The issue of professional responsibilities acquires special relevance When discussing who is eligible to carry out certain procedures related to health care, i.e., acts related to the protection of a very individual right (the right to health). In Argentina, the professional practice of medicine and other professions related to health care are governed by National Law No. 17132/1967 and its amendments. In his article, he lists actions that are considered exclusive to the professional practice of medicine: “Proclaiming any procedure, directly or indirectly, for use in the diagnosis, diagnosis, and/or treatment of diseases of persons , prescribing, indicating, or applying. for the restoration, protection and preservation of their health…”. In its article 69, referring to technical opticians, it stated: “Practicing optics may only by medical prescription may function, and must limit their action to the preparation and adaptation of the optical medium and contacts other than that required by mechanical adaptation, they may perform no function on the patient’s organ of vision that is essential for diagnosis, prescription and/or An examination is meant for the purposes of treatment.
Three years ago, the Legislature of Chubut Province approved and promulgated the Law 673 ° IN (2019), which states that optometry is an exclusively medical activity (Article 1) and that opticians can conclude “only on the basis of an indication or prescription issued by a doctor” (Article 2), it concluding that “violation of the provisions in this law constitutes the illegal practice of medicine” (Article 3).
Any act of evaluating a patient for diagnostic and/or therapeutic purposes They are functions of the competence and exclusive responsibility of doctors. In the case of visual health, this concern is for ophthalmologists only. All this regulatory plexus has also set a very clear boundary in Argentina to avoid conflicts of interest, which is summarized in the following sentence: “He does not sell what he writes and he does not write what he sells. ” Until now, it has been a matter of professional concern between ophthalmologists on the one hand and optical professionals on the other.
it is important to note that Requires a minimum of 10 years to obtain certification as an Ophthalmologist of study (between medical degree and then medical residency in ophthalmology). At the National University of La Plata, in the field of the Faculty of Exact Sciences, the bachelor’s degree in Ocular Optics and Optometry is decided. This is a career with 5 years study plan. At the end of the initial 3 years, the degree obtained is that of Optical Technician; At the end of the fourth year, the optician specializes in contact science, and with the fifth year graduates in ocular optics and optometry.
Duties of who receives as optometrist They are, as stated, expressed by the House of Studies, the following: “The profile is that of a non-medical university professional in the health sector, a specialist in primary visual and ocular care, focused on the detection and optical correction of Have been trained to detect accommodation anomalies and ocular motility as well as for testing and optimization of ocular prostheses, refractive defects from their respective optometric formulas, calculation and optimization of optical aids for low vision “.
conflict of duties with ophthalmologists Inherent in this position are these non-medical professionals (optometrists) who claim to occupy an autonomous position in eye health care. On the web page of the degree in Ocular Optics and Optometry, the following is expressed: “…the optometrist is at the first level of care in the health pyramid, while the ophthalmologist is the specialist in eye diseases and its treatment, and, as such, it is in the second tier of care of the health system”. Finally, regarding the presumed benefit of optometrist performance, the organization that created them expresses: “It will increase the likelihood of early detection of anomalies, dysfunction, or pathological conditions” and “Refer to a second level of care, where The ophthalmologist is located.”
as we can see, Non-medical optometry takes the responsibility That the law on medical practice in our country is exclusively reserved for doctors. This is evident when non-medical optometry, in its description of responsibilities attributed to it, mentions two terms: “detect” and “investigate”, referring to “refractive errors and anomalies, dysfunction or pathological conditions”. . All of these actions are clearly consistent with the task of diagnosis, that is, with a specific medical concern.
another serious aspect This is how optometry claims to be the first line of visual health care and decides which patients should be referred to “second level care” made up of ophthalmologists. The practice of non-medical optometry spread in the early 20th century to many countries with a notorious shortage of ophthalmologists. Not so in Argentina. The Argentine Council of Ophthalmology (the organization that brings together all the chairs of Ophthalmology and all Ophthalmological Scientific Societies), organizes and/or collaborates with many visual campaigns throughout the country and in collaboration with the Ministries of Health and Municipalities of jurisdiction. Always available for. It is a serious mistake and an offense of illegal practice of medicine occurs when some institutions conduct visual campaigns without the presence of ophthalmologists.
Every ophthalmic consultation that a patient does This is an opportunity for the ophthalmologist to perform a comprehensive evaluation of the eyes and thus be able to detect many diseases that do not show symptoms in the beginning of their development, but which can lead to abnormal vision, blindness and even life-threatening diseases of the patient. It is possible , The optometrist receives training for only a partial aspect of the visual exam. Achieving maximum visual acuity with an optical element (eg: glasses) does not mean the absence of eye disease.
And Primary eye care performed by non-medical professionals (optometrists) and if these are authorized to act autonomously (i.e., independent of ophthalmologists), then, understandably, there will be many patients who may lose the opportunity for early diagnosis of initially asymptomatic eye disease, The detection of which depends on the skills that particular ophthalmologists possess.
who is in charge Decision making in the field of public health should be immediate Consider these aspects of professional responsibility to protect the visual health of the population.
Assistant Professor of the First Chair of Ophthalmology of the Faculty of Medicine of the University of Buenos Aires (UBA). Doctor of Medicine (UBA)