Guidelines

for

Standards of Practice

Revised May 31, 1999
Introduction

Opticians must make every effort to maintain the highest level of professional and ethical care. The Alberta Opticians Association is responsible for ensuring that the dispensing of eyeglasses and contact lenses are provided to consumers with generally accepted standards of practice and procedures. The Alberta Opticians Association is especially responsible for protecting the public from harm.

These guidelines will:

· help opticians to determine if they meet regulated, moral and ethical standards in their practice;

· help consumers to assess the quality of their care;

· provide a benchmark for the Practice Review Committee when reviewing a members practice; and

· provide a benchmark for investigation and evidence by the Discipline Committee of unskilled practice or professional misconduct.

These guidelines for standards of practice outline the requirements for:

· professional judgment for dispensing of eyeglasses;

· professional judgment for dispensing of contact lenses;

· professional judgment for practicum supervision of eyeglass and contact lens students;

· organizational skills;

· communication;

· ethics; and

· lifelong learning.

The guidelines for these standards of practice go hand in hand with the Practice Review Self Assessment to help every optician maintain a reasonable level of competency as a professional.

Eyeglass Dispensing

For an office where eyeglasses are dispensed:

At least one licensed eyeglass optician must be on the premises at all times when eyeglasses are being sold, dispensed or adjusted. The licensed eyeglass optician of record will be held accountable for all eyeglasses sold, dispensed or adjusted from the dispensary.

Each eyeglass dispensary is responsible for maintaining in good condition, adequate tools, instruments and items necessary for fitting, dispensing and adjusting eyeglasses.

The following tools and instruments must be on the premises at all times:

1. lensometer;

2. adjustment and bench tools;

3. lens clock (gauge);

4. pupilometer and/or mm pd ruler and penlight;

5. frame heater;

6. pd ruler;

7. vertex distometer;

8. thickness calipers;

9. tolerance charts; and

10. other such equipment and instruments as the Alberta Opticians Association indicates from time to time are necessary to maintain the standard of practice of the profession.

The following tools, instruments and items are recommended to be on the premises:

1. frame and lens cleaning products;

2. lens product samples;

3. a selection of ophthalmic frames; and

4. distance and near visual acuity charts.

Each eyeglass dispensary must be sanitary, provide accessibility to hot and cold running water, and have proper lighting facilities and mirrors to ensure a suitable surrounding for a patient to choose eyeglasses.

An optician must demonstrate safe working practices with regards to chemical, electrical, fire, noise hazards and infection control procedures. Each optician should have the ability to perform basic first aid including a knowledge of CPR and availability of a first aid kit and emergency telephone numbers.

Each opticians must routinely:

1. evaluate every optical prescription and advise patient of suitability of lenses and frames with the knowledge of occupational needs, hobbies and cosmetics;

2. evaluate every optical prescription and advise patient of suitability of lenses and frames with knowledge of optics and geometric physics applied to the product purchased;

3. advise patient of the consequences of changes in their prescription with regard to expectations for new eyewear purchased;

4. analyze changes in prescription with regards to medical complications indicated;

5. ensure that the patients needs and expectations have been fulfilled with regard to safety aesthetics and price;

6. provide follow up care including adjustment and advice to make wear easier and maintenance more effective;

7. be able to recall or locate the following information in detail on their patients eyeglasses;

· Date transaction performed,

· Name of prescriber and date last seen,

· Patients optical prescription,

· Lens type including index of refraction and brand,

· Coating or treatments provided for lenses,

· Placement of optical centers vertically and horizontally,

· Placement of bifocal/ multifocal heights,

· Significant changes in Rx,

· Safety features including special thickness given,

· Frame information including material, size and colour (If a patients own frame is used a lack of information specifics in this area is allowed if no other course of action can produce it.)

· Method and amount of payment including third party billings.

8. recognize anomalies in prescription and wearing success and to refer the patient to a medical practitioner, if required;

9. routinely evaluate every pair of eyeglasses, using tolerance charts before dispensing, for the following;

· Prescription accuracy using a lens meter,

· Frame accuracy, general appearance and standard alignment,

· Transparency of lens surface,

· Coating quality and accuracy,

· Optical center placement,

· Segment height placement,

· Base curves and center thickness where appropriate

10. upon dispensing verify the following;

· Patients expectations have been met,

· Vision requirements have been met,

· Patient understands required maintenance for their eyeglasses,

· Patient understands the necessity of and availability of follow up.

See Appendix A for Technical Standards for Prescription Eyeglasses.

