North Vancouver eye doctors are warning that new eyewear regulations that took effect at the beginning of May could cause an epidemic of blindness in British Columbia.

Antoinette Dumalo, a North Vancouver optometrist and president of the British Columbia Association of Optometrists, says recent changes to the law that allow patients to refill subscriptions without an eye exam will allow degenerative diseases such as glaucoma to go undetected, leading to unnecessary loss of vision for thousands of British Columbians.

Dumalo is backed by numerous colleagues and by several organizations dealing with eye health.

"Eye care has been turned back basically 100 years," said Tony Wong, an optometrist with a practice in Dollarton. "Anyone can walk off the street and sell you contact lenses, which are still rated as a medical device in Canada."

Health Services Minister Kevin Falcon announced the changes March 19, six weeks ahead of their implementation. Up until May, anyone wanting contacts or glasses first had to undergo an eye exam from an optometrist and either order eyewear from that optometrist or take the prescription to an optician (a professional who creates and sells eyewear) to get it filled. Alternatively, they could go to an optician for a simple sight test, get the resulting prescription approved by an optometrist, and order their lenses that way.

Under the revised act, however, most of those restrictions have been dropped. Now, patients can order glasses or contacts from anyone they want to without presenting a prescription or the results of a sight test to the seller.

The new law also allows opticians -- whose historical role has been primarily to create and sell the lenses -- to conduct sight tests for healthy people aged 19-65 without having the results reviewed by an eye doctor.

The changes were made in the interests of consumers, said Falcon in a statement.

"With advances in technology and more consumers turning to the Internet, it makes sense to modernize a decades-old system to give British Columbians more choice while maintaining public safety," he said.

According to the statement, Falcon introduced the legislation in direct response to an October 2009 B.C. Court of Appeal decision that ruled an online company called Coastal Contacts was breaking the law by sending customers eyewear without seeing a prescription.

"These regulatory changes will address the court decision," said the ministry release, which went on to point out that the company employs 120 people (Coastal Contacts has since corrected that to 250).

But optometrists say the move is dangerously shortsighted.

"These changes . . . have been proposed in other jurisdictions and rejected," said Dumalo. "Because to . . . implement buyer-beware regulations puts the patient at unnecessary risk of vision loss."

The problem, according to Dumalo, is that a simple sight test (or refraction), the procedure opticians are now allowed to administer unsupervised, only collects the information needed to determine what shape lenses need to be in order to correct vision. By themselves, the automated instruments do not pick up on a range conditions, such as glaucoma and diabetic retinopathy, which can cause blindness, which are difficult to detect in the early stages, according to the optometrists.

"This is a type of disease where there are no symptoms," said Wong. "You don't feel it; you don't notice your vision is gradually deteriorating."

To catch these things requires a full eye exam, which is more involved than the automated refractions conducted by opticians.

Glaucoma, for example, in which a build up of pressure in the fluids of the eye causes the optic nerve to deteriorate, will not generally be noticed by patients until their sight starts to fail in the later stages of the disorder. To detect it, an eye doctor must measure the pressure inside the eye, said Wong.

"We have patients who come in when the nerve is already burnt out," he said. "It's already been destroyed. . . . There's no saving it at that point."

Wayne Whetstone, a former commercial photographer from North Vancouver, is one of a number of patients from across the province who have lent their support to the optometrists' cause.

Whetstone, 60, went in for a standard eye exam in March 2009, looking to update his prescription. The optometrist who examined him thought there might be more wrong than could be corrected with new lenses.

"She detected what she thought was a slight amount of glaucoma," said Whetstone. "She recommended me to an ophthalmologist. . . . I went down and went through his exams. He was quite amazed she had caught it because it was very slight."

Whetstone has been in treatment for glaucoma since, and he believes his vision is improving. Before going for the exam, he had no idea he had the disease, he said. Had it not been for the optometrist, it wouldn't have been caught in its early -- treatable -- stages.

"There might have been an indication if I turned my head quickly; I might see bright little spots, but I never thought anything of that," said Whetstone. "The prescription would have corrected the vision no problem."

Whetstone, who buys glasses online, believes many people in his position would have gone for a simple refraction given the opportunity -- a test that would likely have missed the glaucoma.

"People will take advantage of it if they can go to an optical store or a lens store or whatever, . . . and they will give them an eye (test) which bypasses the more expensive exam," he said. "No matter what, it comes down to cost."

A lot of people could be affected, said BCAO president Dumalo.

"Ten per cent of patients who present for a quote-unquote 'routine' eye examination have symptomless eye disease," she said. And that's in the lower risk 19-65 age category.

"In 2005, there were 122,963 patients who were referred in that cohort for diabetes, retinal problems, macular degeneration, glaucoma and cataracts. It's a huge number," said Dumalo. "There are hundreds of cases on file at the BCAO where people in that cohort, 19-65, if they had been only sight-tested, a disease would have been missed."

That position has been backed a by a number of organizations involved with eye health, including the Canadian Diabetes Association and the Canadian National Institute for the Blind.

In an April 8 letter addressed to Falcon, the CNIB wrote that "many of (their) clients lost vision irretrievably as a result of ignoring the need for regular eye examinations."

The organization estimates that as much as 75 per cent of vision loss could be avoided through prevention, early detection and treatment.

"This ability to detect eye disease will be lost if autorefractions replace regular refractions," it said.

