Optometrists who leave the profession in Australia: 2011 to 2019

CLINICAL RELEVANCE

The number, demographics, registration status and geographic distribution of optometrists in Australia who do not renew their registration is reported.

BACKGROUND

The size of the optometry workforce in Australia is determined by the number of new entrants to the profession and the number of optometrists leaving it. Limited attention has been paid to the latter.

METHODS

A dataset obtained from the Australian Health Practitioner Registration Agency about registered optometrists during the period 1 January 2011 to 31 December 2019 was analysed. It included registrants' first year of registration, gender, year of birth (in five-year bands), optometry qualification; and annual collection of registration type and postcode of principal place of practice.

RESULTS

Data for 6,595 registrants were analysed. Over the study period, 626 optometrists left the register. When those leaving the register were examined by year of birth bands, two main groups emerged - optometrists aged in their fifties or older, and optometrists who were under forty years of age and disproportionately male. Registration type had a significant effect on whether a registrant left or remained on the register (p < 0.05). Those holding Non-practising Registration or Limited Registration were more likely to leave the register. Registrants with an optometry qualification from an overseas institution, including from New Zealand, were more likely to leave the register (p < 0.05). Optometrists whose registration was not endorsed were more likely to leave the register (p < 0.05). No significant difference was found when the geographic location of optometrists who left the register was compared with those who remained.

CONCLUSION

Optometrists who left the register fell into two main groups - late-career and early-career. An unanticipated finding was that younger optometrists who left the register were disproportionately male. What motivates optometrists in Australia to leave the register is worthy of future research.

Programmatically Localizing Diabetic Retinopathy Features in 45-Degree Retinal Photographs Using Anatomical Colocation

Background: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. Methods: This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen-Dice coefficients were calculated to compare the location of different features. Results: Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. Conclusions: Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening.

Effects of tracker location on the accuracy and precision of the Gazepoint GP3 HD for spectacle wearers

Remote view eye-tracking systems are prone to errors when used on spectacle wearers due to reflections from the lenses and frame that result in inaccurate tracking. Traditionally, these trackers are situated below a computer monitor and the viewer's eye moments are recorded while they view the screen. Reflections may be influenced by the pantoscopic tilt of the spectacles, whereby the tilt angle causes incident light to be reflected to the camera. To overcome this problem, we propose mounting the tracker above the monitor to avoid these reflections and test the accuracy and precision of subjects with single vision spectacles, multifocals, and no correction, using both mounting positions. Experimental results showed that this alternate position had overall worse accuracy (4.06° ± 0.13) and precision (0.67° ± 0.05) compared to the standard configuration (2.15° ± 0.06 vs. 0.50° ± 0.03), with more invalid readings (5.91 vs. 19.19%) for single vision lens wearers. Multifocals performed better for the top-mounting position for the top portion of the monitor, suggesting higher-order aberrations from the bottom portion of the lens negatively impact data quality. Higher pantoscopic tilt angles displayed an improved accuracy for this alternate position (r(9) = - 0.69, p = 0.02), with superior accuracy for tilt angles greater than 14° compared to the standard configuration. This study quantifies the impact of spectacle wear on eye-tracking performance and suggests other alternate mounting positions may be viable in certain situations.

Demographics and distribution of the optometry profession in Australia: 2011 to 2019

CLINICAL RELEVANCE

An assessment of the total number, demographics and geographic distribution of optometrists in Australia may inform policy to address the maldistribution of the workforce.

BACKGROUND

Concerns have been expressed about the growth of the optometry workforce in the context of, in the last decade, the establishment of four new optometry programs in addition to the three long-standing programs.

METHODS

This paper analysed data obtained from the Australian Health Practitioner Regulation Agency about registered optometrists during the period 1 January 2012 to 31 December 2019. The de-identified dataset included information about registered optometrists in Australia: their first year of registration, gender, year of birth (in five-year bands), optometry qualification, registration type including endorsement for therapeutic practice and the postcode of the principal place of practice.

RESULTS

Data for 6,596 registrants were obtained over the study period during which the number of female optometrists increased significantly. The age profile of the profession shifted, with younger age bands becoming a significantly greater proportion of the profession. The majority of the profession comprised optometrists with a qualification from one of the three long-standing Australian optometry programs. Graduates of those programs accounted for 75.1% of registered optometrists in 2019, while 14.3% held a qualification from an overseas institution. The proportion of optometrists practising in major Australian cities was greater than the proportion of the population in those locations. A concomitant low proportion of optometrists, relative to population size, was found in regional and remote areas.

CONCLUSION

Optometrists practising in Australia can be generalised as mostly female graduates of one of the three long-standing optometry programs holding general registration with a therapeutic endorsement, and with a principal place of practice located in a major Australian city. A significant maldistribution of the workforce was found that did not change significantly during the study period.

A guide to optometrists for appraising and using artificial intelligence in clinical practice

Artificial intelligence systems are becoming increasingly available as diagnostic aids for optometric practice. These perform well but are often 'black-box' systems offering little or no insight into how a decision was reached. While there is potential for artificial intelligence to improve patient outcomes, clinicians without training in computer science may find it difficult to ascertain whether these technologies are suitable for their practice, or how they should be used. This review provides an overview of how artificial intelligence systems work in optometry, their strengths, weaknesses, and regulatory considerations. A checklist is provided for appraising a system, covering regulatory approvals, ascertaining what the system can and cannot do, how it can be used in practice, whether it is suitable for the clinical population, and whether the outputs can be explained. Artificial intelligence has the potential to improve accuracy and efficiency in many areas of optometry if used correctly, and should be embraced by clinicians as an assistive tool.

Demographics and distribution of new entrants to the optometry profession in Australia

CLINICAL RELEVANCE

An assessment of the total number, demographics and geographic distribution of new entrants to the optometry profession in Australia can assist planning for workforce requirements.

BACKGROUND

Over the past decade, the number of registered optometrists in Australia has increased by 30.1 per cent, a rate that is greater than the population growth of the country (12.1 per cent). Concerns have been expressed about the size of the optometry workforce in a context of increasing numbers of graduating optometrists. This paper analyses data obtained from the Australian Health Practitioner Regulation Agency (AHPRA) about new entrants to the profession and their initial practice location during the period 1 July 2010 to 30 June 2018.

METHODS

A de-identified dataset was obtained from AHPRA that revealed the following characteristics of new entrants: qualification, gender, year of birth (in five-year bands), registration type, registration endorsement and principal place of practice including its Remoteness Area classification.

RESULTS

Data for 1,680 entrants were eligible for analysis; 80 per cent graduated from an Australian university, 12 per cent graduated from the optometry program in New Zealand, and seven per cent were graduates of an overseas university. The remaining two per cent registered via the Trans-Tasman Mutual Recognition Agreement, although the dataset did not include the qualification. The United Kingdom and Republic of Ireland provided the majority of overseas entrants (60 per cent). Most (75 per cent) entrants commenced practice in a major Australian city. Graduates of Australian universities tended to commence practice in the state in which they trained or an adjacent state or territory. Juxtaposed on the data outlined above is the high proportion (42 per cent) of overseas-trained optometrists commencing practice in Western Australia.

CONCLUSION

Coincident with the newer optometry programs producing graduates is the increased number of optometrists entering the Australian workforce over the past decade, with the majority commencing practice in major cities. Australia-trained optometrists tend to commence practice in the state where their training was undertaken. New entrants to the optometry profession can be generalised as graduates of an Australian optometry program, female, aged in their early-mid 20s and qualified for therapeutic practice.