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The Saskatchewan College of Opticians (SCO) registers opticians in Saskatchewan. All registrants of SCO must meet competency based educational requirements and pass examinations related to dispensing. Registration also requires that opticians keep their knowledge and skills current through continuing competency.

SCO regulates the practice of ophthalmic dispensing and governs its members in accordance with Legislation, Regulations and Bylaws. In addition, it has among its objectives the development, establishment and maintenance of Standards of Practice to assure the quality of practice of the profession. In carrying out its objectives, it has a duty to serve and protect the public interest.

All opticians shall conduct themselves in a manner that is consistent with applicable Legislation and the Regulations, Bylaws and Standards of Practice of SCO.

Saskatchewan College of Opticians is required to:

1. Develop, establish and maintain programs and Standards of Practice to assure the quality of the practice of the profession of ophthalmic dispensing.
2. Develop, establish and maintain standards of knowledge and skills and programs to promote continuing competence among the members.
3. Develop, establish and maintain standards of professional ethics for its members.

Purpose and Scope of the SCO Standards

The Standards of Practice serve the following purpose:

1. To establish a standard of professional conduct, competence and proficiency to be maintained by opticians and governing the manner and the method of their Practice.

2. They provide SCO benchmarks against which it can determine a members’ conduct in the course of investigating complaints.

3. They provide the public with a clear understanding of the quality of care they should receive from an optician.

In their practice opticians do one or more of the following:

• Based on an optical prescription, design, supply, prepare, adjust and dispense optical appliances and prostheses, including corrective lenses,
• Promote eye health and the correct use of optical appliances and prostheses through education of consumers and regulated members,
• Conduct or collaborate in optical related research,
• When providing the professional services referred to in this section, conduct assessments and make referrals where appropriate, and
• Provide restricted activities as authorized by the Opticians Act.


Standard of Practice

PART I - Eyeglasses


General Principles

At least one licenced optician must be on the premises at all times when eyeglasses are being dispensed or adjusted. With permission of an optician, a non-licence may

• Hand the ophthalmic appliance to the patient as put aside by the licenced opticians and/or
• Mail the ophthalmic appliance on the instruction of the licenced person.


Responsibility

A registered optician employed by the dispensary will be held accountable for all eyeglasses dispensed or adjusted from that dispensary. Annual Certificate(s) for Registration must be prominently displayed for every optician in a dispensary.


Equipment

Each registered opticians 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 (but are not limited to) 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. distance and near visual acuity charts
10. tolerance charts; and
11. other such equipment and instruments as SCO indicates from time to time are necessary to maintain the standard of practice of the profession.
12. frame and lens cleaning products;


Record Keeping

Privacy - All opticians, as regulated health professionals, are responsible to ensure the patient’s rights of privacy according to the Health Information Protection Act (HIPA). It is the responsibility of all opticians to review and understand HIPA. A copy of this document is available through the office of the Saskatchewan Information and Privacy Commissioner.


File Contents - Each file must record the following information legibly.

• Patient’s name
• Date each transaction performed
• Name of dispenser
• Release of information to the patient or another practitioner
• Date, reason, who released to, authorization if any
• Name of prescriber and date last seen
• Any changes in Rx
• Patients optical prescription
• Duplication information if applicable
• Method and amount of payment including third party billings
• Lens type including index of refraction and brand
• Coating or treatments provided for lenses
• Safety features including special thickness given
• Financial transaction, including billing details.


PART II - Required Procedures for Fitting or Re-fitting of Glasses

Each optician must routinely:

Evaluate every optical prescription and advise patient of suitability of lenses and frames with the knowledge of occupational needs, hobbies and cosmetics. Part of the duty of an optician is to educate patient about eye health issues and in particular about the importance of an eye health examination. SCO has endorsed the guidelines laid out by the Canadian Ophthalmological Society as printed in the appendix to this Standard of Practice.

1. advise patient of the consequences of changes in their prescription with regard to expectations for new eyewear purchased;
2. analyze changes in prescription with regards to medical complications indicated;
3. ensure that the patients needs and expectations have been fulfilled with regard to safety aesthetics and price;
4. provide follow up care including adjustment and advice to make wear easier and maintenance more effective;
5. be able to recall or locate applicable information in detail on their patients eyeglasses and or contact lenses;
6. recognize anomalies in prescription and wearing success and to refer the patient to a medical practitioner or optometrist, if required;
7. Evaluate every pair of eyeglasses using tolerance charts approved by SCO before dispensing.



