CONTACT LENS PRACTITIONERS BILL

Order for Second Reading read. 3.25 pm

The Senior Minister of State for Health (Dr Aline K. Wong): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

My Ministry had announced in a press statement in February 1990 that we intend to introduce legislation to control the practice of contact lens in Singapore by 1995.

This was prompted by a number of reports of eye injuries and infections from the improper use of contact lens. A survey conducted by my Ministry in 1988 had revealed 320 cases of eye complications from contact lens, 23 of which were corneal ulcers which could have led to blindness if they had not been diagnosed and treated early.

Another survey in 1992 showed that out of 194 cases of contact lens related complications seen within a 6-month period at the Singapore National Eye Centre, six cases required hospitalisation for complications including corneal ulcers, corneal abscesses and corneal abrasions. The Eye Clinic at the Tan Tock Seng Hospital also reported three cases of corneal abscesses from contact lens use in the same year.

However, my Ministry realised that at that time the number of qualified contact lens practitioners and optometrists in Singapore was not sufficiently large to meet the demands of the large number of contact lens users (estimated at 150,000 to 200,000) and that immediate legislation could cause hardship to the existing practitioners and inconveniences to the public. So my Ministry embarked on a step-by-step approach to address this problem. I shall now outline the steps that we have taken since then.

Part-time Certificate Courses

Firstly, my Ministry arranged with the Singapore Polytechnic for the Polytechnic to offer a special 2-year part-time certificate course on contact lens practice (CCLP) to upgrade the existing practitioners. This course was started in 1990 and attracted a total of 303 applications from 278 optical shops. Of these, about 180 candidates met the entrance requirements and were accepted into the course in batches from 1990 onwards. The CCLP course has since produced 133 qualified contact lens practitioners. A final batch of about 20 will obtain their certificates this year. In addition, another group of 20 private students had also passed the examination at the Singapore Polytechnic. So the total number of existing practitioners who have benefitted from the programme is about 170. Besides these, there are also at present about 70 existing qualified optometrists in Singapore who have the necessary training to practise contact lens. Altogether, these 240 or so qualified persons would form the core of qualified persons who can carry out contact lens practice under the proposed legislation.

Diploma in Optometry

As a follow-up to this upgrading certificate course, my Ministry had also arranged with the Singapore Polytechnic to start an optometry diploma course at the Singapore Polytechnic to meet the future requirements of optometrists and contact lens practitioners. This 3-year full-time diploma course has formalised the optometric education in Singapore with yearly intakes of about 40 students who have good "O" level qualifications. The first batch for this diploma course was enroled in 1994 and is expected to graduate in 1997. With this course, we can expect to have a steady supply of about 40 qualified optometrists and contact lens practitioners each year from 1997 onwards. Other Safety Measures

As a third measure, we have been promoting patient vision care through the Singapore National Eye Centre and other departments under my Ministry. After we started the contact lens upgrading course in 1990, we have worked with the Registry of Companies and Businesses to prevent unqualified persons from setting up new contact lens practices. Regulations under the Medicines Act have also been introduced to control the quality and sterility of contact lens solutions sold in Singapore. In addition, my Ministry has worked with SISIR to come up with a Singapore Standard on Contact Lens to set quality specifications for contact lens.

With these programmes in place, the time is now right for legislation to control contact lens practice in Singapore. This Bill is specifically drafted to meet this objective.

Sir, I must stress at this point that this new legislation is not intended to control the dispensing and fitting of spectacles. Existing opticians who are not qualified to deal with or fit contact lens will still be allowed to continue their business in the fitting and selling of spectacles. This is because spectacles do not come into direct contact with the eyes and do not pose the same level of hazard as contact lenses. So, optical shops that deal only with spectacles need not fear that this new legislation may jeopardise their livelihood. Those who also deal with contact lenses will, however, have to ensure that they have qualified contact lens practitioners to continue to provide this service.

Scope of Control

In considering the scope of this control, my Ministry has received feedback and submissions from various optical and optometric bodies. We have met with representatives of the Singapore Optometric Association, Singapore Contact Lens Society and Singapore Society of Optometrists. We have sought their views, as well as those of ophthalmologists, academicians and so on, on various aspects of the proposed legislation. From these discussions, it was clear that while there is general support for the legislation, there are some who advocate a comprehensive control of all opticians, contact lens practitioners, as well as optometrists. There are also others who are apprehensive of the extent of control and have asked for special exemptions and a "grandfather's clause" to allow existing opticians to continue their practice in contact lens without having to pass examinations or attend the Singapore Polytechnic's certificate course. My Ministry has considered all these proposals very carefully in drafting the Bill. However, after thorough consideration, we have come to the conclusion that these additional proposals cannot be accepted. I will now explain the reasons.

