- position papers and guidance for professionals and patients
- policy papers and responses.
Our Environmental Sustainability Hub and our COVID Information Hub each contain a variety of resources for eye care professionals.
Our Blue Book contains extensive information on the professions of optometry and optics in countries across Europe.
Position papers and guidance
Position papers and guidance for professionals and patients.
Environmental sustainability guidance (01/2023)
This guidance provides an introduction to the issue of environmental sustainability and how it relates to eye care. It makes some suggestions for the steps that national associations can take and the information they could provide for their members. It also provides links to further information for eye care professionals and optical businesses. This guidance can itself also be adapted for use by national associations. You can access the guidance here.
Myopia management: a comprehensive approach (01/2023)
This paper follows on from our earlier Position Paper, Myopia in the 21st Century and its Management by Eye Care Professionals. This new Position Paper considers the World Council of Optometry 2021 resolution on myopia management standard of care, considering three main components: measurement, management, and mitigation. It makes recommendations with respect to each.
This paper was developed and written by José Manuel González-Meijome, Chair of the European Academy of Optometry and Optics’s Education Committee, with input from Martin O’Brien of ECOO’s Professional Services Committee.
This paper includes minor updates to a version originally published in October 2022
Download the position paper here: Myopia management: a comprehensive approach
Better vision and eye health in Europe through digital development (10/2022)
This Joint statement by ECOO’s Public Affairs and Economic Committee and the Professional Services Committee considers the role that technology is increasingly playing in the delivery of health care. It explores some of the ways in which it is already used in eye care and highlights the importance of opticians and optometrists being able to both follow and contribute to the rapid development that comes.
Read the joint statement here: Better vision and eye health in Europe through digital development
Myopia in the 21st Century & its management by ECPs (05/2021)
Commonly known as short-sightedness, people with Myopia experience blurred distance vision. This is due to fractive error caused by excessive growth of the eye (axial length). Therefore, myopic individuals require optical correction to experience clear vision. Worldwide, Myopia is one of the leading causes of preventable blindness and vision impairment in the working age population.
The prevalence of Myopia is increasing worldwide, including in Europe, where both the prevalence and magnitude (increased refractive error) of Myopia continue to increase at a substantial rate. By 2050, it has been estimated 1 in every 2 people may be myopic, with the prevalence significantly higher in younger generations.
The purpose of this Position Paper is to provide information, to Eye Care Professionals (ECPs), policy makers, parents and other health professionals, regarding guidance relating to Myopia & Myopia Management (Control) that will be of benefit to parents of children with Myopia.
Download the position paper here: Myopia in the 21st Century & its management by ECPs
Contact lens safety (06/2020)
There are approximately 120 million contact lens wearers globally; with around 40 million in USA and 25 million in Europe. Therefore, contact lenses are a high volume, widely used device.
With professional advice, contact lenses can be used at any age, from newborns to the elderly. Contact lenses can be fitted for many eye and vision conditions as an alternative to eyeglasses/spectacles or refractive surgery. There are some eye conditions, for example keratoconus, where contact lenses provide superior vision correction and where they may be the only useful option.
In a new paper, ECOO offers guidance to wearers and professionals on how to ensure contact lens safety, including advice on correct management and regular eye checks and what to pay attention to with online purchase of contact lenses.
Download the position paper here: Contact lenses are safe: don’t misuse them
How opticians and optometrists can help prevent falls in older patients (01/2020)
At least a third of people over the age of 65 years report falling at least once per year, with about half of these people reporting multiple falls. While falls in older people are multifactorial, there is clear evidence that they are associated with well-defined intrinsic and/or extrinsic factors, some of which can be minimised through targeted inventions to reduce the risk of falls.
New ECOO guidance, kindly drafted by Professor David B Elliott, University of Bradford, UK; Professor Joanne Wood and Dr. Alex Black, Queensland University of Technology, Brisbane, Australia, provide recommendations for Optometrists and Opticians regarding how to best manage their older patients to minimise the risk of falls.
Download the guidelines here: How opticians and optometrists can help prevent falls in older patients.
Digital imaging – an optometry perspective (06/2019)
Eye care professionals increasingly use new instruments that enable them to examine both the internal and external eye, like Digital Fundus Photography, Ocular Coherence Tomography (OCT) and Corneal Topography. In this context, there has been a debate among professionals about how digital imaging can be correctly used as part of the patient record. ECOO’s position paper on digital imaging presents the optometry perspective on this topic.
Diabetic Eye Disease Toolkit (03/2019)
As part of the Retina Action Initiative, a “global initiative for a lifetime of vision”, ECOO contributed to the development of an educational Toolkit on Diabetic Eye Disease (DED).
