Parliamentary Speech for the Second Reading of the Optometrists and Opticians Bill 2007

17 Jul 2007

By Mr Heng Chee How

Venue: Parliament

Background

Like other countries, eye care in Singapore is provided by ophthalmologists, with auxiliary support from optometrists and opticians. Our ophthalmologists are highly trained and enjoy an international reputation with many foreign patients as their clientele. 

However, unlike most other countries, we have largely left the practice of optometry and opticianry unregulated. This is historical. 

Some years ago, the Health Ministry decided that we should bring the practice of optometry and opticianry under regulation and started to prepare the industry for it. 

In 1994, we took the first major step when the Singapore Polytechnic launched a diploma course in optometry and certificate courses in ophthalmic dispensing. This was to provide the industry with well-trained optometrists and opticians to help raise the standard of eye care by these allied health professionals. Over the years, the Singapore Polytechnic has graduated about 600 optometrists and provided training for about 300 opticians. We now have an active market in such eye care practices with competitive prices.

In 1995, we took the second major step when the Contact Lens Practitioners (CLP) Act was introduced to regulate contact lens practice. This was a priority to ensure public safety by allowing only properly trained practitioners to fit and dispense contact lens. 

We are now ready to take the third major step by bringing legislation to bear on the remaining practices of optometry and opticianry which fall outside of the CLP Act. This is an important piece of legislation particularly because myopia is rather common in Singapore. Our prevalence rate is high at 40% among Chinese adults over 40 years old, as compared to say, 15% among Australians and 27% among Americans in the same age group. The problem will grow as our population ages.  There are several reasons why we need to regulate the practice of optometrists and opticianry. First, the public will then be better assured of high standards of primary eye care, refraction and optical aid dispensing. Second, practitioners will be required to maintain high standards in their professional practice through mandatory continuing professional education (CPE). Third, errant practitioners may be disciplined for, amongst other things, professional misconduct or negligence, or any improper act or conduct which brings disrepute to his profession, arising from a complaint brought by an aggrieved patient.

Our Approach to Regulation

The regulation of optometrists and opticians is, however, not straight-forward. In most other countries, there is a clear division of labour between optometrists and opticians, depending on their training. Optometrists are trained to perform refraction and basic eye examination procedures such as examining eyeball pressure, visual field and retina (innermost lining of the eyeball essential for vision). On the other hand, opticians are trained to prepare, adjust and fit optical aids and perform other retail duties. However in Singapore, there is much overlap between the practices of these two groups of eye care professionals, with opticians doing refraction and optometrists dispensing optical aids. As a result, our public has become accustomed to having both refraction and dispensing provided by the same optical service provider rather than being served by separate providers as is practised in developed western countries.

In developing our regulatory framework, our principal objective is to ensure that optometry and opticianry services are safe for our public. While we want to regulate the optometrists and opticians as two distinct professions, we want to take into account market realities and avoid unnecessary disruption to the way that the public uses the services of these professionals. Our legislation will therefore enable opticians to continue to perform refraction provided that they are properly trained.  But we propose to exclude children under 8 from the persons whom an optician may refract. Young children are more difficult to refract and may have eye anomalies that opticians are not trained to detect. With our legislation, refraction services for such young children will require the higher skills of an optometrist. In addition, optometrists will be formally recognised for their ability to perform basic eye examination procedures and diagnose certain eye problems. 

We are mindful that regulation may cause some disruption to the practices of some existing optometrists and opticians, and we seek to minimise this as far as possible. Some opticians currently only perform dispensing and have no intention to learn refraction. We accept this as part of market reality and will register such opticians to perform only dispensing so as to allow them to continue their practice.  Nonetheless, there is a competing need to ensure that opticians attain a reasonable level of competence. To achieve this balance, existing opticians will be registered under the Act according to their experience, qualifications and competence. Those who do not satisfy certain minimum requirements will be required to undergo upgrading courses in order to qualify for registration.

Based on this approach, we have drafted the Optometrists and Opticians Bill which is now before this House.