PART III - Contact Lenses

General Principles

Contact Lens Practitioner must be on the premises at all times when contact lenses are being dispensed or adjusted. Providing the fitting characteristics have been assessed, A Contact Lens Practitioner may put aside contact lenses, for pick up by the patient in his/her absence. Without permission of a Contact Lens Technician, no one shall dispense contact lenses.


Responsibility

A Contact Lens Practitioner will be held accountable for all contact lenses sold, dispensed or adjusted from the dispensary where they are employed. Annual Certificate for Registration must be prominently displayed for Contact Lens Practitioner in a dispensary.

A Contact Lens Practitioner will record the date of the prescription and discuss the validity of the prescription with the patient."

Subject to the provisions of Section 22 of the regulatory bylaws
A Contact Lens Practitioner will perform a detailed biomicroscopic examination of the cornea, conjunctiva tears film and adnexa.

Other tests may include but are not limited to:
• Corneal curvature readings
• Trial contact lens evaluation
• Eversion and inspection of upper and lower lid.
• Corneal thickness measurements
• Sequential corneal staining

When dispensing a contact lens, the Practitioner must verify the following:

1. Patient expectations have been met
2. Patient understands the necessity for and availability of follow-up care
3. Visual requirements have been met
4. Patient understands required maintenance for their contact lenses Patient has demonstrated a minimum level of competence in insertion and removal of contact lenses

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

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

1. keratometer/ophthalmometer;
2. slit lamp/biomicroscope;
3. lensometer;
4. Method of disinfecting tools, equipment and lenses.
5. Distance and near visual acuity charts.
6. appropriate, currently dated solutions for caring for lenses
7. currently dated starter kits for patients
8. diagnostic trial lenses
If fitting Rigid Contact lenses must also have:
9. radiuscope or equivalent;
10. loupe
11. sodium fluorescein

Record Keeping

The licenced Contact Lens Practitioner is the custodian of information collected for the contact lens fitting. Without permission of that Practitioner, no one shall access information from a contact lens file. As a modifier for the previous statement: A licenced optician may access information from a contact lens file to be used in the continued care of the patient in fitting and preparing eyeglasses only.

A licenced Contact Lens Practitioner may at their discretion grant permission to access a contact lens file to another Practitioner for the purpose of assisting in the dispensing by that Technician.

A contact lens file must have the following patient information:

1. patient history;
2. visual acuity;
3. keratometer / ophthalmometer readings;
4. observations from a slit lamp / biomicroscope evaluation including pathological or physiological anomalies;
5. base curve, diameter and Rx of contact lenses lens type, including manufacturer and colour
6. patient’s wearing expectations
7. solution instructions for lens disinfection
8. placement of bifocal/multifocal heights if applicable tear quality.
A contact lens file should have the following lens information:
9. HVID (horizontal visible iris diameter);
10. Pupil size, when necessary (in bright and dim light)
11. Fissure size
All findings must be documented and the suitability of the patient for contact lenses, including the type of lens recommended and its advantages and Disadvantages should be discussed with the patient.

Counselling the patient with respect to application, removal, care of the lenses,
Solutions, recommended wearing schedule, use and hygiene.

The effects of wearing the contact lenses should be monitored, and the following criteria met:

Minimal edema or fluorescein staining observable with a biomicroscope,

Minimal distortion of keratometer mires,

No significant corneal curvature changes,

The records must show the patient has been informed that it is their responsibility to see the contact lens practitioner frequently enough and over a long enough period of time so that the contact lens practitioner can be assured that the lenses are fitting correctly and ocular health has been maintained.

Disposal of Files

1. Upon retirement or closing of a practice, files still must be accessible to the patient for six years.
2. The SCO office must be notified as to where the files are being sent.
3. A Registrant who receives patient files must advise SCO that the files have been received
4. Only a registered Contact Lens Practitioner may receive contact lens files
5. Any registrant who receives patient files must advise those patients through an economical broadcast means, that their files have been received and a copy of proof maintained by the practitioner.
6. Destruction of files after a period of six years must be performed in a manner that will protect the privacy of the patient and in accordance with HIPA
7. (HIPA Act states that trustees must have a policy regarding retention and disposal of patient records. This is the compliance to that statement)

In verifying the physical properties of a contact lens, technicians must use the SCO approved Tolerance Chart for Contact lenses.