Citing figures from Statistics Canada, the CNIB estimates about 4,700 British Columbians lose their sight annually. "This number can only be expected to increase significantly if the frequency of eye examinations is decreased."

But the province says such concerns are misplaced.

"We would not be making changes if we thought it put anyone's health and safety at risk," wrote Falcon in an e-mail to the North Shore News. "Ministry staff have examined the medical evidence and have determined there is no strong scientific evidence that regular eye health examinations for asymptomatic individuals between the ages of 19 and 65 improve health outcomes."

And the ministry has promised safeguards to ensure eye disease doesn't go undetected

"A screening process will be put in place to ensure a client is healthy enough to be eligible for the sight-test, and is fully informed about the difference between a sight-test and an eye-health examination," said the ministry in a release. "The screening process will also require the optician to refer a client to a medical doctor or optometrist if the client has a specified pre-existing condition or if certain test results occur."

In his e-mail, Falcon acknowledged that it's important for healthy adults to go for eye exams periodically, but said it's ultimately up to them to ensure they do that.

"If the public wishes to go and have an eye health exam by an optometrist every year or more, they have the right to do that," he said. "But the public should also have the right to determine whether or not they wish to take advantage of the services of an optician and now they can make those decisions if they meet certain health requirements. . . . No B.C. resident is being required to purchase contact lenses online."

Dumalo, however, doesn't buy this argument, saying most people don't really know what going for an exam means. Past studies have shown that the majority of patients who go to an optician for a refraction leave thinking they've had an eye health exam, she said.

"Even though there are disclaimers, even though there are waivers, patients don't understand the difference," she said. "There's mass confusion."

This point was driven home in her recent meetings with MLAs, said Dumalo, who has met with numerous politicians to promote her cause.

"Without exception, every single one of them has to ask me what the difference is between an optometrist, an ophthalmologist, an optician," she said. "These are well educated, informed people. How is the public going to know what service they're providing?"

Dumalo finds it frustrating that there appears to have been no serious conversation with the industry before the minister pushed the legislation through, despite a reference to "lengthy consultation" in Falcon's original announcement.

"I'm the president of the BCAO. I've talked to the college. . . . There has been no consultation," said Dumalo.

"We were all caught by surprise," said Wong.

Coastal Contacts, the company at the centre of the legislative change, appears at least to have communicated with the government ahead of the rule change. It had a lobbyist working on its behalf in an attempt to update the regulations, and in 2009 it made six separate donations to the B.C. Liberals totalling more than $10,000.

A representative for Coastal Contacts said their actions were warranted.

"We are a stakeholder just as the optometrists and opticians are who are represented, I believe, by lobbyists," said Terry Vanderkruyk, the company's vice-president of corporate development. "We felt we needed to do that and we did that."

What's more, the donations were nothing out of the ordinary, he said. "If you did a thorough search, you would see we've been a supporter and have made donations for a number of years prior to any of this process."

Over the past five years, according to Elections BC, the company's only contribution prior to 2009 was a single donation in 2005.

Vanderkruyk said he was not in a position to comment on the safety implications of the legislation, but noted the company positions itself as a "contact replacement company."

"If you're a contact lens customer, we encourage you to go to your doctor, have an exam, get fitted for contact lenses, . . . and often times people will buy their first order from their doctor," said Vanderkruyk. "But what we're saying is we're better equipped to provide replacement contact lenses to that user than the doctor is, because we buy in large quantities and we can deliver very quickly."

On the whole, the change is good for the consumer, he said.

"The regulations that existed previously were written in the '90s, and really didn't incorporate a channel that involved the Internet," said Vanderkruyk. "There was a need to update those regulations."

Ordering online appears to be growing rapidly in popularity. Last year Coastal Contacts, which was founded only 10 years ago, shipped 1.4 million orders to customers around the world. Vanderkruyk expects that number to grow to 1.6 million this year. He wouldn't say how many of its customers are in British Columbia, but he estimated it was in the thousands.

It's not clear whether the company would have been forced out of province by the court of appeal ruling had the government not stepped in to change the law, but Vanderkruyk said that had definitely been a possibility.

"Had the regulations not been updated in the manner they were, certainly we would have considered relocating the business, but that would not have been our first choice."

But Dumalo does not see that as a valid reason for changing the rules.

"To say that this Internet company is going to move out of B.C. if the regulations aren't changed -- where are they going to move?" she said. "Nowhere in North America allows contact lenses and eyewear to be dispensed without verification, nowhere in England, nowhere in the Commonwealth. The only jurisdictions where this is allowed are in Third World countries."

But Vanderkruyk said the rules around eyewear vary from jurisdiction to jurisdiction, that Coastal Contacts obeys them all, and that they are generally trending in the same direction -- although he acknowledged that B.C.'s are now "progressive" compared to others.

With the province giving no signs of backtracking, Dumalo says her organization will be setting its sites on the federal government, in the hope it can convince Ottawa to introduce national regulations that would require online retailers to verify a prescription before dispensing lenses.

In the meantime, the optometrists are left shaking their heads.

"Most people, if they want to save a buck, they're going to go online; they're going to go elsewhere and avoid having a comprehensive check up," said Wong.

"It's a massive change. . . . Most of the public won't know; they'll read about it, but they won't know the difference. It's unfortunate. It really is."

jweldon@nsnews.com