Clive Peckar

Happy New Year to all of our readers across the world!!!

The first Euro-Asian ophthalmology congress was held in Shanghai in December, partly sponsored by the ESCRS. This was a great success and was much appreciated by the 400 delegates. The largely European faculty were very warmly welcomed by our Chinese hosts. There is an enormous opportunity for professional interchange and we should all strongly support the second congress planned for 2005. I would like to thank my colleague Clive Peckar for his huge effort in helping to organise this congress.

In this issue of Eurotimes, we report and welcome the expanded role of optometrists in clinical practice. The concept of optometry is firmly established in the UK , USA and Spain , but is much less well developed in the rest of Europe . In the UK optometrists have a well structured training program and their clinical responsibility is aimed at identifying abnormality (as opposed to diagnosis and treatment) as well as refraction, orthoptics, dispensing glasses and contact lenses. They are more ubiquitous than hospital eye departments and have well equipped practices in the community. Not surprisingly optometrists wish to broaden their practice for both professional and commercial reasons, to include the management of diabetes, glaucoma, pre-op assessment of cataract and prescribing medication. The government is very supportive of this as they believe it will reduce the workload of the hospital eye surgeons. The cost may be huge: financially it will be more expensive than hospital based service (but in the UK we have seen stg £ millions squandered in other areas so that may not be an issue) and more significantly the professional risk may be enormous.

Who will take responsibility for further training, clinical governance, audit, appraisal and supervision? This is a central feature of the Doctor's professional life aimed at ensuring high quality patient care. Ultimately, will optometrists be prepared to take the increased clinical risk including very expensive malpractice insurance? Up until now all the risk has been with the eye surgeon, but this will have to change under these proposals.

The other paper from the UK relates to providing patients a choice as to where they have their cataract operation. In the UK nearly all patients go to the local government hospital, unlike other countries in Europe where they can have government funded treatment in private clinics of their choice. This is an excellent idea and will introduce competition which is potentially very good as long as it is a level playing field. However it is likely to be inefficient, with significant overcapacity and it remains to be seen whether patients do indeed want to be "empowered".

We are all looking forward to a happy, exciting and successful New Year!!

CLIVE PECKAR