PART IV - Referrals

Contact Lens Technicians will recognize any limitations in their expertise or scope and therefore the need for referral. Referral to another suitable health professional will be given freely and in a timely manner.

If appropriate a referral should be accompanied by supporting documentation including assessments and specifics leading to the referral. Referral letters and the reply to the referral must become part of the patient record. Telephone referrals must be documented in the patient’s record. Transfer of information between optical offices and or practitioners must also be recorded in the patient’s record.


PART V - Duty to Inform Re: Eye Health Examinations

Part of the duty of a practitioner is to educate patients about eye health issues and in particular about the importance of regular eye health examination. Although SCO has endorsed the guidelines laid out by the Canadian Ophthalmological Society (as printed in appendix A) to this Standard of Practice, The contact lens Practitioner shall recommend an eye health examination be performed by an optometrist, ophthalmologist, or medical doctor every two years.


PART VI - Owning and Staffing a Dispensary

Ownership

The owner of an Optical Dispensary does not have to be a registered optician. SCO places no restrictions on ownership however the operation of the dispensary must conform to the following rules:

1. Only licenced personnel may perform the restricted activity of ophthalmic dispensing.
2. Licenced staff should carry a minimum of one  million dollars of errors and omissions insurance.
3. Only licenced opticians may sign insurance and third party contract forms.
4. Any person working in the dispensary that is trained and educated to be an optician must register as such.
5. No individual may use the title optician unless they are registered as an optician.

Amended February 22, 2012

Students

Student refers to any person employed in the optical field and registered and currently participating in an approved optical course. A registered optician or contact lens technician, optometrist or ophthalmologist may be a practicum supervisor.

It is the responsibility of the practicum supervisor to determine when a student is proficient enough to perform particular duties, i.e. frame adjustment. The practicum supervisor will be held accountable for all activities carried out by a student under their supervision.

Duties that must be performed by the licenced optician or may be performed by a student with on-site supervision and deemed by the practicum supervisor as competent to do so:

1. final selection of frame to hold prescription lenses;
2. measurements for the horizontal and vertical positioning of lenses in the selected frame;
3. adjustments of lens power to accommodate for vertex distance and focal length;
4. verification for accuracy of optical appliance before dispensing to the patient;
5. duplication of existing eyeglass lenses, telescopes or low vision aids;
6. frame manipulation to adjust the position of prescription lenses in front of the eye;
7. verification of subjective suitability of an optical appliance

Duties that must be performed by the licenced contact lens practitioner or may be performed by a contact lens student if directly supervised or deemed by the practicum supervisor as competent to do so with on site supervision.

1. history taking procedures;
2. measurement of keratometry mires for the purpose of fitting a contact lens;
3. assessment of tear quality and quantity;
4. corneal health assessment using a biomicroscope;
5. adjustments of lens power to accommodate for vertex distance, spherical equivalence, tear power or toric lens requirements;
6. verification for accuracy of optical appliance before dispensing to the patient;
7. Verification of subjective suitability of an appliance.

Supervised Activities for Unregulated Staff

1. Greet the patient and direct them to the appropriate section of dispensary for frame selection.
2. Offer aesthetic opinion on frame selection.

• the optician holds the responsibility to see that the frame selected is suitable for the lenses required.
• transfer information i.e. name, address and phone number, to chart to assist the optician. The optician holds the responsibility to see that the information is transferred correctly.

3. Book appointments for the optician; take care of cash transactions and package goods for patient.

• the optician holds the responsibility to be sure that follow up requirements are relayed to staff and patient.

4. Decorate and organize dispensary, clean frames, contact lenses and equipment.

• the optician holds the responsibility in assuring that all proper Infectious Disease Control methods of disinfection are being observed.


PART VII – Hygiene & Infection Control

Each dispensary must be sanitary, provide proper lighting facilities and mirrors.  The dispensary must provide the optician easy accessibility to hot and cold running water.

