Let this be known and let the controversies behind the blurry lines of the scope of practice be left exposed. 

In some Nigerian government-owned health facilities (Federal and State Hospitals), Ophthalmologists have resorted to self-loathing, going as far as becoming the primary eye care professional and leaving limited professional responsibilities for the Optometrist to practice. In many cases, optometrists are left to refraction only which is but one of many capabilities of an optometrist. 

Note that this is just one of many controversies members of the Nigerian Medical Association(NMA) are a part of, there have been so many cases of suppression and invasion of practice in the cases of nurses, medical laboratory scientists, and even the physical rehabilitation specialists (Physiotherapy) by members of the NMA. 

However, they hold political powers, and they are much older in the system but it does not mean suppression of others is the only way to thrive. 

Optometry practice in other parts of the world like the United Kingdom, America and other advanced health-oriented countries are thriving within well-defined boundaries, expanding their practice to some non-invasive surgeries but in Nigeria where Optometrist is also the refractive expert, Ophthalmologist has hijacked laser procedures, including refractive procedures that require training for anyone involved. Many countries subject practitioners to core training allowing them to expand the scope of practice for the benefit of better care and management of people’s health, which is the purpose of expanding the scope of practice in the first place. 

It is highly worrisome. The Optometrists and Dispensing Opticians Registration Board of Nigeria(ODORBN) has a lot of work to do and the stakeholders in the healthcare industry in Nigeria need to leave behind ancient ways which have held us back for far too long and move forward and embrace better days. 

The government health facilities in Nigeria should allow Optometrists to thrive, allow them to diagnose, treat, manage and co-manage eye abnormalities within their scope of practice and refer where need apply while Ophthalmologists focus on their surgical expertise, co-manage eye diseases with optometrists and let the collaboration become the new competition. 

The difference between a Doctor of Optometry (optometrist), an Ophthalmologist and an Opticianisa common question among both healthcare professionals and the general public. The levels of training and expertise, and core competencies, are different for each type of eye care provider. 

Doctors of Optometry (Optometrists) 

On vision care and eye health, the primary healthcare provider is your Doctor of Optometry. A Doctor of Optometry completes a 6-year of study in an accredited Nigerian University. An Optometrist is clinically trained and licensed to deliver the best standard of comprehensive primary eye care. Note that in Nigerian public health facilities, these abilities are suppressed by Ophthalmologists(who are Heads of departments) and the system. Having questioned optometrists from over 20 public hospitals with an eye department in over 18 states in Nigeria, the response had been the same – they are suppressed from proper practice. 

According to samples from the scope of practice by other countries not limited to Canada, UnitedKingdom and the World Optometry Council (WOC) model framework; The Optometrist provides an eye examination to examine, assess, measure and diagnose disorders and as well diseases within the visual systems, such as Glaucoma, Conjunctivitis, Uveitis, Cataract and Macular degeneration, etc, Fit and dispense eyewear – including glasses, sunglasses, contact lenses, safety eyewear and low- vision aids – to ensure they meet the vision and eye health needs; In managing eye diseases and conditions, can prescribe medications; Also where needed provide referrals to secondary specialists, such as Ophthalmologists (for treatment of systemic disease or eye surgery when necessary), co- manage pre and post-operative care for laser vision correction, remove foreign bodies from the eye and co-manage ocular diseases with ophthalmologists. 

It is recognized that these scopes vary between countries and states. 

In Nigeria, the act of parliament, Cap 09 of the law of the Federation of Nigeria 2004 (formerly known as Decree No. 34 1989) defines, Optometry as a healthcare professional specializing in the art and science of vision care and whose scope of practice includes: 

1. a) Eye examinations to determine refractive errors and other departures from the optimally healthy and visually efficient eye; 
2. b) b) Correction of refractive errors using spectacles, contact lenses, low vision aids, and other devices; 
3. c) Correction of errors of Binocularity by means of vision training (Orthoptics);
   
4. d) Diagnosis and management of minor ocular infections which do not pose a threat to the integrity of the ocular or visual system and, e) Ocular first aid. 

For Nigeria, this scope above is indeed very limited and does not meet up to the future expectations of eye care with better health outcomes as a goal. It requires further expansion in order to meet up with international standards. It is alarming that Optometrists in most public health facilities (Federal and state Hospitals) are not granted an environment to practice this’ limited’ scope as allowed by law, stifled by their Ophthalmologist counterparts, especially in the aspects of eye examinations, diagnosis and management of certain eye conditions as permitted by law. Let me be clear, an atypical Nigerian Optometrist is knowledgeable, educated and clinically trained to be able to treat, manage and co-manage most eye diseases and conditions that do not require surgical intervention. 

Countries that are advanced in eye health care like the United Kingdom, Canada, Saudi ArabiaandUnited States of America, just to name a few, have on regular and steady occasions welcomed into their countries Nigerian optometrists who then practice with a more advanced scope of practice, competently and effectively. As I write this, this week alone 10 of my colleagues are off to the West equipped with foreign licence that required several exams and scrutiny to acquire, and they surpassed expectations armed with only the education and clinical training gotten primarily from Nigeria. Hence, no need to wonder why brain drain is now becoming a health crisis in Nigeria. 

It is also worth noting, that there are Federal and State Hospitals in Nigeria that do not accept Optometry Interns. They have eye departments but do not accept optometry interns and please let us not debate about the inability to carry out responsibilities on the lack of capacity at these facilities, because they have the capacity for other interns as long as they are not Optometrists. 

In addition, Ophthalmologists are surgeons and specialists in eye disease. They have completed their bachelor’s degree at an accredited university, as well as a residency in the medical and surgical care of the eyes in an accredited university hospital. They are secondary-level healthcare providers and patients usually require a referral from an Optometrist to obtain an appointment for medical or surgical treatment but this is absolutely not predominantly the case in Nigeria. Usually, Ophthalmologists tend to overshadow all aspects of the practice including primary eye care. 

Lastly but certainly not the least in the eye care team are Opticians. They are trained through a college program to fabricate and fit vision aids, such as glasses, based on the prescription given by an Optometrist or Ophthalmologist. They do not assess, diagnose, or treat eye conditions, nor can they check or write prescriptions for eyeglasses or contact lenses. 

We need to do better in Nigeria. The Minister of health need not be biased or narrowminded about the future of health in a possibly 250 million-capacity country like Nigeria. History does not forget great people, so I call on all optometrists to seek their rights and all stakeholders in health to find, not just a middle ground but a conducive one for all to thrive.