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College of Optometrists of Ontario 2019 Annual report

See our full timeline celebrating 100 years of optometric regulation

Letter from the President

This past year, optometry marked 100 years of regulation in Ontario. From the first registered optometrist, to the Optometry Act, to the ability to prescribe drugs – much has changed in a century. Throughout the changes and advancements, one aspect endured: the College’s dedication to serving the public.

2019 not only represented evolution within the profession, but also marked a year of transition for the College itself.

After eight years with Dr. Paula Garshowitz at the helm, the College welcomed new Registrar Maureen Boon in June and with whom I had the pleasure to work for several months before my own term as President concluded in December.

It was my immense privilege to serve as President, and I take great pride in the work the College Council engaged in during that time, including expanding optometrists’ drug prescribing list and working to replace this list with broader drug categories that would enable members to prescribe all approved ophthalmic topical medications; concluding a comprehensive review of the College’s Quality Assurance program and initiating evidence-based revisions to align with best practices and improve flexibility and effectiveness; approving policies and standards that allow more flexibility for practitioners providing optometric or dispensing services using the Internet; modernizing the College’s governance structure; ensuring those entering the profession are challenging high-quality, defensible standard assessment exams; and increasing support for patients who experience sexual abuse.

I would like to express my sincere gratitude to everyone I had the opportunity to work with on Council – especially our public members who volunteer their time, skills, and knowledge and bring a valuable perspective to College work.

Beyond my term as President, I have also had the opportunity to be part of numerous committees for more than a decade, including Registration, Quality Assurance, and Governance. I know first-hand the valuable contributions that committee members make and encourage optometrists to consider joining a College committee.

I wish Council and the new President Dr. Patrick Quaid much luck as they embark upon further transition at the College and prepare a new strategic plan. I also look forward to continuing my involvement in committees and College work in the coming years. Optometry has indeed come a long way in 100 years, and as the profession keeps moving forward, the College will be there to ensure Ontarians continue to have access to high-quality, competent and ethical eye and vision care.

Letter from the Registrar

I’m thrilled to have joined the College of Optometrists as it celebrated 100 years of regulation. And while it’s always fun to see how far we’ve come, we’re also keen to look forward and focus on the ways in which the College can adapt to the changing needs of the profession and the public.

The College isn’t alone in this experience. Regulation itself is undergoing a transition that is challenging regulatory colleges to remain agile and anticipate the real risks the public faces.

It’s an exciting time to be reviewing and modifying our own processes: in 2019, the College began the work of creating a new strategic plan that will be finalized in 2020 and will set a new direction for our work, which is focused on our three main responsibilities: Registration, Quality Assurance, and Investigations. That is: are optometrists qualified to join the profession? Are they maintaining those skills? And if not, how are we ensuring the public is receiving safe care?

Read on to see how we answer these questions and what we accomplished in 2019.

This past year has been a wonderful welcome as your new Registrar and I look forward to continuing the College’s work to increase responsiveness, transparency, and collaboration.

2019 College Council

Front row from left: Winona Hutchinson, John Van Bastelaar, Registrar Maureen Boon, Dr. Pooya Hemami, Dr. Richard Kniaziew, Dr. Annie Micucci.

Back row from left: Bashar Kassir, Suzanne Allen, Dr. Patrick Quaid, Dr. Bill Chisholm, Dr. Lisa Christian, Howard Kennedy, Dr. Areef Nurani, Dr. Christopher Nicol, Ellen Pekilis, Dr. Linda Chan, Dr. Kamy Morcos, Narendra Shah.

Not pictured: Hsien Ping (Albert) Liang.

Committees

There are more than 60 committee members (both Council and non-Council) who support and facilitate the College's work. Our sincere thanks for the time, skill, and thoughtfulness they bring to their work on the following committees:

  • Audit/Finance/Risk
  • Discipline
  • Executive
  • Fitness to Practice
  • Governance/HR
  • Inquiries, Complaints, and Reports
  • Patient Relations
  • Quality Assurance
  • Registration
  • Strategic Planning

How we ensure public safety and excellence in optomtetric care

Quality Assurance

The College isn’t just responsible for setting the requirements to become an optometrist; we also ensure that optometrists update their knowledge and skills throughout their careers to continue meeting patients’ needs.

The College’s Quality Assurance (QA) Program allows us to assess optometrists’ competence on an ongoing basis, while helping optometrists seek out new learning opportunities.

Our QA program is centred around:

  • self, peer, and practice assessment;
  • continuing education (CE); and
  • a way to monitor optometrists’ participation in and compliance with the QA program.

Assessment

As part of an ongoing review of the program, Council approved changes to the random selection criteria for those undergoing random assessments. To better reflect high-risk areas, the revised criteria includes a greater number of optometrists in their first five years of practice. In addition, optometrists who successfully complete the Short Record Assessment are exempt from selection for 10 years.

