By JoAnne Sommers

The contentious issue of interpupillary distance (PD) measurements is back in the news in British Columbia. The latest development is a May 26 decision by the Board of the College of Optometrists of B.C. to amend its policy respecting eyeglass prescriptions.

The provincial government deregulated ophthalmic dispensing in B.C. in May 2010 and one result was to require optometrists to measure a patient’s PD at the time of an eye health examination. The measurement had to be included as part of the prescription for corrective eyeglass lenses, where such a prescription is a reasonable outcome of the exam. Optometrists who do not dispense corrective lenses and those who are not affiliated or associated with someone who does, are not required to provide that measurement as part of the prescription.

The College amended its policy in response to a letter from the Ministry of Health by deleting a phrase which had allowed optometrists to charge separately for the service, with the agreement of the patient prior to the exam. From now on, optometrists must include any fee for this service in the fee for the eye health exam.

When it announced deregulation, the Ministry cited an October 2009 decision by the B.C. Court of Appeal, which found that Coastal Contacts, a B.C.-based online eyewear seller, was contravening existing regulations by dispensing contact lens refills without seeing a prescription. “These regulatory changes will address the court decision,” the Ministry said, in a news release.

At that time, the College advised the Ministry that the PD measurement is part of the dispensing function, not part of an eye health examination. And the Ministry said that the changes being implemented would not prohibit optometrists from charging a reasonable fee for the service of providing a PD measurement.

B.C. remains the only jurisdiction in North America that allows eyeglass and contact lens sales without verification of a prescription.

The Ministry raised the matter of PD measurements with the College this spring after receiving complaints of non-compliance with the Optometrists Regulation. In its letter to the College, the Ministry referred to allegations that some optometrists were “illegally charging fees in relation to PD measurements.” The letter also referenced, “documents… which appear to set out the business practices the optical retailer IRIS follows in relation to PD measurement, as well as the rationale for them,” based on IRIS’s interpretation of the Optometrists Regulation and the College policies. IRIS had been by advising all its patients of a separate fee for the PD measurement on its pre-exam questionnaire.

That practice and the statement in the College policy document suggesting that patients may be asked to agree to pay a separate fee for the PD measurement, “are inconsistent with and not supported by the relevant provisions of the Optometrists Regulation,” the letter said.

In his response to the letter, College Chair Dr. Dale Dergousoff said the organization’s jurisdiction is limited to regulating the activities of individual registrants, not businesses such as IRIS, and that it is not accountable for IRIS’s business practices.

Dr. Dergousoff added that the College, “would have been grateful for the opportunity to have prior consultation,” before the province deregulated ophthalmic dispensing, “as it represented a significant departure from the practice of optometry in this province and indeed continues to reflect a significant departure from the practice in all other Canadian and American jurisdictions.”

Nevertheless, the College decided to amend its policy, removing the phrase that allowed optometrists to charge separately for taking PD measurements if the patient agreed to it before the eye exam.

The decision was called, “very disappointing,” by IRIS officials. In a letter to its membership, Vice President Michael Chaiken said: “Although, we believe that neither the Ministry of Health nor the College has the legal right to force optometrists to act in this way… IRIS has decided to conform to the new College policy and focus all its attention on ongoing efforts to provide the best possible patient care and the highest quality eyewear to its customers.”

His letter added that IRIS would, “continue to examine all options relating to this decision as events evolve in British Columbia.”

Both the B.C. Association of Optometrists (BCAO), which has about 500 members, and the Canadian Association of Optometrists (CAO), which represents 517 optometrists across the province, criticized the Health Ministry’s position on the matter.

Dr. Gurpreet Leehka, chair of the BCAO’s external public relations committee, said he understood the College’s decision to amend its policy. “I think it was necessary for them to clarify the rules, given the government’s request.” However, he questioned the government’s handling of the issue.

“It is odd that the B.C. government is playing a role in what information goes on a prescription for glasses,” he said. “Putting just one measurement on a prescription can be confusing for the person who is ordering glasses, but the more information we give the consumer the greater the risk of errors. The matter should be left in the dispenser’s hands.

“I know of few other cases in the healthcare industry where government has lowered the standard of care to assist one company that’s known to provide products of inferior quality,” Dr. Leehka added, referring to Coastal Contacts. “Government should want to ensure that safety standards are being met. But allowing anyone to sell glasses without a license and requiring the PD measurement to be put on all prescriptions means a lower standard in eyewear dispensing.”

CAO Executive Director Glenn Campbell said the B.C. government is, “wrong and ill-informed by requiring the PD to be part of the eye examination process. PD measurements are dependent on the type of frames and lenses that make up the prescription glasses. A PD is only one required measurement for any lens beyond a single vision lens.”

Obtaining prescription eyewear online is in conflict with provincial regulations in every province except B.C., he added.

According to Campbell, the provincial legislation should be revisited. “If Internet companies want to dispense product, they should be governed by the same rules as everyone else,” he said.