First of all, to extend the control to cover all opticians and optometrists will be outside the scope of this programme, which is to prevent the danger of injuries posed by the improper use of contact lens. As I have explained earlier, spectacles do not come into direct contact with the eyes and do not pose the same dangers as contact lens to the eyes. It is not the intention of my Ministry to legislate all activities and services that are related to health unless there is clear evidence of hazard, abuse or misuse. Otherwise, we will raise the costs to the public unnecessarily. There is at present no compelling reason to register opticians who do not deal in contact lens.

Grandfather's Clause

As to the request for a "grandfather's clause", this would be defeating the purpose of the Singapore Polytechnic's upgrading certificate course, and would be manifestly unfair to all those who have undergone this course since 1990. It would also defeat the purpose of the Bill which seeks to ensure competence in contact lens practice for the safety of the public.

Optometry Diploma Course

Sir, the adequacy of the Singapore Polytechnic's Optometry Diploma Course has also been criticised by some who advocate a University degree course in optometry. I would like to reiterate that the Singapore Polytechnic's Diploma in Optometry is recognised by my Ministry as adequate training for optometry in Singapore, and is also acceptable under the proposed Bill for contact lens practice.

University Degree

The question of setting up a University course in optometry in Singapore has been repeatedly raised by the Singapore Optometric Association and the Singapore Contact Lens Society. They have even lobbied for support from overseas professional organisations. They have written to the press and to my Ministry to urge us to adopt their approach in this matter. I think it is useful for me to elaborate on why this approach is not as necessary or as sound as it appears.

Firstly, eyecare is provided by a whole range of providers ranging from opticians, contact lens practitioners, optometrists, general practice doctors to ophthalmologists. This wide range of providers caters to the many different needs for different levels of eyecare services, and not all of them need to be University trained.

Secondly, we need to consider the local situation and requirements in Singapore. In larger countries, where geographical distance is a problem, some medical personnel such as nurse practitioners are allowed to undertake certain diagnostic and curative procedures where the services of a medical doctor are either not required or not readily available. In contrast, Singapore is small and our doctors and ophthalmologists are easily accessible to the population to deal with any eye injuries and diseases. Granted that we do need a number of graduate nurses and optometrists to provide leadership in these professions, there is no special need at present for us to train all our nurses and all our optometrists to University level.

Thirdly, upgrading of any profession must be done in a step-by-step fashion and in a practical way. For example, we went through similar steps in the training of dentists, nurses, physiotherapists, occupational therapists and radiographers. Most professions started with some kind of certificate course and may progress to diplomas and degrees as appropriate in stages. These diploma and certificate courses would serve to upgrade the training of these healthcare personnel and would help us meet the manpower needs of the country. They are the necessary steps we need to take in upgrading these services.

Finally, we must consider the practical effects of upgrading. Too fast a pace of upgrading will have a disruptive effect on existing practitioners and will have serious cost-implications to the general public. Within safety limits, we should not unduly confine the public's choice by restricting optometry and contact lens practice only to University graduates. In short, we will continue to encourage upgrading, but this must be done in a way which is practical and does not raise costs unnecessarily to members of the public. Too much regulation will also create market inefficiency.

Mr Speaker, Sir, I will now deal with the major provisions of the Bill.

Contact Lens Practitioners Board

Under this proposed Bill, a Contact Lens Practitioners Board will be set up. Its major functions are to maintain a register of persons qualified to prescribe, dispense and fit contact lens; to approve acceptable qualifications and training; and to regulate the practice and institute disciplinary proceedings.

Qualifications for Registration

The Board may approve any qualifications or training including the Singapore Polytechnic's certificate and diploma, as well as specific overseas qualifications, as acceptable qualifications for registration.

Annual Licences

The Registrar of the Board will grant annual licences to all registered contact lens practitioners.

Provisional Licences

Clause 10 of the Bill provides for a transitional arrangement. Those practitioners who have registered to undergo or are still undergoing the Singapore Polytechnic's Certificate Course or any other approved course will be granted provisional licences to continue their practice.

Offences and Penalties

Clauses 16, 18 and 20 specify the offences and penalties under the Bill. Offences include engaging in the practice of contact lens fitting without a valid licence or allowing premises to be used by such persons to practise. For such offence, the penalties are a fine of not exceeding $10,000 or a jail term of not exceeding six months, or both.