These changes, approved in the fall 2019, took effect January 1, 2020.

For 2019, 112 optometrists were selected for random audit and 86% received a satisfactory assessment.

Optometrists are required to have 750 hours of direct patient care in Canada every three-year period. We check patient care hours annually to ensure optometrists are meeting this requirement. In 2019, nine optometrists with insufficient patient care hours underwent practice assessment. Four received satisfactory assessments and the remaining five are still under assessment or receiving coaching.

Continuing Education & Monitoring

In 2019, the College launched a new online learning module Eye Consent – The Optometrist’s Guide to Informed Consent. The module, offered for free to Ontario optometrists, covers what qualifies as consent, when and how to document consent, and how to protect patient privacy. It has already been taken by more than 550 optometrists.

The College continues to use OE Tracker to confirm optometrists are engaging in relevant CE. The current three-year CE cycle runs through to the end of 2020.

Inquiries, Complaints and Reports

Every year, nearly 3 million Ontarians see an optometrist for their vision care. While the vast majority are happy with the care they receive, the public contacts the College when issues arise.

When the College receives complaints about an optometrist, we investigate the allegations and make decisions, either for actions the optometrist must take to resolve the issue, or to move the case onto our Discipline Committee for further hearings.

Here's how investigations proceeded in 2019:

  • New Cases Filed: 55
  • Cases Reviewed by ICRC: 70
  • Decisions Issued: 71
  • Alternative Dispute Resolution: 5

The vast majority of our complaints fall into two broad categories: Professionalism and Clinical Care.

Professionalism includes: unprofessional behaviour and/or communication issues, improper billing, breach of patient confidentiality, and staff supervision. Unprofessional behaviour and/or communications issues was the single top allegation in 2019, with 33 allegations.

Clinical Care includes: failure to diagnose/misdiagnose, issues related to eyeglasses or contact lens prescriptions, issues related to eyeglasses or contact lens dispensing, failure to refer, and unsafe practices; issues related to prescriptions being the top clinical complaint.

Discipline Decisions

In 2019, the Discipline Committee held five discipline hearings into allegations of professional misconduct/incompetence. Read the each of the full decisions below:

Registration

The College’s role is to regulate optometrist in Ontario and ensure those practising optometry are qualified to provide care. To do this, we need to set the qualifications required to work as an optometrist in Ontario and ensure that incoming optometrists are being appropriately tested to meet those qualifications. In 2019, we moved forward with several new initiatives aimed at revamping our processes and ensuring the best outcomes.

In January, the College announced it would accept the National Board of Examiners in Optometry examination as an alternate standards assessment examination required for registration.

We launched an online Jurisprudence seminar in the spring to allow candidates to participate remotely throughout the year and 70 exam candidates have used the online seminar to date.

Last year we also revised processes for internationally trained optometrists wishing to practise in Ontario. In February, the newly developed Therapeutics Prescribing Assessment for Optometry (TPAO) was piloted and in the summer, the Federation of Optometric Regulatory Authorities accepted the TPAO as part of the exam international students must write. Those who score high enough on both the TPAO and regular exam component can bypass bridging, allowing more optometrists to join the profession sooner.

Finally, to ensure consistent standards are being met across the country, we hired Touchstone Institute to begin the work of developing a national competency profile for optometry. Touchstone has, and will continue, to meet with stakeholders from across Canada in developing the competency framework. The competencies defined through these meetings will be validated by survey of Canadian optometrists in 2020.

Our Membership

Regulation and Guidance

In addition to our three main regulatory functions, the College serves the public interest through public communication, providing guidance to optometrists, and monitoring and adapting to an ever-changing regulatory environment.

That change - be it to the public's needs or the ways in which we do business - was reflected in the final decision in our case against Essilor Group Inc. In June 2019, the College of Optometrists and College of Opticians of Ontario filed an application to the Supreme Court of Canada to appeal the Ontario Court of Appeal's decision in College of Optometrists of Ontario v. Essilor Group Inc., 2019 ONCA 265. In October, our application for appeal was not granted. Both colleges continue to believe that the internet can be an effective tool for providing vision care services and we encourage Ontarians to ensure a licensed provider is involved in their vision care.

We are in the process of reviewing our public communications and looking to enhance simplicity and clarity to make sure the public gets the information it needs. We have already revised our Patient FAQ and increased our presence on social media channels as first steps.

For optometrists, several notable updates to the Optometric Practice Reference (OPR) were made in 2019, including removing clinical practice guidelines to ensure the OPR focused on required standards. In addition, we updated sections on low vision assessment, managing dry eye disease, and delivering glasses without an in-person fitting. These revisions ensure the OPR reflects the latest definitions and standards of care.

Financials

The College Council approved the audited financial statements for the fiscal year ending December 31, 2019 at the April 20, 2020 Council meeting. See the full audited financial statements on the College website.