Optometry is a primary healthcare profession involving the provision of eye and vision care. This includes the conduct of eye examinations and diagnosing eye conditions including refractive error (such as near sightedness and astigmatism) and other diseases, prescribing and dispensing of spectacles, prescribing ophthalmic drug treatments in some situations, and the rehabilitation of conditions of the visual system. Through eye examinations, optometrists often identify eye diseases such as glaucoma, cataracts and diabetic retinopathy and other diseases (e.g. diabetes) or other eye conditions that require specialist medical care. They are able to refer patients with these conditions to their GP or directly to an ophthalmologist.
As at August 2011 there were 4,440 optometrists who were active registrants with the Australian Health Practitioner Regulation Authority. The vast majority of optometry services are provided by optometrists working in the private sector who either work in a small business or as part of a chain of optometry outlets.
Optometry services are located where they are economically viable. Most large rural towns in Australia have a local optometrist, but practice in smaller towns and communities is not always viable. In some instances, an optometry practice may set up a ‘branch’ in a smaller town nearby, which is only attended on certain days.
Optometry services attract medical benefits under Medicare. In 2010-11 there were 6.7 million optometry services for which a medical benefit claim was lodged and $316 million in benefits paid. The vast majority of these services were direct (bulk billed), with gap fee charges around $2 million. The average charge for optometry services is $47.70, an average medical benefit of $47.36. There are several Medicare items that can be charged for optometry. The most common items are 10900 (comprehensive initial consultation), which accounts for around 47% of MBS optometry services and 57% of benefits paid; and 10918 (subsequent consultation), which accounts for around 25% of MBS optometry services and 15% of benefits paid.
Optometry services billed under Medicare have been increasing at an average rate of 4.6% per year over the last 10 years, compared with an average increase 3.3% for other services under the Medical Benefits Scheme (excluding pathology).
In addition to optometry services that can be billed under Medicare, optometrists derive income from dispensing spectacles, which is paid for by the patient or their private health insurance provider. States and territories have a range of subsidy schemes where disadvantaged people (typically people with health care cards) are able to obtain subsidised spectacles. Optometrists derive some income through the dispensing component of these schemes, but this is typically quite limited.
For the vast majority of outreach optometry services, the principal source of income associated with outreach services is the Medicare benefit associated with delivering the services to patients and to a lesser extent the dispensing fee associated with the provision of spectacles. VOS covers the additional costs associated with outreach delivery such as travel and accommodation. Most outreach optometry services are provided by optometrists working in private practice. As discussed below, some optometrists work exclusively or predominantly in providing outreach services. These include some mobile services such as the Eyebus that provides optometry services to a large number of small rural towns in South Australia.
A small number of outreach services are delivered under the auspice of organisations such as International Centre for Eyecare Education (ICEE) or the Fred Hollows Foundation. ICEE has developed a memorandum of understanding (MOU) with the Aboriginal Health and Medical Research Council of New South Wales and individual AMSs across New South Wales for the provision of outreach optometry services. Under the arrangement, ICEE arranges for local optometrists or an optometrist employed by ICEE to provide optometry services to AMSs. Services under the MOU are provided to 110 locations, and VOS funding has been claimed and provided to 24 of these. ICEE also provides outreach optometry to many communities in the Northern Territory, through an optometrist engaged on a full time basis. The Fred Hollows Foundation has a team providing outreach services to a range of communities in the Northern Territory.
Optometrists are one component of eye health services. Other components of eye health services include:
- Ophthalmologists, who are doctors specialising in the medical and surgical treatment of eye health issues. Ophthalmologists may work in private practice or be employed as a staff specialist at a public hospital. Many ophthalmologists in private practice are also visiting medical officers within public hospitals.
- Orthoptists, who specialise in diagnosis and management of ocular motility, amblyopia (lazy eye) and binocular vision disorders, usually through eye exercises. Orthoptists typically work closely with ophthalmologists to manage binocular vision treatment.
- Ophthalmic nurses, specialising in working closely with and assisting ophthalmologists.
- GPs, who are often consulted on emergency eye health issues (e.g. minor injuries or infections) and may also include eye examinations as a part of routine medical care.
- Remote area nurses, who often play a similar role to GPs in remote locations, and may also play a role in screening programs (such as trachoma screening).
- Aboriginal health workers, who may also be involved in screening (e.g. trachoma screening), managing minor eye health issues, patient and community education, working with visiting optometrists and ophthalmologists.
- Regional eye health coordinators, who are in positions funded by OATSIH and employed by AMSs. Eye health coordinators play different roles across Australia but frequently work with outreach optometrists and ophthalmologists in coordinating and assisting with outreach services. Eye health coordinators have a regional role, not exclusive to the AMS that employs them. The positions were originally established with funding from OATSIH. However, in recent years the funding has been incorporated into more general funding, without an explicit requirement to continue the employment of a designated eye health coordinator.