Professional and Regulatory Standards Interpreted
This document describes how optometrists may utilize their website and/or the internet in spectacle dispensing practices, while meeting the standards of practice of the profession. Ophthalmic dispensing is defined as “the preparation, adaptation and delivery” of vision correction, and is a controlled act in Ontario authorized to optometrists, physicians and opticians:
3. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses.
Standard of Practice for Spectacle Therapy
Section 6.4 Spectacle Therapy in the Optometric Practice Reference (OPR) describes the professional standards for spectacle therapy. Optometrists providing spectacle therapy must satisfy the following standards, regardless of whether or not technology is used as a tool to facilitate the provision of spectacle therapy to patients
- Reviewing with the patient any relevant environmental, occupational, avocational, and/or physical factors affecting spectacle wear;
- Reviewing the details of the prescription;
- Advising the patient regarding appropriate ophthalmic materials;
- Taking appropriate measurements (including but not limited to interpupillary distance and segment height) to ensure proper function of the spectacles;
- Arranging for the fabrication of the spectacles;
- Verifying the accuracy of the completed spectacles to ensure that they meet required tolerances;
- Fitting or adjusting the spectacles to the patient;
- Counselling the patient on aspects of spectacle wear including, but not limited to: the use, expectations, limitations, customary adaptation period and maintenance requirements of the spectacles.
Application of the Standard when providing Spectacle Therapy using the Internet
Reviewing factors affecting spectacle wear
- Optometrists must review, with patients, factors affecting spectacle wear. This can be done either in-person, or by telephone, video conference, or online questionnaire. If this review is not performed in person, optometrists should include a precaution for patients that in-person reviews are recommended for individuals with special needs or atypical facial and/or postural features. If optometrists choose specific patient factors by which to limit their internet dispensing services, including, but not limited to, a specific age range, this should be disclosed on the website where patients can easily find it.
Reviewing the details of the prescription:
- Optometrists must review prescription details. This can be done in-person or using the internet. Optometrists are responsible for confirming the validity and/or veracity of prescriptions and must have a mechanism in place to do so. Prescriptions provided using the internet must be provided in a secure manner and collected in an unaltered form (pdf/image). All prescriptions must contain information that clearly identifies the prescriber (including name, address, telephone number and signature), and specifies the identity of the patient and the date prescribed (OPR 5.2 The Prescription). All prescriptions must include an expiry date.
Advising the patient regarding appropriate ophthalmic materials
- Optometrists must advise patients regarding appropriate ophthalmic materials. This may be done in-person or by an online algorithm. In the latter scenario, patients must be given clear directions on how to contact the office/optometrist with any questions they may have.
Taking appropriate measurements
- Optometrists must take appropriate measurements when providing spectacle therapy. These can be done in-person or by computer application. If computer applications are used (in-office or remotely) to determine dispensing measurements, optometrists must be satisfied that the application determines these measurements with equal accuracy to traditional in-person measurements, including the production of supportable evidence should this matter come to the attention of the College.
Arranging for the fabrication of the spectacles
- Optometrists must review the suitability of patient orders before arranging for the fabrication of spectacles.
Verifying the accuracy of the completed spectacles
- Optometrists must verify the accuracy of completed spectacles.
Fitting or adjusting the spectacles to the patient
- Fitting or adjusting the spectacles to patients must be performed in-office and cannot be performed virtually, by tutorial and/or video conferencing. Optometrists providing spectacle therapy will possess the equipment required to fit and adjust spectacles. In-person fitting and adjusting of spectacles provides a final verification and mitigates risk of harm by confirming that patients leave the clinic with spectacles that have been properly verified, fit and adjusted. In-person delivery of spectacles establishes a patient/practitioner relationship in circumstances where patients are new to the clinic and spectacle therapy was initiated through the optometrist’s website.
Counseling the patient regarding spectacle wear
- Counseling regarding spectacle wear is ongoing and involves in-office, telephone, and/or electronic communications.
- Optometrists who delegate elements of spectacle dispensing (for example, the fitting and adjusting of spectacles) to staff who are not authorized to independently perform the controlled act, must be present in the same physical location as their patient and able to intervene, unless another optometrist is present to provide appropriate delegation (OPR 4.3 Delegation and Assignment).
Most Responsible Dispenser
- In collaborative or multi-optometrist practices, where multiple optometrists may participate in dispensing spectacles to an individual patient, the College considers that the last optometrist to provide care, or “touch the patient,” typically the optometrist fitting or adjusting the spectacles, is the most responsible dispenser. This optometrist is responsible for all preceding steps in the dispensing process, as well as the performance of the spectacles and any potential risk of harm to the patient. Similarly, where optometrists practice in working arrangements with opticians, the most responsible dispenser is the last professional to provide care to the patient.
- Ontario-based optometrists providing care to patients in other jurisdictions (provinces/states) may need to be registered in those jurisdictions and should consult with the appropriate regulatory authorities. Optometrists participating in any aspect of ophthalmic dispensing in Ontario must be registered with the College of Optometrists of Ontario.
The Patient Record
- Internet prescriptions and orders must be maintained in the patient record (OPR 5.1 The Patient Record).
- Where the Internet is used in the provision of spectacle therapy, websites must:
- comply with College advertising guidelines and relevant paragraphs in the Professional Misconduct Regulation (O. Reg. 119/94, Part I under the Optometry Act);
- identify the website as belonging to or referring to a member registered with the College of Optometrists of Ontario;
- collect and record patient information in a private and secure manner respecting patient confidentiality;
- identify the physical location of the clinic/dispensary, including address and city/town, and the hours of operation of the clinic; and
- include the telephone number to contact the clinic/dispensary.