PO Box 1097 Newcastle 2940, KwaZulu-Natal, South Africa
E-mail: pauleyes@mweb.co.za
Introduction
It is an immense privilege to share my perspective on the existence of the South African Optometric Association (SAOA) as well as optometry in the Republic of South Africa (RSA). I wear the badge of honour with pride, serving the noble profession of optometry. It has given me so much – in return, I strive to give my best in advancing eye and vision care at all times. Allow me to unveil the SAOA’s time capsule and that of the profession of optometry through my eyes and mind, capturing both our victories and challenges.
Highlights of the century
The formation of the South African Optical Association in 1924 was a colossal step in laying the foundation of organised optometry in South Africa. Essentially, this milestone paved the way for civil society, health professionals and optometrists to direct their concerns to the designated custodian of the profession. Equally far-reaching, Rex vs. Saks in 1931 became a historic cornerstone of optometric legislation in RSA and many parts of the World. JL Saks’s victory in court was a momentous catalyst, establishing the credible, professional status of optometry in South Africa; legally enabling optometrists to charge professional fees for services rendered. Julius Louis Saks served as President of the South African Optometric Association several times. In recognition of outstanding contribution to the profession, the SAOA conferred Honorary Life Fellowship on JL in 1946 and in 1951, as well as its highest award, that of Honorary Life President.
SAOA’s adoption and promotion of a professional qualification (DipOptom) via Wits Technikon was a tremendous stride. The SAOA played a pivotal role in setting the curriculum as well as the way people practised. For many years, Mrs Bell was the education officer while Mrs Meisie van Blommenstein ran the affairs of the profession (everything from tariffs to rules and regulations). The late 1970s saw the emergence of University of the North and University of Durban-Westville heralding the BOptom degree followed by Rand Afrikaans University and then Free State University more than a decade later. In many ways, the status of the profession was inextricably linked to the university degree programs.
Optometry’s development mirrors that of the United States of America (USA). Closed windows and brass nameplates were later replaced by neon signs, open windows and savvy commercialism. Commercialism has become both boon and bane. Boon offers the public informed choices while bane is an affliction ensnaring the unsuspecting, naive public utilising hooks and baits. When I entered the profession, ophthalmologists used to issue optical prescriptions; this has dwindled over the years. These days, ophthalmologists often issue a prescription recommending optometrists to “refine and prescribe as you deem necessary.”As time moved on, the public stopped referring to us as opticians and optometrists became the norm with similar, parallel trends to the USA.
Reminiscing through the local optometric reels, I recollect some role players that have taken the profession to greater heights. Deryck Humphriss gave the profession the famed Humphriss Immediate Contrast (HIC) method that allows for subjective refraction under conditions which maintain peripheral fusion while testing foveal vision monocularly. Sam Schneider’s term as SAOA president exemplified road traffic screenings and television educational advertisements encouraging the public to have regular eye examinations. Eagerly, I used to watch the award winning, Hunt Lascaris flighting of Satchmo’s What a wonderful world. Pete Swanepoel and Sanjay Singh are remembered for Optometrists’ altruism through welfare days and SAOA clinics. Prof Jannie Ferreira is synonymous with Phelophepha to this day. Besides producing several post-graduates (myself included), he has also championed Sports Vision when South Africa re-entered the international sports arena. Stef Kriels’presidency was noted for diagnostics training in RSA. Recognising the prejudices that still exist in the optometric world, Patrick Mawila and Dollars Boloka advocated inclusivity at conferences and committees of the association. Kovin Naidoo placed South Africa on the world map with the Durban Declaration on refractive error and service development. Prof William (Bill) Harris and his protégé Prof Alan Rubin are regarded as world leaders for elegantly describing dioptric power matrices in optics with application to vision. Their body of work and that of local researchers made The South African Optometrist one of the most cited and respected peer-reviewed publication in the world. Prof Vanessa Moodley, Professional Board for Optometry and Dispensing Opticians (PBODO) chairperson, saw that the expanded scope became a reality notwithstanding legal hurdles and frustration from Ophthalmological Society of South Africa (OSSA). Maemo Kobe was equally tenacious against the onslaught against optometry at the Health Professions Council of South Africa (HPCSA). The gallant Prof Khathutshelo Percy Mashige gave me tremendous support for submission of pharmaceutical substances approval to the South African Health Products Regulatory Authority (SAHPRA). Peter Brauer, the perennial SAOA stalwart, has always committed his skills to the coding committee and affairs of the SAOA. Faith Chabedi served as clinical advisor for Special Olympics Africa embracing sports for the physically-challenged. Similarly, Brian Sneag, the elder statesman of optometry, has promoted bowls for the visually impaired. Dr Casandra Seethal is revered for her par excellence chairing of the Education and Clinical Standards committee while facing extreme personal adversity and tragedy. The tariff resource person is John Stein who assigns monetary values utilising relative value units (RVUs) to determine the cost of optometric services. Dr Dirk Booysen’s clinical guidelines has served as great resource materials for practitioners while Prof Mike Gowans and Dr Chris Faul’s articles and texts made sense of the cents of being in practice. During the Covid-19 pandemic, Sibodla Lucky Nkosi gave us daily updates on matters pertaining to the novel corona virus as well as invaluable clinical information to build camaraderie while Harry Rosen, SAOA CEO, ensured that the profession got vaccinated like our other health colleagues timeously, not forgetting his adept finger on the pulse of the association’s daily tasks during this difficult time as well as for more than two decades at the helm admirably.
