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Óptico- Optometrista (Spain)

  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       The requirements established in our legal system are not, directly or indirectly, discriminatory based either on the nationality or country of residence for the professional practice of opticians-optometrists. There are not limitations, due to the regulation of our profession and the established mechanisms for the professional practice of opticians-optometrists.

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
    • Public health
    • Protection of consumers and recipients of services

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       Opticians-optometrists are health care professionals who safeguard the visual health of users/patients. Their professional practice, since it is regulated, benefits and avoids direct risk in:  People’s Health, as it impedes serious and irreversible damage to them if we bear in mind that the main function of opticians-optometrists is to take care of the eyes, considered unique and irreplaceable body organs.  Physical safety, as adequate eye prescriptions can avoid traffic, work and domestic accidents.  Visual health, as their practice prevents visual disturbances, which otherwise could produce high economic and social costs.  Consumer/user help, as they know they are being assisted by qualified optics-optometry professionals, and they are certain of the existence of a regulation that establishes the necessary knowledge and competences for these professionals. Thus, providing high quality service guarantees to consumers/users/patients.  Professionalism, since it is a regulated health care profession, the guarantee of good practices in the delivery of the activity is increased which reduces the loss ratio, since opticians-optometrists actively participate in the health alert network. Professional practice requires qualifications and internship periods in accordance with their competences, as well as a continuing education that guarantees high quality service to patients/users. Users have more choice when choosing a professional and they can look for the best price. They can freely choose the optician-optometrist with the best price, as qualifications are identical among practitioners. The benefits that come along with a regulated profession guarantee high quality service. This allows price improvement which implies more choice for consumers/users/patients and reduces inequality among them. The state ensures the regulation of the optician-optometrist professional practice. The Royal Decree No. 1387/1961 and the state law on the regulation of the health profession of optician-optometrist, inter alia, establish the functions and activities of the profession. These laws avoid legal disputes among professionals and uncertainty among users. The necessary post-secondary education, its competences, professional functions and the implementation of sanctions for malpractice are regulated by legal norms. As a consequence of the professional recognition, studies and expertise of opticians-optometrists new job opportunities have emerged in the national health system for these professionals. Similarly, collaboration agreements have been signed by some Health Departments of Autonomous Regions, and colleges and regional offices that form part of the Optical-Optometric Organisation. Through them, Primary Care Physicians can refer patients with visual problems to opticians-optometrists, so that they can assess whether their problem is refractive or pathological. If they consider their problem to be pathological they can refer patients to ophthalmologists or any other medical practitioners to treat their pathology.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The statutes contain the disciplinary regime applicable to registered opticians-optometrists. Opticians-optometrists are also subject to arbitration and mediation systems by their compliance with the Code of Ethics and the Handbook of Good Practices. Court action can be taken to report people who practice the profession of optician-optometrist without the necessary qualifications through criminal, civil and/or contentious-administrative proceedings. The following decisions have been issued on this topic: The Supreme Court, in the third courtroom for contentious-administrative proceedings on 25 October 1982, demanded the presence of a certified optician at the head of every optician's premises at all times during opening hours; The Supreme Court, in the second courtroom on 22 November 1985, sanctioned a person who was not licensed by the state to be an optician-optometrist for unauthorized practice of a profession; The Supreme Court, in the fourth section on 4 December 2003, established that the secondary level certificate in Optics of Spectacles was not equivalent to the Bachelor's degree in Optics, and that people holding only the former certificate did not qualify to be at the head of an optician's shop; The decision of the Regional Ministry of Health of La Rioja to allow an owner to be at the head of his optician's store without holding the Bachelor's degree in Optics and Optometry certificate was annulled by the Supreme Court, in its fourth section on 9 October 2006; The Supreme Court, in its seventh section on 12 September 2007 denied the official equivalence recognition of people holding secondary level certificates in Optics of Spectacles and Contactology to those holding a Bachelor's degree in Optics and Optometry certificate; The Provincial Court of Granada in its first section on 29 October 2012, sanctioned against Mrs. LG, college member and certified BSc in Optics and Optometry, for not being at the head of her optical establishment, leaving an unqualified person in her stead; The Provincial Court of Navarre on 28 January 2013, sanctioned against Mrs. MDMN for unauthorized practice for not holding the necessary BSc in Optics and Optometry qualification while performing these functions; The High Court of Justice of Madrid in its eighth section on 15 June 2010 annulled the certification of the Ministry of Health that allowed a French citizen holding a BTS Opticien Lunetier certificate to practice as an optician-optometrist in Spain. As an example we show the decision issued by the High Court of Justice of Asturias on 6 June 2007, Legal Basis No. 2: "The appellant alleged, as the basis of her appealing claims, the difficulty of hiring a qualified BSc in Optics and Optometry professional, despite all her efforts. However, this allegation cannot be accepted due to the legally protected interest -public health- which should prevail over the appellant's individual interests on the operation of the aforementioned centre without the presence of a certified BSc in Optics and Optometry professional. Thus, it is justified the imposition of a sanction as well as the fine imposed on it, which cannot be considered disproportionate due to the subjective element of admission of guilt when the appellant admitted unlawful action". Opticians-optometrists have an obligation to hold valid professional liability insurance for their professional practice as established by the Law No. 44/2003 on the organization of health professions.

