ECOO: “Optometry and optics can do much more than it does now”

Overall, the provision of visual aids in Europe seems to be relatively good. But at the same time, opticians and optometrists are facing various challenges: for example, the change of professional duties, the large number of the aging population whose care must be ensured, and the use of new technologies. MAFO has talked to Gabriëlle Janssen, the new president of the European Council of Optometry and Optics (ECOO), about those hot topics, the education and competencies of eyecare professionals and the potential of artificial intelligence and screenings.

MAFO met the current ECOO President Gabriëlle Janssen one day before the official handover of office, on October 12 in Hamburg, as part of the ECOO’s autumn conference. Janssen herself studied optics and optometry and MBA Health in the ­Netherlands and she has been Chair of the Optometristen Vereniging Nederland (OVN). During her professional career, she has worked both as an optometrist and in project management, and it is this experience that will now guide the organization into the future. ECOO represents the interests of opticians and optometrists in Europe. Their members are national professional associations from 25 countries who together represent more than 200,000 opticians and optometrists.

How are you looking forward to your official inauguration?
I am very much looking forward to it. I was president of the Dutch association until one year ago and therefore I have had the time to prepare myself to be president for the European Council of Optometry and Optics. I think this kind of association is very important to improve eyecare and especially the working environment for optometrists and opticians.

What would you especially like to achieve as the president of the organization?
A lot of projects are running already and we will continue them, but it is my job to continue it in a proper way – and of course with a fantastic management and the other executives. We established for example the I-Screen project (editor´s note: A system established to detect and profile AMD with the help of AI) and for the next two years, we will develop the new Blue Book, a comprehensive data set which provides invaluable information about the professions across Europe. We decided that it’s a good time to republish it, because the WHO and the World Council of Optometry recently shared new data about eyecare professionals.

ECOO aims to ensure a good quality of vision care and eye health in Europe. In your opinion, how good is the provision of vision aids and medical care in comparison?
We are lucky that we live in Europe, as most people have access to eye care in Europe. If you compare the situation with the less developed countries then we are providing eye care of a high standard, but still, it can always be better. That is why we promote World Sight Day for example, and we have a focus on healthy eye care for children and healthy aging. For children, we try to make sure that parents are aware that their children have to have their eyes tested regularly and that they should not look at digital screens all day.

Where do you see potential for improvement?
In my opinion it´s good to have the highest standards of eyecare in primary eyecare and I think the multidisciplinary approach of looking at people who needs eye care can be better. For example, I’m from the Netherlands. We are now in the Netherlands looking for a way where optometrists will be part of the health care system where the eye examination will be paid by the health insurance, as we know that 25% of the patients can be sent from the ophthalmologist to the optometrists. I think also in many other European countries, this can be done better than what it is now. I think more recognition of our competences is an important part of this big question: how can we ensure that the large group of the ageing population is well cared for and that they continue to see well for the rest of their lives?

ECOO tries to ensure that training standards in Europe are as uniform as possible. For example, through the European ­Diploma in Optometry and the Qualification in Optics, what advantages does this bring?
The European Diploma in Optometry and the European Qualification in Optics establish a higher standard of eyecare. ECOO wants to promote the highest standards of training and skills consistently across Europe.
Another advantage is harmonization, so it’s easier for eyecare professionals to travel from one country to another to work.

And for the different European countries, it is a chance to evaluate their own standards, and accredited universities and schools can benchmark themselves easier to other countries. We see the success of this all over Europe as educational institutions design their degree programs based on the syllabi of the ECOO qualifications.

Until now only seven universities received the accreditation and only very few students have received the diploma so far. What good is a diploma that hardly anyone wants?
Basically, the European Diploma is set at the highest education level for optometry, and it is divided in several parts. One part of that is the portfolio of clinical experience. This is the most challenging part as it raises the question of how to bring the students to practical experience. This is something that is not established in many universities, especially in those without clinics as part of the usual course − but it is something universities are moving towards. Meaning when they redesign their course program, they take the syllabus of the European diploma into account more and more.

So, we are starting to change the landscape throughout Europe and the education towards harmonization – but not unification, just harmonization. This is the reason why we don´t have that many accredited schools and students yet but we have a lot of interest and a lot in the pipeline.

In Germany, for example, there exists the dual system in which opticians learn their profession at the local optician’s store and the vocational school. How does this system fit into the purely school-based education in other countries?
I’m familiar with that system, as it is similar in the Netherlands. But generally, ECOO is not looking at how the system works in different countries. It’s about competencies. It doesn’t matter for ECOO, if it’s like four days working in a practice and one day going to school or the other way around. In the end, we share the idea that it’s important to have the same competencies.

Are you satisfied with the education system in most ECOO countries or is there potential to develop?
I think every country has potential to develop because I think optometry and optics can do much more than it does now. We have a huge number of people getting older and we have developments in technical parts, so the kinds of treatments are expanding. More people can have treatment, for example, for macular degeneration. Therefore, you need also more eyecare professionals. It is too much work for only the ophthalmologists. In my opinion opticians and optometrists should be part of the whole chain of eyecare. To give eye exams, for prevention, but also to have early diagnosis of eye diseases. So, every country has its challenges.

AI could change the work of ECPs in the future and we can already see the potential of AI around screening. How do you personally feel about these changes?
For me personally, it’s quite exciting. I think it’s interesting to see this kind of development. As I said we have more people getting older and more treatment opportunities. I guess we can’t do it without AI. We can’t do it only with human resources. The most important thing is that we implement artificial intelligence without high false positive rates − and sometimes I´m worried about that. Because false positive rates mean the computer says there is something wrong when there is nothing wrong. Then people are waiting for a medical appointment and during this time they are very concerned − and then there is nothing wrong. And there’s also extra costs.

I think, most important is that we should implement artificial intelligence devices when it’s safe and that the professional can still interpret the results. For this reason, you will still need a professional.

And in case your next question is, will eye care be available in the supermarket tomorrow: I can say that I am sure optometrists and opticians are still highly important. We still need our profession because while low complex care can be handled with screening and artificial intelligence, we also have the high complex care. Those serious problems still need to be seen by an optometrist or optician and if the patient needs a treatment, then we send it to an ophthalmologist.

ECOO also deals with the topics of healthy aging, driving and vision, the Medical Device Regulation and sustainability. For which of these topics do you currently see the greatest need to tackle them?
They are all connected. If we look at healthy aging, driving, children and myopia. Often the first eye test is when kids are four. Adults are around 40 when they start having presbyopia. And then when they are even older, they can have cataract, macular degeneration, etc. A person’s whole life is about good vision. We are always there for them to have their eyes checked. For healthy aging, but also when you drive a car and more. All these projects are connected to each other.

Is there anything left, that you want to share?
That’s very personal. I’m worried about what’s going on in the world as we are closing the borders. It seems like we are afraid of each other and not happy as equals. But we, our profession, are one big family. We work together. We care. And that’s a different feeling than what’s happening in the world. And maybe it helps remind us that more people want to work to provide solutions so that people can live better lives.

Thank you very much for the interview and your thoughts