Contact Lens Dispensing

For an office where contact lenses are dispensed:

At least one licensed contact lens practitioner must be on the premises at all times when contact lenses are being sold, dispensed or adjusted. A licensed contact lens practitioner may put aside contact lenses, which have already been assessed, for pick up by the patient. The licensed contact lens practitioner of record will be held accountable for all contact lenses sold or dispensed from the dispensary by any staff, with or without permission.

Each contact lens dispensary is responsible for maintaining in good condition, adequate tools, instruments and items necessary for fitting, dispensing and adjusting contact lenses.

The following tools, instruments and items must be on the premises:

1. keratometer/ophthalmometer;

2. slit lamp/biomicroscope;

3. lensometer;

4. radiuscope or equivalent; and

5. method of disinfecting tools, equipment and lenses.

The following tools, instruments and items are recommended to be on the premises:

1. diagnostic trial lenses;

2. a variety of currently dated contact lens solutions for in office use and patient starter kits;

3. Burton lamp; and

4. distance and near visual acuity charts.

Each contact lens dispensary must be sanitary, provide access to sink equipped with soap and hot and cold running water, and have proper lighting facilities and mirrors. The dispensary must ensure a suitable surrounding to accommodate fitting and measurement equipment.

A contact lens practitioner must demonstrate safe working practices with regards to chemical, electrical, fire, noise hazards and infection control procedures. Each contact lens practitioner should have the ability to perform basic first aid including a knowledge of CPR and availability of a first aid kit and emergency telephone numbers.

Each contact lens practitioner must routinely:

1. evaluate every optical prescription and advise patient of suitability of lenses with the knowledge of occupational needs, hobbies, wearing time requirements and cosmetics;

2. evaluate every optical prescription and advise patient of suitability of lenses with knowledge of optics and geometric physics applied to the product purchased;

3. advise patient of the consequences of changes in their prescription with regard to expectations for new contact lenses purchased;

4. analyze changes in prescription with regards to medical complications indicated;

5. perform an ocular health assessment before fitting contact lenses;

6. ensure that the patients needs and expectations have been fulfilled with regard to safety aesthetics and price;

7. recall or locate the following information in detail on their patients contact lenses;

· Date transaction performed,

· Name of prescriber and date last seen,

· Patients optical prescription,

· Base curve, diameter and Rx of contact lenses,

· Lens type including manufacturer,

· Lens information including material, water content, and colour,

· Patients wearing expectations,

· Solution instructions for lens disinfection,

· Significant changes in Rx,

· Placement of bifocal/ multifocal heights if applicable,

· Method and amount of payment including third party billings.

8. provide follow up care on a routine basis (recommend at least once per year) including adjustment and advice to make wear easier and maintenance more effective;

9. recognize anomalies in prescription and wearing success and to refer the patient to a medical practitioner, if required;

10. evaluate every pair of contact lenses, using tolerance charts before dispensing, for the following;

· Prescription accuracy using a lens meter.

· Transparency of lens surface.

· Surface quality.

· Base curves.

· Diameter.

· Edge finish.

· Segment height placement, if applicable.

· Center thickness where appropriate.

11. upon dispensing routinely verify the following;

· Patients expectations have been met.

· Vision requirements have been met.

· Patient understands required maintenance for their contact lenses.

· Patient understands the necessity of and availability of follow up.

A contact lens practitioner should obtain and maintain accurate physical measurements including but not limited to:

1. keratometer/ophthalmometer readings;

2. observations from a slit lamp/biomicroscope evaluation including pathological or physiological anomalies;

3. HVID (horizontal visible iris diameter);

4. pupil size, when necessary (in bright and dim light);

5. fissure size; and

6. tear quality.

A contact lens practitioner must maintain all patient files for a minimum of three years from date of last entry, with patient name, current address and telephone number. The patients date of birth, occupation, hobbies, and corrected and uncorrected visual acuity should also be recorded in the patient’s file.

Practicum Supervision of Eyeglass and Contact Lens Students

Student refers to any person employed in the optical field and registered with NAIT for their apprenticeship and with the Alberta Opticians Association as a student eyeglass or contact lens dispenser. Direct practicum supervision of eyeglass or contact lens students must be provided by a licensed optician, contact lens practitioner, licensed optometrist or ophthalmologist (for contact lenses only) at least 75% of the student working day. A student may be employed full time or part time. An eyeglass student must complete two thousand (2000) hours in their practicum logbook under direct supervision of their supervisor. A contact lens student must complete five hundred (500) hours in their practicum logbook under direct supervision of their supervisor. A licensed eyeglass or contact lens practitioner, optometrist or ophthalmologist may supervise no more than two students at one time.

