Conflict between ophthalmologists and optometrists over powers

A strong opposition between doctors and optometrists is shaking up Bulgaria's healthcare system. At the heart of the conflict is a public debate about the powers of optometrists, which has intensified following the publication of a draft ordinance by the Ministry of Health that aims to approve a new standard for “Ophthalmology.” Against this backdrop, the Bulgarian Medical Association (BMA) has taken a firm stand, insisting on a strict distinction between medical responsibilities.

According to the official position of the BMA, published on its website, optometrists do not have the right to independently perform clinical examinations, diagnose, correct vision, or provide treatment. These are medical activities that require in-depth training. The medical association emphasizes that these complex procedures can only be performed by specialists with a university medical education and specialization in ophthalmology—qualifications that only ophthalmologists possess.

In its position, the BMA cites specific provisions of the draft ordinance that provoked a strong reaction. The draft explicitly states that "Masters in the specialty of “optometry” cannot independently determine refraction and independently prescribe glasses to patients." Their role is limited to performing instrumental examinations within medical facilities, while the diagnosis and treatment remain the exclusive responsibility of “Ophthalmology” specialists.

Earlier, the Bulgarian Union of Optometrists publicly called for a change to the Health Act. Their request is prompted by an existing regulation that restricts the prescription of glasses in optician shops to ophthalmologists and residents only, which optometrists consider an unfair restriction.

The BMA categorically rejects this argument, insisting that the in-depth, long-term training of ophthalmologists is irreplaceable. It consists of a minimum of six years of general medical education, followed by a specialization in ophthalmology. Only such comprehensive training provides the necessary knowledge and competencies to assume full responsibility for the patient's health and vision.

Despite the tension, the BMA recognizes the important role of optometrists. They define them as valuable specialists who support the work of ophthalmologists. According to the medical association, optometrists can perform activities related to the correction of visual defects and certain specialized examinations. The key condition, however, is that this must happen under the direct guidance and supervision of an ophthalmologist, with the interpretation of the results necessarily being carried out by a doctor.

In its position, the BMA emphasizes the need for the public to be informed that prescribing glasses or vision correction is not equivalent to a comprehensive eye examination. The latter includes complex examinations that can detect serious eye diseases, which often occur without symptoms. In this process, the ophthalmologist's irreplaceable role is to bear responsibility for the diagnosis, treatment, and follow-up of the therapy.

In conclusion, the BMA emphasizes that ophthalmologists, optometrists, and opticians have been successfully collaborating for more than 20 years. The professional association adds that this partnership is of extreme importance and should be developed, but only under the conditions of clearly distinguished responsibilities to ensure the health and safety of patients.