ECOO ensured that a section on “The Role of the Optometrist in Diabetes and Diabetic Eye Disease Management” was added, which highlights that optometrists are in the unique position to educate and counsel patients with diabetes and pre-diabetes. This section also notes that optometrists have come to play a key role in educating and encouraging people to make lifestyle changes, which helps to prevent retinopathy and reduces the need for people to visit a retina specialist. In this regard, optometrist should take a few extra minutes to provide clear and concise patient education, make patients aware of the need for timely eye care to reduce the risks of vision loss, and inform people of the importance of controlling systemic risk factors for the development and progression of DR and vision loss.
Download the Toolkit here: Diabetic Eye Diseases Toolkit
ECOO guidance documents on good online practices for professionals and consumers and patients (06/2018)
In the wake of the growing online presence of optical and optometric services and the advancing European Digital Single Market, ECOO developed guidance documents to establish common principles and reduce uncertainties around professional practice and consumer and patient safety in the online world.
The guidance document for professionals outlines key principles of good practice when it comes to the provision of online services and e-commerce activities. Touching upon issues of integrity, privacy and data access, communication with patients, and awareness of regulatory frameworks, the main aim of the guidance is to ensure that the online engagement of professionals is driven by needs and benefits of consumers and patients.
The guidance document for consumers and patients focuses on empowering people that seek professional advice by promoting safe and informed online behaviour. The key principles outlined in the guidance document pertain to ensuring that consumers and patients are aware of their rights, both online and offline, and to ensuring that they adopt a careful approach towards the websites and applications they use.
Ready Readers (07/2015)
Ready readers or “ready-made reading spectacles” are spectacles that have 2 single vision lenses each of which have the same positive spherical power not exceeding 4 dioptres and the purpose of which is to relieve the condition known as presbyopia.
Presbyopia is the term used to describe the requirement for help with near vision tasks caused by natural ageing of the eye; defined as “a refractive condition in which the accommodative ability of the eye is insufficient for near work, due to ageing”. The symptoms of which normally start when people reach the age of their mid-forties and onwards (Millodot M. Dictionary of Optometry and Visual Science, 7th ed. Edinburgh: Elsevier; 2009).
These “ready-readers” are widely available across Europe can be bought without prescription from a variety of outlets, without professional advice or supervision. They are designed to be used for near vision tasks only and should not be used for driving or any other distance vision activities (e.g., watching TV) under any circumstances.
Visual standards for driving in Europe (01/2017)
Driving a vehicle is a key means by which individuals maintain independence and mobility. There are over 440 million people who hold a driving licence in Europe (60% of the European population).
A new consensus report prepared by ECOO looks into the visual standards for driving in Europe and highlights the implications for eye health and road safety. It summarises national systems and demonstrates that there is continuing discrepancy in visual standards for driving across member states.
It concludes that policymakers have a responsibility to provide a framework or legislation to enable safe driving conditions for both drivers and other citizens. Eye care clinicians need to be able to counsel patients about the visual criteria for driving, and correct and maximise vision for driving.
Its main conclusions are that there is a need to:
- Advocate for the requirement of assessment of visual standards upon renewal of driving licence in Medical Annex of the EC directive
- Standardise the visual acuity assessment method to ensure consistency in application of visual standards for driving.
- Engage with member states to recognise that the licence plate test is not a measure of visual acuity
- Ensure assessment is carried out by an eye care professional
- Promote effective assessment of vision, visual fields, contrast sensitivity and twilight vision, clarify what such tests comprises to avoid discrepancy across member states
- Encourage more research in effective assessment tools for measurement of visual functions.
- Advocate for increased public awareness of fitness to drive.
Download the paper here.
The Orthokeratology Procedure (07/2014)
Orthokeratology is fitting custom designed, high oxygen-permeable contact lenses to reshape the cornea in a controlled manner to correct ametropia. Orthokeratology lenses are worn at night whilst sleeping and are taken out in the morning.
Depending on the extent of the ametropia, and the time that Orthokeratology lenses are worn, good visual acuity can be achieved during all waking hours without the need for spectacles or contact lenses.
‘Best practice’ for the selling of Contact Lenses and Lens Care Products (01/2014)
The importance of new distribution channels (namely the Internet) for contact lenses (CLs) and lens care products (LCPs) increases continuously.
The European Contact Lens Forum (ECLF), which ECOO is a member of, has provided a ‘Best Practice’ document as guidance for all those engaged in the selling of contact lenses.