Main Features of Bill

Let me now go through the main features of this Bill. First, we have defined the acts constituting optometry and opticianry in the Schedule. Only persons who are registered as optometrists or opticians are allowed to perform the respective activities listed in the Schedule. However, exemptions will be made in subsidiary legislation to allow health professionals such as medical practitioners and orthoptists to continue performing eye examination procedures which are part of their scopes of practice.

Part II of the Bill establishes the Optometrists and Opticians Board. The Board will be represented by members from the optometry, opticianry and ophthalmology professions, public officers from MOH and MOE as well as some lay-persons. The main functions of the Board are to approve or reject applications for registration, accredit courses in optometry and opticianry, and determine guidelines for the professional conduct and practice of optometrists and opticians. 

Part III sets out the role of the Registrar in maintaining the registers of optometrists and opticians, and the powers of the Board to take disciplinary action against registered optometrists or opticians, including the cancellation or suspension of the registration of such persons, and the imposition of monetary penalties. It also provides for a right for any person aggrieved by the decision of the Board to appeal to the High Court. Part III also requires optometrists and opticians to apply for practising certificates, which will be made renewable subject to mandatory continuing professional education to be specified in subsidiary legislation. This is to ensure that the practitioners continue to maintain a high level of competence so as to provide quality and safe primary eye care to the public. 

Part IV provides for offences in regard to the unlawful engagement in optometry and opticianry and fraudulent registration. A person who practises optometry or opticianry without registration or a valid practising certificate will be liable on conviction to a fine not exceeding $25,000 and / or to imprisonment for a term not exceeding 6 months for a first offence, and a fine not exceeding $50,000 and / or to imprisonment for a term not exceeding 12 months for subsequent offences. Under clause 29, the Board may also compound any offence prescribed as a compoundable offence under the Act. 

Part V clause 31 allows for the appointment of Inspectors to investigate into offences under the Act, and complaints against registered optometrists and opticians. Finally, under Part VI clause 39, the Contact Lens Practitioners Act will be repealed.

Implementation

Let me now touch on implementation. To minimise the impact of regulation on contact lens practitioners licensed under the Contact Lens Practitioners Act, licensed practitioners will be automatically registered as opticians and granted practising certificates in respect of opticianry when the Act comes into operation. Furthermore, contact lens practitioners with the appropriate qualifications and experience may also apply to be registered as optometrists. 

For optometrists, those with recognised qualifications and at least a year of optometry experience will be fully registered. Optometrists with less than a year of experience will be provisionally registered, and will have to work under supervision for 1 year before they become fully registered. 

For opticians, those with work experience of at least 5 years will be fully registered as opticians if they pass a competency test. Those with between 2 to 5 years of experience will need to undergo a part-time modular upgrading course.  There may be some opticians who do not intend to do any refraction but wish to do only dispensing; they will need to undergo a competency test or failing which, an upgrading programme but without the refraction component. This will ensure that they can uphold safe standards in dispensing. 

Opticians with less than 2 years experience and all new entrants to the profession will need to attend a certificate course in opticianry in order to qualify for registration. Singapore Polytechnic has organised a course to cater to these opticians. Such a course can be completed in 9 to 24 months. 

Further details of the registration of optometrists and opticians will be spelt out in subsidiary legislation to be enacted at a later date. My Ministry will be reaching out to existing optometrists and opticians through the media and seminars to inform the practitioners on the procedure for registration, including details on the competency tests and upgrading courses necessary for registration.

In preparing this Bill, the Ministry has consulted persons who will be affected by this new legislation, in particular the key representative groups of the professions such as the Singapore Optometric Association, Singapore Opticianry Practitioners and Singapore Polytechnic Optometry Centre. These stakeholders have been supportive of the Bill. We will continue to consult them as we develop the subsidiary legislation that will follow.

Conclusion

In conclusion, we are ready now to regulate the practice of optometry and opticianry. The existing Contact Lens Practitioners (CLP) Act has laid the ground for us to take this step, and years of training optometrists and opticians have created a sufficiently competitive market to support this move. I seek the House’s support for this Bill to ensure that the public continues to enjoy high standards of eye care, in relation to the practice in optometry and opticianry. 

Mr Speaker, Sir, I beg to move.