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Optometrist with Ocular Therapeutics: The inside story of how it came about



(ALSO READ: Optometrists with Ocular Therapeutics by Prof Paul Ramkissoon)

PR: Most optometrists know Dr Vanessa Moodley but how would you describe yourself?
Well at this stage in one’s life I feel it is more important how others describe you as opposed to how you describe yourself.  However, I do agree with the observation that I am extremely passionate about my work and relentless when pursuing an initiative to assist the marginalised. I cut my teeth as a health activist when I was a 2nd year optometry student in a body called the SA Health Workers Congress. Today, despite the numerous successes, I find that there is still a need for that level of “commitment to the cause”. I have always viewed my involvement in the various organisations within which I have served tenure over the years, as my opportunity to make an impact, rather than merely an opportunity to hold an important position.

PR: Tell us about the path that led to the advanced scope of optometry in South Africa.
VM: We were very fortunate, during the period when the ocular therapeutics issue was being dealt with, to have serving on the PBODO individuals who brought the diverse skills-set needed for success.  The collective (optometrists and community representatives) were strong in both public health beliefs and technical knowledge, highly competent clinicians and experienced in academic matters.  However, as the scope expansion was underpinned heavily by professional politics, it turned out to be one of the most challenging and draining experience of my 10 year tenure.  The tenacity and commitment to make a difference, acquired in the early days as health activists, sustained many of the PBODO members through much of the attacks from different quarters.  Remaining focused on the dire state/lack of eye care for the majority of the population made us more determined to never give up and persist until legislation.

The PBODO spent many years engaging in the processes to prepare for regulation changes and we had to continually overcome the deliberate roadblocks from opponents who frustrated us with delayed responses. Complaints to the national ministry of health, letters to the HPCSA registrar, fear mongering and other tactics to prevent the scope change, were the order of the day.  However, noting the needs of the population, progressive forces in government, the HPCSA, the MCC and other relevant bodies eventually aided to have the legislation passed.

PR: Tell us briefly about the Ocular Therapeutics Curriculum and the rationale of the 600 hours that optometrists have to complete.
VM: The outcome competencies were benchmarked with many developed and developing countries and due consideration given to the local context.  A module in Public Health was specifically included to create an understanding of the local health context.

We considered the exposure of students in South Africa to ocular diseases during their undergraduate clinical training and the clinical training done during the CAS: Ocular Diagnostic Course held previously and found both to be grossly inadequate to provide patients with good clinical care. There was a strong belief on the PBODO that the clinical exposure must afford practitioners an opportunity to acquire knowledge and skills in ocular diseases in the context of comprehensive systemic patient care.  An audit of the number of ocular disease patients seen and clinical training hours acquired by students in our reference countries before licensure far exceeded the 600 hours.  We then questioned why then will South African patients not deserve to be treated by equally competent clinicians? Additionally, optometry students in South Africa were expected to complete 1000 hours in their current non-therapeutic training.

Ophthalmologists criticised previous courses and rightly warned that patient care will be compromised with inadequate clinical exposure.  However, most concerning was the pressure from some within the profession stating that the hours were “ridiculous” and that “2-4 weeks should be adequate”.  We realised very quickly that quality of patient care was not a priority to these practitioners. It was heartening, when practitioners who had previously done a period at Edendale hospital willingly did the expected hours and then confirmed that indeed the 600 hours were necessary and most beneficial.  We repeatedly get practitioners comment on the fact that they “will not accept any lesser clinical training hours” and that “their work in public sector hospitals has been most enriching in respects of ocular diseases exposure”. 

The guidelines stipulate the variety of conditions that candidates must get exposure to during the minimum of 600 clinical hours and write up on specific cases eg. glaucoma, conjunctivitis, uveitis etc.   The rationale for selecting public sector facilities for the training was two-fold: for practitioners to be exposed to the wide variety of clinical conditions and to themselves contribute to the clinical care at the overburdened state facilities. The majority of optometrists who have completed their hours did many more than the minimum hours and some continue to go to the hospitals as they see the need and want to continue assisting – true value of this experience!

PR: How has your university adapted its curriculum to meet the challenges of the advanced scope?
VM: The current PBODO is still in the process of working on a new programme structure. UKZN has provided input on the recommendation, and currently awaits feedback.  This experience with the ocular therapeutics programme has convinced us that the undergraduate optometry course must be designed so that graduates exit with ocular therapeutics competencies, which is also the World Council for Optometry Competency Level 4.   In deciding, I feel that we will be failing in our duty if we do not make informed decisions based on the actual eye care needs facing the country and the structure of the SA Health System.

PR: If you had the power to change optometry, what would you implement?
VM: I will work with others to change the narrative on how we determine or claim success in the optometry space in general. I feel that we put most effort into input only, with mediocre outputs, slowly becoming the norm in the absence of concrete measures. Like our experience with the Ocular Therapeutics journey, the real measure should not be on who worked on it, the legislation or the few Essential Drug List (EDL) drugs that were first approved, but rather on how many more patients were able to receive basic services for the first time as a result of this initial intervention.

I will, as a start, ask that we self-measure:

  1. universities – programme standards, impact that their graduates are making and the local adoption of their research innovations;
  2. industry – the quality, cost effectiveness and local appropriateness of their products as well as their contributions across all sectors to practitioner development;
  3. practitioners – on affordability and the comprehensiveness of the eye care services provided
  4. organisational optometry – on contribution to promoting and positioning the profession within the public realm and overall professional maturity over the years.

“strive for accolade of excellence……bestowed on you by those you serve”

PR: Thank you Vanessa for your sterling contribution.