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        Based on the regulation of studies for the obtaining of the University degree, the State normative regulation, and the regulation and control of the collegiate body, lead to the minimization of malpractice cases.

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       Yes, the general interest objective is pursued in a consistent and systematic manner through the Optical-Optometric Collegiate Organisation, by its governing statutes approved by the Spanish government, by Royal Decree No. 2207/1979 of 13 July 1979, and by Decree-Order SAS/145/2010 of 21 January 2010, it is expressly stated the disciplinary regime applicable to registered opticians-optometrists in their practice therein. It is also pursued the compulsory compliance with the Code of Ethics for Opticians-Optometrists and the Handbook of Good Practices, both approved by the Governing Board of the National College of Opticians-Optometrists on 15 February 2003 and the General Board of Members on 27 April of the same year. The general interest objective is also pursued through arbitration systems, in accordance with the Law No. 60/2003; as well as mediation, included in the Law No. 5/2012 of 6 July on mediation in civil and commercial matters. The general interest objective can be found in the provisions of the Law No. 25/2009 of 22 December 2009 on the modification of diverse laws for their adaptation to the law on the free exercise of service activities and its code of practice, a Single Window service was established. This service allows patients/users/consumers to submit their claims and complaints against opticians-optometrists practice. These records help enforce a better control over the professional practice of opticians-optometrists.

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       The nature of the activities that opticians-optometrists perform is complex because they take care of the visual health of patients, which justifies why these activities can only be performed by professionals possessing this specific qualification. They look after people with visual problems, trying to find out the nature and scope of such problems (diagnosis), so that they can provide them with solutions for these problems (treatments). Opticians-optometrists perform mainly clinical optometry. The clinical tasks they perform in their practice, including but not limited to, are:  Consultation with patients to record their anamnesis or medical history, which allows the professional to make a tentative diagnosis by observing and detecting signs of visual and eye problems, or symptoms of related systemic diseases  Preliminary and specific ocular or visual tests, which allow them to make an initial diagnosis as a basis for a possible treatment.  Inform patients of the diagnosis and the treatment to follow and proceed only after an informed consent is given  Referral to a different health care professional in case a pathology is found  Multidisciplinary management in low vision, ophthalmic or neuronal illnesses, paediatrics, learning, geriatrics, etc Opticians-optometrists acquire during their university course training competences and skills to analyse the visual function and the ocular health, using always the most adequate clinical diagnostic tests for: Measuring and appraising:  Visual acuity  Contrast sensitivity  Intraocular pressure  Corneal radius  Pupils  Colour vision  Visual fields  Ocular structures for anterior and posterior segment  Corneal topography Assessing and determining:  Objective and subjective refractive status of the eye for far and short distance, both monocular and binocular  Ocular motility  Extraocular muscles movements  Near point of convergence  Ocular deviations  Fusion, phorias and stereopsis problems  Accommodation function and accommodation/vergence relationship Prescribing, dispensing and selling optical and optometric aids:  Ophthalmic lenses  Contact lenses  Specific programmes for visual therapy and vision training  Low vision aids  Protection lenses and filters Performing tests prior to contact lens fitting:  Anamnesis or medical history  Study and measurement of the eye structures:: Eyelids Conjunctiva Quality and quantity of tears Cornea Visible iris diameter Corneal esthesiometry Corneal pachymetry Corneal epithelial fragility Fitting and controlling all types of contact lenses Handling, placing and removing contact lenses, as well as training patients in their use  Carry out and interpret fluorescein patterns tests (fluorograms)  Calculate the adequate lens  Choose the most adequate contact lens cleaning system  Control and monitor adaptation as well as knowledge of possible ocular complications for users Controlling, assembling and fitting all types of ophthalmic lenses Elaborating, applying and controlling visual rehabilitation programmes for low vision Fitting and monitoring optical and non-optical aids for low vision Using ergonomic assessment skills for place of work and schools

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       The effect of the regulations and measures on the professional activities has been positive. The cumulative effect of the legislation has led to the evolution of the profession, both in training and competences, which has caused benefit for consumers/users/patients. They are aware that trained and certified health care professionals will assist them, and that the state government is the body ensuring their training and professional practice. Training has improved with the current Bachelor's degree in Optics and Optometry, which provides more competences and skills, extending graduates training in ocular pathology and pharmacology as well as giving them the opportunity to do internships and apprenticeships in clinics.

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       They have not been considered because the university degree certificate and its professional regulation (by the state, region and the Optical-Optometric Organisation) suffice and do not need any other alternative mechanisms.

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Maintain current system

       Explain where relevant:

       No further comments

    11. Any other comments?
       In other State Members of the EU, when our professionals migrate to work in countries like the United Kingdom and Ireland they have to pass a language test. Then, they start doing internships without a salary for a few months, despite having a similar training level to that of the optometrists in the UK. In other Member States, optometry is not a regulated profession so Spanish opticians-optometrists are not eligible to work in them.
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