Recently the media published an advertisement inviting applications for the ‘Bachelor of Optometry and Vision Science’ programme at the National Academy for Medical Science (NAMS).There is a chasm between the proposed teaching structure as expressed in their plan and the available infrastructure for proper optometry training. It creates some confusion and nervousness about the future of optometry training in the country. NAMS’ decision to  start  a new programme is concerning, as it plans to implement a two decade-old optometry curriculum in a setting with no essential infrastructure. The proposed training route could prove devastating to the future of optometry and eye health services in the country in terms of quality maintenance. Before starting such a programme, NAMS needs to understand the basic national and international norms that regulate the optometry profession.

Appreciating skills

A three-year Bachelor of Optometry programme was first started in Nepal at the Institute of Medicine (IOM) in 1998; the course was later upgraded to four years to meet international standards. In the last two decades, 86 optometrists have graduated and nearly half of them have emigrated for several reasons. There are two reasons behind this high rate of emigration.

First, the standard of the optometry qualification in IOM is highly regarded across the world; most optometry graduates are unconditionally accepted for higher degrees across the US, Australia, New Zealand and the UK. Nearly 60 percent of the graduates have either completed a master’s degree or a PhD from outside Nepal. Although improvement in core optometry training and labs are necessary, the quality of the existing optometry programme at IOM is unquestionable. A vigorous entrance examination of IOM which selects the most deserving candidates contributes to the high standard of its graduates.

Second, the high emigration rate of optometrists has raised the question of how to retain them in the country. As the optometrists’ international recognition and collaboration are on the rise, they are neglected within the country. All decisions regarding eye health, including optometry itself, are made without their involvement. A virtual involvement is often seen when big projects are developed for attracting large international grants.

It is shameful that the eye care community in Nepal, which considers itself a care-taker of the eye health sector, does not accept optometrists as a part of the integral team. Optometrists in developed countries such as the US, the UK, Canada or Australia are considered as primary eye care providers, spectacles cannot be tested for or dispensed without consulting them. Optical services should come under the jurisdiction of a qualified personnel. Twenty years down the line, optometrists in Nepal are still struggling to be known as primary eye care providers. They still suffer from job insecurity, lack of proper recognition and respect, and a lack of career growth.

Falling short

Although the full picture of the programme proporsed by NAMS is still emerging, earlier signs indicate that it is poorly designed. There doesn’t seem to be any involvement of optometrists in teaching classes, nor is there a proper optometry lab to train students in core optometry which includes refraction, vision therapy, contact lenses and visual rehabilitation. World Council of Optometry, an international regulating body, recommends that for laboratory and clinical teaching, there can be a maximum of four students under the supervision of an optometrist. That means that, in order to align with international practice, NAMS should have invited applications for at least 10 full-time optometrists to train 40 students concurrently with the entrance examination announcement.

NAMS proposes that students will be taught in several hospitals. This clearly indicates that there will not be uniformity in lectures, training and quality. Unless specifically trained, ophthalmologists are not qualified to teach courses regarding contact lens, ophthalmic optics, binocular vision and visual rehabilitation modules. The selection criteria needs to be as fair as possible to attract capable students from both ten plus two science and ophthalmic science backgrounds and the students should not be left alone for a self-directed learning. Also, what is the plan for engaging optometrists after their graduation—are there any permanent positions created to absorb them? We acknowledge that a quality optometry education will stop students from going overseas, attract international students and produce qualified manpower. But, the currently proposed new programme seems to be a disaster and may only help promote personal short term benefits. 

It seems that NAMS is aiming to produce less competitive optometrists who can be used for ad hoc eye service delivery rather than to facilitate their learning and produce independent practitioners. It is worrisome to see an incomprehensive approach to eye care in Nepal. Before making any decisions that have long-term impacts, it is necessary to talk to the right stakeholders—in this case, the Nepalese Association of Optometrists. There is a need to rethink the programme structure. The new optometry course is an attempt to prove that it is possible to get optometry services on the cheap. But if optometrists are wanted, quality cannot be compromised.

Kaphle and Marasini are optometrists and currently pursuing PhD degrees in Queensland University of Technology (DK) and the University of Auckland (SM)