Following and / or implementing these practices will result in good client services being provided to the customers. It also points out the need for professional care when wearing contact lenses.
ECOO Guidelines for optometric and optical services in Europe (07/2013)
ECOO has developed guidelines for optometric and optical services in Europe to establish consistent guidance on the quality of service provision that the public should expect when accessing eye care services.
The Guidelines, to which a number of ECOO representatives from across several countries have contributed, set out the expected quality of eye care service provision in Europe for the general public. It offers a comprehensive overview of the aspects that quality optometric and optical services entail as well as clear explanations to provide guidance to professionals across Europe.
Certain aspects of optometric and optical eye care service delivery may be encompassed by national regulations and existing national standards, and it is recognised that the guidelines may not reflect national legislative requirements in member countries. However, while national regulations will take precedence over any guidance, the guidelines should provide direction regarding the quality of service provision for eye care services. They also complement the World Council of Optometry statement on a global model for optometry.
View the ECOO Guidelines for optometric and optical services in Europe
Paediatric Eye Care (03/2011)
The context in which eye care for children is available and the personnel providing that care varies across European countries. In some countries paediatric eye care is exclusively provided by ophthalmologists, in others by physicians or other health care professionals, and in others again care is predominantly provided by primary care optometrists who refer on to specialized colleagues, hospital-based optometry, orthoptic and ophthalmology colleagues as appropriate.
The principal reason for providing eye examinations for young children is to identify those whose visual development is not following normal patterns, those who require spectacle correction, or who have, or are at risk of, developing amblyopia or strabismus. Whilst it is important to detect pathology and other, less common visual deficits or anomalies, the most common visual deficits accessible to treatment or amelioration are amblyopia, strabismus and uncorrected refractive error.
It has been estimated that children obtain about 80% of their information about the world through the sense of vision. For successful learning it is therefore essential that every child achieves the best vision of which he/she is capable. In Europe about 6% of typical children starting school will have visual deficits and amongst children with special needs, the figure may be ten times higher. There is growing evidence of the detrimental impact on educational achievement of uncorrected refractive errors, including hypermetropia.
Low Vision (03/2011)
Low vision describes a visual impairment that restricts the ability to perform visual tasks in everyday life. This handicap cannot be corrected by ordinary glasses, contact lenses or medical intervention. Obvious types of visual impairment are the loss of visual acuity and the loss of visual field. Other examples include loss of contrast sensitivity, abnormalities in colour vision and night vision, as well as an increased sensitivity to light (such as disability glare or photophobia).
Raising the Standard of Primary Eye Exams in Europe (02/2010)
This paper describes the procedures required to perform a comprehensive optometric eye examination. It does not, however, require all the listed procedures to be performed and additional procedures may be indicated in some cases. Each eye examination should be conducted according to the patient’s clinical condition and according to the professional judgement of the practitioner performing the eye examination.
Dependent upon the patient’s symptoms and condition, it is the optometrist’s responsibility to select the appropriate variety and sequence of tests that will best enable a safe and efficient examination. In some European countries legislation may prevent optometrists from undertaking all of these tests. In these cases, optometrists are required to refer the patient for further investigation and possible treatment to a medical doctor, for example, an ophthalmologist.
UV labelling for spectacles and contact lenses (09/2009)
ECOO position paper on ocular ultra-violet radiation. The human eye is exposed to toxic Ultraviolet Radiation (UVR) from natural sunlight and man made artificial sources. UVR induced damage and related diseases can occur in a number of tissues within the eye, ranging from the corneal surface to the retina (Bergmanson and Söderberg 1995).
Contact Lenses (05/2008)
In this paper ECOO sets out its concerns about the unregulated sale of contact lenses by non-qualified sellers and from the internet, especially those with a plano prescription for cosmetic use. The reasons for these concerns relate to the risk potential, which may be sight threatening, that can arise with wear of any form of contact lens if patient compliance is lacking or professional management is inadequate.
Policy papers and consultation responses
Policy papers and consultation responses to legislative proposals.
ECOO, GCOA and IAPB call for eye health to be included in the European Care Strategy (03/2022)
The three organisations submitted input to an EU call for evidence to underline the importance for vision and eye health to be included in the European Commission Communication on a European Care Strategy and in its proposal for a Council Recommendation on long-term care.
ECOO, GCOA and IAPB call on European Commission to include vision in its ageing initiatives and policies (04/2021)
The three organisations submitted a joint letter to Vice-President for Democracy and Demography Dubravka Šuica explaining that good eyesight plays a critical part in active ageing.
EssilorLuxottica acquisition of GrandVision (03/2021)
ECOO responds to the European Commission conditions for the proposed merger arguing that they are not far reaching enough.