The penalty for administering any prescription containing any poison or controlled drug without authorization is a fine not exceeding $5,000 or a jail term not exceeding two years, or both.

The penalty for selling or supplying contact lens without being a registered contact lens practitioner is a fine of not exceeding $5,000 or a jail term of not exceeding six months, or both. However, manufacturers and wholesalers are allowed to supply contact lens to registered contact lens practitioners, or for export.

Referral of Eye Injuries and Diseases

To ensure that proper medical care is provided for eye injuries and diseases, registered contact lens practitioners are required under clause 19 of the Bill to refer clients who are suffering from an injury or disease of the eye to ophthalmologists for medical advice and treatment.

Power of Board to Discipline

Clauses 12 and 13 stipulate the power of the Board. This includes removal of names from the register, caution, censure, suspension or fine. Any person who is aggrieved by the decision of the Board may appeal to the Minister within one month.

In summary, Mr Speaker, Sir, the Contact Lens Practitioners Bill will ensure safe and competent contact lens services to the public and prevent injuries to the eyes from contact lenses which are improperly fitted or used.

Sir, I beg to move.

Question proposed.

Mr Loh Meng See (Kampong Glam GRC): Mr Speaker, Sir, I rise to support the Bill.

Contact lens use became a vogue some 10 years ago when prominent Singaporeans started wearing them. Many young people and those who want to look young and presentable wear contact lens. However, it is not for vanity alone that people wear contact lens. The use of contact lens, instead of spectacles, can help slow down the deterioration rate of poor eyesight.

The question we ask is: why do we take so long to register and regulate the standard of contact lens practice? The pair of eyes is a vital organ for all of us. The loss of sight of one eye, according to the Schedule of the Workmen's Compensation Act, is 50% loss of earning capacity. The total loss of sight is treated as total permanent disability and equivalent to 100% loss of earning capacity.

This Bill highlights the dangers and risks involved in the fitting of contact lens. And utmost care is needed for both the practitioners and users to prevent injuries and disease to the precious eyes.

Sir, so far the situation is under control. As our society becomes more sophisticated, we would expect more users of contact lens. I would envisage that the contact lens market will be a lucrative one in the future. Therefore, the Bill is very timely to ensure that from now on, only trained and qualified people are allowed to set up practice in contact lens.

I appreciate the effort put in by the Ministry to balance the interest of public safety and the cost of use of contact lens. Many contact lens wearers are students and young adults. They have become necessary items to individuals who need to wear them for doing certain kinds of work and in occupations that make the wearing of spectacles inappropriate.

I support the step-by-step approach taken by the Ministry of Health to help as many of the existing practitioners as possible to be trained and qualified for continued practice. This is to ensure that there is no sudden reduction in the number of shops supplying the needs of contact lens users, as otherwise the cost of contact lens may shoot up and this is not in the interest of the consuming public.

Contact lenses are also fashion items. Some people use them not to correct vision but, as we have read, to enhance the colour of their eyes.

I wonder if it is possible from now on for disposable contact lens to be freely available over the counter in pharmacies and optical shops. From now, are contact lens considered controlled items? Are consumers allowed to self-administer, buying the contact lens on their own and fitting them themselves? Is there a difference between disposable and non-disposable contact lens and those contact lens that correctvision and those that do not? Are they all encompassing?

May the Senior Minister of State please clarify the practical difficulties in enforcing the provisions?

Dr Aline Wong: Sir, I would like to thank Mr Loh Meng See, Chairman of the GPC for Health, for his support for this Bill and the step-by-step approach my Ministry has taken to balance the interest of the public as well as the cost implications.

He asked what we intend to do should disposable contact lens become widely used in Singapore. I am aware that some people wear contact lens for aesthetic reasons. But whether it is worn to correct vision, or because some people need them for certain types of occupations, or wear them mainly for fashionable reasons such as to change the colour of their eyes, as Mr Loh pointed out, the fact is, contact lens are in contact with the eyeballs, in contact with the cornea. So for all practical purposes, the dispensing of all contact lens should be brought under this Bill. I think it is far safer for members of the public to see a qualified optometrist to have the contact lens fitted and to have proper checks done periodically in order to prevent any infections from arising or to detect any injuries that might have resulted from the improper use of the lens.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Dr Aline K. Wong].

Bill considered in Committee; reported without amendment; read a Third time and passed.