In France, making an appointment with the ophthalmologist requires a little anticipation, as pointed out in January 2021 a report from DREES. So, to relieve the waiting lists, a decree published in April 2022 authorizes the first prescription of optical equipment by orthoptists (professionals specializing in eye rehabilitation) for patients aged 16 to 42 years old.
Until then, this decree had not yet been applied. This is done with the publication of a stopped of the Ministry of Health in the Official Journal of January 31, applicable from February 1, 2023.
For the Ministry of Health, it is not only the waiting times to obtain an appointment to have one’s eyesight checked but also the retirement of ophthalmologists (44% are over 60) and visual disturbances which are increasing due to the use of screens which has led to finding and enrolling in the 2022 Social Security financing bill.
Prescription of glasses and contact lenses by an orthoptist: for whom? what conditions?
Only patients from 16 to 42 years old are concerned. They must consult for the first time for vision problems, and not have any serious pathology.
As stated on the site public service :
- The visual assessment and the prescription can be carried out by the orthoptist for patients aged 16 to 42 years and not presenting any of the contraindications listed by order of the Minister for Health (see below).
- For patients who already wear corrective lensesthe visual assessment and the prescription can only be carried out by the orthoptist if the last visual assessment carried out by the ophthalmologist dates back less than 5 years;
- For patients who already wear soft contact lensesthe visual assessment and the prescription can only be carried out by the orthoptist if the last visual assessment carried out by the ophthalmologist is less than 3 years old.
Here is the list of contraindications defined by the Ministry of Health:
- The following eye pathologies:
– glaucoma;
– isolated intraocular hypertension;
– vitreous and/or retinal pathologies (including AMD, diabetic and pigmentary retinopathy);
– optic neuropathies (especially MS and Leber’s disease);
– vitreous and/or retinal pathologies (including AMD, diabetic retinopathy);
– cataract and other lens abnormalities;
– pterygium;
– ocular and palpebral tumours;
– history of refractive surgery;
– history of intraocular surgery;
– history of severe eye trauma dating back less than 3 years;
– history of severe inflammatory eye disease (in particular iritis, uveitis, scleritis);
– corneal abnormalities (in particular corneal transplant, keratoconus, keratopathies, corneal dystrophy, etc.);
– bilateral or organic functional amblyopia;
– recent and/or progressive diplopia;
– recent strabismus and/or nystagmus;
– strong anisometropia of 3 diopters or more;
– observation of an unknown unilateral decrease in visual acuity, less than 9/10th and not correctable with corrective glasses or contact lenses.
- Refractive disorders associated with a general pathology:
– diabetes ;
– autoimmune diseases (in particular Basedow, multiple sclerosis, rheumatoid arthritis, lupus, ankylosing spondylitis);
– poorly controlled arterial hypertension;
– acquired immunodeficiency syndrome (AIDS);
– neurological conditions with an ocular component;
– primary eye cancers or other cancers that may be associated with secondary ocular localization or a paraneoplastic syndrome;
– organic amblyopia;
– recent nystagmus.
To note ! The text also specifies that in case of doubt about a situation or pathology not provided for in the decree, the orthoptist redirects his patient to the ophthalmologist.
What do ophthalmologists think?
Ophthalmologists fear a deterioration in the quality of care and screening errors.
At the end of December, the Union of ophthalmologists, Snof, recalled that the median time to obtain an appointment has continued to improve since 2019, from 43 to 28 days (-15 days).
“Loss of vision can hide a lot of things”alerted to France Blue the president of the union, Thierry Bour, skeptical about the level of training of orthoptists. These are “paramedics who have a training limited to bac+3, they do not know all the pathologies. For the patient, there may be a loss of chance”he commented.
Sources:
- Order of January 25, 2023, published in the Official Journal.
- Orthoptists can now prescribe first corrective lenses, Service-public.fr, February 1, 2023.
