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October 11, 2010

Current Challenges of Ophthalmology in France

Arch Ophthalmol. 2010;128(10):1358-1359. doi:10.1001/archophthalmol.2010.216

To comprehend the current challenges that French ophthalmic care is facing, one has first to appreciate the system and the changes that have occurred over the years leading to the current situation. French ophthalmic care is organized differently from its British and American counterparts and resembles its European neighbors. It follows a basic principle of the French medical practice, which should guarantee a strict separation of medical care and prescription from commercial sales. Ophthalmologists and orthoptists provide care to a patient, on one hand. Pharmacists and opticians, on the other hand, enter commercial transactions with a client. The ophthalmologist is the center of the ophthalmic care, performing regular ophthalmic examination, prescribing glasses and contact lenses and supervising their tolerance, and performing ophthalmic surgery. The French ophthalmologist works closely in relation with orthoptists, who can provide additional examinations, such as visual field tests and strabismus or low-vision aid rehabilitation, and opticians, who provide glasses and contact lenses on medical prescription. French patients are free to choose their practitioner and the National Health Insurance, la Sécurité Sociale, covers about 70% to 80% of the ophthalmologists' and orthoptists' fees whereas fees for optics and even more for low-vision aid devices have never been well reimbursed and would be covered by optional private insurances. During recent years, optometrists have been trained through schools of optics and master's programs delivered by 2 scientific universities. However, their status is not well defined by the Health authorities, their potential fees for private consultations resulting in glasses prescription and delivery would not be covered by the National Health Insurance, and their role in the scheme of French eye care is a recurrent and often passionate matter of debate.

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