The Practicum Supervisor will be held accountable for all activities carried out by a student under supervision to them. Practice standards for the dispensing of eyeglasses and contact lenses outlined previously pertain to the supervision of all students.

Organizational Skills

Based on their knowledge of the expertise of other health care professionals, opticians make referrals when appropriate. Opticians will use the available financial, physical and human resources in their practice efficiently. An opticians filing and accounting practices will be such that information retrieval can be done efficiently. Delegation is limited to registered students except in non- professional activities.

Communication

Opticians must be able to provide understandable information to patients and to other health care providers. Opticians must provide patients with appropriate information for safe and effective use of their optical goods and determine that the patient understands the use of their optical goods.

Code of Ethics

It shall be the IDEAL, the RESOLVE and the DUTY of each Optician to act in accordance with the following principles:

1. I shall keep the WELFARE of my customer / patient uppermost at all times, and shall continuously enhance my educational and technical proficiency in order that my customers / patients might receive the benefits of all acknowledged improvements in Ophthalmic care.

2. I shall render my services to all my customers / patients with equal diligence, respect and without discrimination.

3. I have a duty to hold in strict CONFIDENCE all information acquired in the course of the professional relationship with my customer / patient, and shall not divulge any such information unless expressly authorized by my customer / patient, or by law.

4. I shall assist in MAINTAINING the integrity of the profession, shall contribute to, and participate in its activities. I shall encourage and participate in the education of all participants in the profession.

5. I shall foster good relationships among members of the Ophthalmic professions, in order to facilitate inter-professional relationships and REFERRALS for the benefit of my customer / patient.

I shall be professionally responsible for all services rendered by myself or under my supervision.

Lifelong Learning

Each optician will evaluate the quality of their optical services and the areas they need to improve, effectively choose education which addresses their learning needs and apply what they have learned to their practice.

Each optician will maintain the minimum requirement for continuing education set out in the Opticians Regulations.

Appendix A

Technical Standards for Prescription Eyeglasses

Inspection Procedure	Tolerance	Testing Procedure
Surface Curvatures	+/- 0.50 D from request	Lens Gauge (clock)
Refractive Power (diopters) Sphere and Cylinder	0.00 +/- 0.06 Over 0.00 to 6.00 +/- 0.12 Over 6.12 to 12.00 +/- 0.18 Over 12.00 +/- 0.25	Power measured in principal meridian on a standard lens meter at the optical center as specified.
Cylinder Axis (diopters)	0.12 to 0.37 +/- 3degrees Over 0.37 to 1.00 +/- 2 degrees Over 1.00 +/- 1 degrees	Axis shall be determined in relation to the cutting or mounting line.
Optical Center Location and Prism Power	Vertical or Horizontal imbalance to not exceed +/- 0.25 prism diopters for each lens or +/- 0.50 prism diopters total	Lenses shall be measured at the specified reference point (optical center).
Multifocal Segment Power	Within +/- 0.12 diopter	Power measured on a standard lens meter.
Multifocal Segment Size	Within +/- 0.50 mm of the size specified. Pair must be symmetrical on visual inspection.	Segment to be measured on segment side of lens.
Multifocal Segment Height	Within +/- 0.50 mm of the height specified	Measured from the apex of the bevel to the highest portion of the segment on the convex side of the lens (relative to box measurement)
Surface Defects	No waves, pits, scratches, watermarks, grayness shall be acceptable	Lenses inspected by grazing incident light beam from clear 40 watt incandescent light bulb with lens 12 inches from the light source
Internal Imperfections	No bubbles, aberrations or striae	As above.
Impact Resistant Dress Eyewear Lenses	All dress impact resistant lenses must have an appropriate optical center thickness for the type material used in its manufacture.	It is recognized that current impact resistant glass lenses do not meet CSA impact resistance requirements. Consumers must be informed when a lens is dispensed that does not meet the standard.
Impact Resistant Occupational Protective Lenses	Tolerance for power, size, etc., shall meet minimum thickness edge or centre of 3.0 mm or less where allowed by CSA standard.	Shall meet the requirements of CSA Z94.3-92 (including safety trademark when indicated).
Warpage	Curves in the principle meridians of the mounted lens must be within +/- 0.50 diopter of the design specification of the lens.	Curves shall be measured with a lens gauge (clock)
Thickness	As specified within +/- 0.2 mm	Thickness Gauge (calipers).