The expanded scope of optometric practice has catapulted the profession to the pinnacle of eye care. My unrelenting fight for the expanded scope, ocular therapeutics, pioneer in advanced orthokeratology and immersing myself in various capacities of the SAOA has been acknowledged by the profession (in 2018, awarded the Distinguished Achievement Award for Exceptional Achievement in the Realm of Academia plus the Award for Best Editorial Contribution to Vision; in 2019, the SAOA awarded me its highest award, Honorary Life Member; in 2021 ASAIPA excellence award for optometry). I was able to achieve these feats, because of my better half, Prelina, ably supporting me by wearing the love of optometry on her sleeve tirelessly.
In spite of OSSA’s thwarting the expanded scope of optometry practice, the National Department of Health (NDOH), seeing the benefits of optometry as a primary health care profession, has supported the optometric profession by relaxing the need of section 22A permit (that required non medical practitioners to possess pharmaceutical substances), promoted the access of optometrists for clinical training at hospitals, encouraged the use of pharmaceutical substances and has employed hundreds of public sector optometrists in eight provinces. The National Traffic department also recognises optometrists’ role in vision, hence, the ubiquitous “purple” form being symbolic of divers licence renewals. These days, optometrists attend CMEs with other health disciplines and also share the platform as presenters. We must applaud the brave, generous ophthalmologists who support the clinical training of optometrists and maintain a strong collegial relationship.
Challenges faced by the SAOA and optometry
Optometry in South Africa has been fraught with many challenges in its quest to be recognised as an autonomous, legislated profession.
Ophthalmology, even one hundred years ago, felt threatened by optometry. It objected to optometrists using equipment such as retinoscopes, ophthalmoscopes or instruments for objective examinations. They argued that optometrists should not examine children under 16-years of age, charge a fee and should not make diagnoses but be limited to “selling glasses. OSSA is still a vociferous opponent of the expanded scope of optometry practice. They have escalated their disapproval to SAHPRA, HPCSA and medical aids. Prof Mashige describes the perpetual tussle between ophthalmology and optometry as a “forced marriage” while I refer to it as professional apartheid. Governments in many parts of the world have embraced the modern view that accessible delivery of primary health care is paramount and refuse to succumb to the archaic view that the medical practitioner wields dominion over all the other health disciplines. Consequently, dentists; podiatrists; emergency practitioners; optometrists, etc are authorised to prescribe medicines. My fervent wish is for OSSA to make peace with this reality.
Major issues that irk the majority of optometrists include: mobile practices, on-line sales and unethical advertising. These concerns keep gnawing away, leaving them despondent and betrayed. Also, frustrated practitioners view the HPCSA as an ineffective regulatory body because it meets seldom and has inadequate monitoring mechanisms. Additionally, there is no functioning Advertising Standards Authority to keep adverts in line to protect the public from unscrupulous advertisements.
The world is often viewed through political and social prisms. Optometry has witnessed and felt the same pains that general society has encountered. People of colour were excluded from being members of the early SAOA, however, the last two decades has seen optometrists of colour becoming equal members, directors and SAOA presidents. It is indeed heart-warming when the SAOA pays homage to diverse religious and cultural observances such as Rosh Hashanah, Yom Kippur, Eid ul Fitr, Diwali and Raksha Bandhan.
It will be remiss not to report that there were instances when SAOA directors, being privy to the economic landscape, usurped their portfolios for self interest in order to advance pecuniary gains. Sadly, the profession has also seen window dressing that is prevalent in South African society.
As a way forward, transformation should not be solely restricted to race but be embraced as a regular opportunity for each one of us to see how we all can make our fellow humans’ lives easier and pleasurable for mutual respect and growth; after all, all lives matter. People are good or bad not because of their race or social standing but because of their own insecurities. Avarice, injustice and prejudice are inherent in all spheres of society. Each of us must introspect daily in order to make sincere amends to treat fellow beings with dignity regardless of their backgrounds. This is the epitome of service to humanity.
Quo Vadis South African Optometric Association and optometry
My crystal ball shows increased commercialisation and advancement of the profession. However, medical aids and medical aid benefit organisations (previously known as medical aid administrators) have a close rapport with one another and will still clutch the purse strings. Why is optometry under constant threat?
According to Harry Rosen, CEO of SAOA, The South African optical industry is estimated to be worth close to 7 billion rands. The annual (2021-2022) CMS report, reveals that R180 billion rand was disbursed from the medical aid risk pool. The optometry medical aid payments is estimated at 2.5%, giving a total of R4.5 billion (R2.5 billion estimated to be in the private patient payment. The following represents the approximate breakdown: eye examinations 17%, spectacle lenses 46%, contact lenses 6%, and spectacle frames 31%. Optometry is a vulnerable target since a significant amount of the income is derived from materials. So, the lure of the optometry pie is no surprise. With National Health Insurance (NHI) on the horizon, the public purse intended for eye care will also be under threat if we are not vigilant.
The ideals of the profession will be a dream deferred without the collaborative efforts of many earnest practitioners steering the profession for a just society zealously.
Conclusion
With profound gratitude, I acknowledge the food and comfort my staff, colleagues and family enjoy abundantly because of optometry. Through the lens of appreciation, raise your glasses and cheers to a century reached by our professional association. Long live the ideals of optometrists who live and have passed on and best wishes to our future colleagues who receive the baton to cultivate the ideals of our great profession of optometry with pride and dignity!