OptometryStringent certification puts qualified professionals in high demand According to recent statistics from the World Health Organisation, 80 per cent of global blindness is avoidable. Of all the factors that can contribute to blindness, the most common is refractive error - changes in the focusing power of the eyes. In pursuit of better vision, people visit their high-street opticians. But it is not the optician who evaluates their vision. Eye testing is done by an optometrist - a specialist trained to assess eyesight, prescribe corrective eyewear and, where necessary, run further diagnostic tests to determine overall ocular health. The optician then advises on frames for glasses and care of eyewear, based on the optometrist's recommendations. 'Optometry grew out of the gap between opticians and eye doctors,' said Henry Chan Ho-lung, associate professor at Hong Kong Polytechnic University's School of Optometry. 'Opticians do not know what happened to the eye and eye doctors deal with diseases of the eye. Optometry developed between the two.' Before 1994 there was no regulation of optometry in Hong Kong. To help streamline the situation and make it easier for the public to understand, the government set out a four-part system, clearly delineating the qualifications and experience needed for each sector. Part-one optometrists have full-time formal university training from a recognised institution. They are the most highly qualified in their field, and are licensed to perform all routine and advanced tests. Part-two optometrists are usually trained to a lower level, such as higher certification, and they can only perform basic diagnostic tests. Part-three and part-four optometrists have no academic training and can only measure refractive errors and prescribe eyewear. 'Ten years ago the government stopped new registrations of part-four optometrists,' said Alan Cheung Ka-wing, an optometrist at a local practice in Kowloon. 'Now they only want optometrists with part-one training.' Mr Cheung, who has a part-one qualification, has practised for 10 years and works at a doctor's surgery. Like other part-one optometrists, he is in great demand. 'If you count all optometrists practising in Hong Kong today - part-one to part-four - there are around 2,000 practitioners,' Dr Chan said. 'But of these only 600 are trained to part-one standards. These 600 can't possibly provide services to the whole population. Right now, Hong Kong has a shortage of part-one optometrists,' he said. Polytechnic University offers a bachelor's degree programme in optometry and has an annual intake of 35 students, chosen from a pool of 2,500 to 3,000 applicants. 'Once completed, the newly qualified part-one optometrists enter the job market and 99 per cent of them find employment at private clinics, optical chains, eye care product companies such as Bausch & Lomb, or in their own practice,' Dr Chan said. Many will update their learning via the professional associations that offer continuing education opportunities. Polytechnic University also offers workshops and lectures in certain specialist areas. Larry Ng Hou-yan is a clinical optometrist practising at the optometry clinic, part of Polytechnic University's School of Optometry. 'I like to practice in my home town and serve my people,' he said. 'At this clinic we have many different machines, which are the most state-of-the-art in Southeast Asia, for analysing the eyes.' Mr Ng, who specialises in contact lenses, said that 90 per cent of what he did was routine. Indeed with 80 per cent of vision problems in Hong Kong due to refractive errors, the bulk of what optometrists do is eye testing and prescribing eyewear. For the 20 per cent of cases that relate to diseases of the eye or brain, the optometrists' diagnostic skills are critical and potentially life-saving. Conditions such as glaucoma, cataracts, age-related maculopathy and diabetes retinopathy must be ruled out. With Hong Kong experiencing a rise in the instance of diabetes, primarily due to changes in diet, any alterations in vision that are not accountable by refractive measurement must be tested for diabetes. Many other life-threatening illnesses can also be found through careful optometric testing. One of the limiting factors that local optometrists face is government restrictions on the extent of their practice. 'In the United States and Canada, optometrists are licensed to prescribe drugs to treat certain eye diseases, which in Hong Kong we are not allowed to do,' said Dr Chan. Such restrictions mean that local optometrists still have to refer clients to a third party for medication and, although Dr Chan teaches his students this therapeutic knowledge, they will have to wait for a change in the law before they can practise it. Key Players Part-one optometrist Optician Ophthalmologist General practitioner Jargon Refraction testing the process of measuring and correcting refractive error in the eyes Dioptric the unit of measurement that describes the strength of the lens Vision chart the basic chart of letters and numbers used to test long vision Orthokeratology a non-surgical procedure which reshapes the cornea of the eye by using specially designed high oxygen permeability hard contact lenses Glaucoma damage to the optic nerve, over time, which causes blindness Diabetes retinopathy vision changes caused by diabetes