ECOO Manifesto for the 2019 European Parliament elections (04/2019)
Healthy eyes and good vision are paramount for independent and active living, at all ages. Yet, the role of vision on the wider policy agenda, from access to primary healthcare to road safety and healthy ageing, at both the national and the EU level, remains limited.
ECOO therefore launched a manifesto for the 2019-2024 mandate of the European Parliament and the European Commission, outlining 5 recommendations for promoting eye health and harmonising clinical and educational standards of optometric and optical practice across Europe.
Read the full manifesto here.
Proposed Proportionality Test Directive (08/2017)
ECOO argues that the proposed Proportionality Test Directive should respect national sovereignty and ensure consistency in healthcare exemptions and outlines several recommendations for the EU institutions to consider in their deliberations.
Visual standards for driving in Europe (01/2017)
A new report prepared by ECOO looks into visual standards for driving in Europe and highlights the implications for eye health and road safety.
- Download the paper here.
ECOO Response to European Commission Consultation on the Definition of Primary Care (05/2014)
ECOO makes the case that the definition of primary care should be amended to include the fact that primary care is the first point of contact with a health care professional for the public.
Report on Driver Vision Screening in Europe (01/2014)
The EU committed to halving road death across the EU by 2020. The goal was to achieve this by legislative means that change driver behaviour, raise the technical standards of vehicles and improve road design. The visual requirements to drive safely in the Driving Licence Directive 2009/113/EC are currently being implemented by EU Members States.
The report on Driver Vision Screening in Europe highlights substantial variation in the assessment of drivers’ vision across Europe and recommends that the European Commission should act to harmonise assessment in EU Member States to the standards in the best performing countries.
The report was jointly developed by ECOO and the European Federation of Optical Lenses, Frames and Instrument Manufacturers (EUROM I) and the European Federation of Contact Lens Manufacturers (EUROMCONTACT).
Download the Report on Driver Vision Screening in Europe (June 2011) (PDF)
Comparative health economic study on the delivery of primary eye care in Germany, France and the UK (01/2014)
In 2011, ECOO commissioned a comparative health economic study on the delivery of primary eye care in Germany, France and the UK, led by Professor Wasem of the University of Duisburg-Essen.
The study’s results relating to the health-economy show that:
- a model based entirely on optometrists – such as in the United Kingdom – where optometrists are the primary eye care providers, is just as safe as a model based entirely on ophthalmologists – such as in France – where ophthalmologists are the primary eye care providers.
- in a country such as Germany, where optometrists and ophthalmologists currently share responsibilities, the provision of eye care would have collapsed if optometrists had not already taken on essential tasks in this area. This relates to the fact that currently in Germany around 73% of all visual aid prescriptions and around 67% of all primary care for contact lenses are carried out by optometrists.
- the clinical and academic training of an optometrist is considerably more cost-efficient than that of an ophthalmologist, since costs are up to two thirds lower.
- demographic change owing to an aging population is fundamentally leading to an increase in age-related eye conditions, which must be recognised and treated early; for “age-related macular degeneration (AMD)” alone, the authors of the study suggest an increase in Germany from 875,000 cases in 2007 to 1,769,000 by 2050; this in turn causes a need for more primary eye care providers in the future.
- a country such as France, where ophthalmologists have almost exclusive responsibility in this area, needs to see a clear increase in the number of primary eye care providers in the future owing to demographic changes and a decreasing number of ophthalmologists.
Download the Study (PDF)
Driving and Vision (11/2010)
ECOO believes that member states should use the opportunity presented by their implementation of the latest EU directives on driving licences to scrap the so called ‘number/licence plate test’ of drivers’ vision (and any other unscientific assessments of drivers’ vision) and replace it with an appropriate Snellen-based assessment, similar to that used in Finland, Germany and Ireland.
This assessment should be completed by all applicants for a provisional driving licence to ensure that their vision is adequate to learn to drive. Moreover, since drivers cannot be expected to assess their vision against the detailed and technical standards of the directives as their vision changes over time, ECOO recommends that Group 1 drivers should undergo a screening of their vision when renewing their licence in accordance with the EU directive, including an assessment of their visual fields.
Response to the Public Consultation on Driver Training and Traffic Safety Education (06/2009)
The European trade associations active in the optical field responded to the public consultation on driver training and traffic safety education. We hope that its outcome will result in concrete actions to improve the road safety in Europe by implementing measures that improve not just competence and experience in driving, but also physical fitness to drive, including good visual acuity. From both statistical and intuitive perspectives, eyesight has an enormous impact on driver safety.