Cleaning and Disinfection Checklist

Opticianry Considerations What to Use Recommendations

Environmental Surfaces General Housekeeping

 Floors
 Sinks (in the dispensary  etc)
 Counter Tops
 Storage shelves and bins
 Cash register, telephones, computers
 Washrooms (public & staff)
 Private Counselling rooms
 Water filtration systems (for distilled water)
 Refrigerator
 Cleaning usually involves soap and water, detergents or enzymatic agents to physically remove soil, dust or foreign material
 Low level disinfection
 Quaternary Ammonium Compounds
 Iodophores
 3% Hydrogen peroxide
 Diluted Bleach
 Daily and when visibly soiled
 Clean high traffic areas more frequently ie: where patients drop off and pick up prescriptions an near the cash register
 Keep shelves and bins tidy and clean, dust free

Equipment / Tools Sanitation

 Adjustment & bench tools
 Lensometer
 Lens clock
 Frame heater
 P.D. Ruler
 Pupilometer and/or penlight
 Thickness callipers
 Vertex distometer

Cleaning usually involves soap, water, detergents or enzymatic agents to physically remove soil, dust or foreign material following use and prior to use if suspected contamination. Care must be taken to ensure residues from the cleaning process itself (eg: detergents, solvents, etc) are also removed from equipment
 

Infection Control - The Spaulding Classification

As an optician, it is your responsibility to provide safe and ethical care to the public in compliance with the standards of your profession.

There is a degree of risk to technicians, support staff and patients from cross-infection of systemic diseases (e.g. HIV, TB, tetanus, meningitis, syphilis, herpes simplex, hepatitis B and C, adenovirus and Chlamydia infection) via skin contact, blood, other body fluids and instruments. These concerns have led to increased awareness of the need to practice strict infection control in clinical work. HIV has been isolated in the tear film it is considered unlikely that this would lead to a risk of cross-infection between patient and technician. (See below)

Recommended Advice

Immunization – All technicians and support staff should be up to date with immunizations against infectious diseases e.g. tetanus, polio, hepatitis B and tuberculosis.

Barrier Techniques - All cuts and abrasions should be covered with waterproof sticking plasters. When there is a risk of infectious diseases, surgical gloves should be worn and discarded after each use.

Hand Washing

Every consulting room should have a sink and clinicians should thoroughly wash their hands between patients and after certain procedures as necessary. Hands should be dried with disposable paper towels or fresh cloth towels.
The most cost effective and the easiest way of preventing the transmission of infection is hand washing? This simple procedure reduces the incidence of health-care associated infections.


When Should My Hands Be Washed?

• When hands are visibly soiled
• Before fitting or adjusting a patient’s eyeglasses
• After fitting or adjusting a patient’s eyeglasses
• Before contact with a patient who wears contact lenses
• After contact with a patient who wears contact lenses
• Before handling any contact lens
• After handling a contact lens that has been in a patient’s eye
• Between contact with different patients if not just performed
• Before handling, preparing or eating food
• After handling money or other items that may be contaminated
• Immediately, if your skin is contaminated or and injury occurs
• After personal bodily functions, such as using the toilet or blowing one’s nose

Consideration is given in the medical profession to three levels of hand washing:

Social - Use of liquid or bar soap covers most needs.

Hygienic - Use of an antiseptic hand cleanser.
Indications: Before and after contact with any patient
                   After contact with contaminated articles
                   Before and after dealing with high risk patients

 Surgical scrub - Not normally required in dispensing/ophthalmic practice.

Proper Hand Washing Technique

The most important thing to remember is that in order to be effective, hand washing technique must be performed properly and thoroughly. No matter what agent is used, the essential components of proper hand washing are:
 
• wet your hands first;
• apply cleaner;
• Rub all aspects of your hands vigorously, including the palms and backs of your hands, thumbs, fingers, nails and wrists. This should be done for at minimum 10 seconds up to 20 seconds. Then rinse and dry your hands properly. It is best to turn off the tap with a paper towel after you dry.


Soaps, antimicrobial agent and extra hand washing can be hard on your hands. A very important aspect of infection control is skin integrity. In order to keep your skin healthy dry your hands well and use lotions as needed. Contact lens technicians must be careful to use appropriate lotions.


You may visit Clean Hands, Good Health for a video tutorial on hand washing:
http://www.ahsc.health.nb.ca/cleanhandsahsc/cleanhandsworkingahsc.html


Opticianry Considerations

Most of the routine procedures performed by optician are clean procedures, as opposed to sterile procedures. As such, most infection control processes involve cleaning, sanitization and low level disinfection


PART VIII - Safety

An optician must demonstrate safe working practices with regards to Chemical, electrical, fire, noise hazards and infection control procedures.

SCO recommends EVERY optician should have the ability to perform basic first aid.