Purpose: This study aims to demonstrate that Finnish optometrists have the skills to act as primary eye care providers and that the current state of eye healthcare in Finland requires a new division of labour to meet the healthcare challenges of an ageing population.

Methods: This clinical case study aims to describe the assessment and symptom-based management of a 73-year-old Caucasian female examined by an optometrist at the optician shop in March 2023. In this clinical study, an optometrist is acting as a primary examiner in an eye health problem, which is discussed using evidence-based literature. The literature describes the level of Finnish optometry compared to Sweden, Norway, and Europe and the state of Finnish healthcare, particularly eye healthcare. The regional example used in the evidence-based literature is the Wellbeing Services County of Lapland. Due to the subject matter, most of the material used in the literature was searched from national grey literature sources in May 2023 using Google, Pubmed and Google Scholar. This was a single case study, and the researcher collected all data anonymously on-site while the patient was seen at the practice. Therefore, a separate IBR approval was not needed. This project was done for the Finnish Association of Vision and Eyecare (NÄE Ry). The partner was Brillet, where the examinations were carried out.

Results: In the clinical case study, the optometrist was able to get the patient quickly to the examination and, with the help of his skills and OCT scan, was able to diagnose the condition to the level of suspicion and, by consulting an ophthalmologist, was able to get the patient the further treatment she needed. As this clinical case and the evidence-based literature show, the skills and training of optometrists are quite high compared to other European countries. In Finland, laws restricting the activities of optometrists, restrictions on the prescription of spectacles, and the lack of referral rights limit the possibilities for developing eye care. Healthcare organizations, particularly eye care organizations, face significant challenges that must be addressed through a new eye care strategy and division of labour between eye care professionals. Without this, the growing challenges of an ageing population cannot be met without a deterioration in the quality and quantity of public eye care services. In Lapland, the large and sparsely populated area poses challenges for the organization of publicly funded services.

Conclusions: Optometrists, with their expertise and research equipment, can act as primary eye health professionals and also in acute cases, allowing for a new division of labour between the different professions in eye health care. The study suggests this would free up ophthalmologists´ resources for managing complex eye diseases and surgery. At the same time, an area of eye care currently missing from primary healthcare in Finland could be created. This would be a cost-effective approach, saving on the cost of eye care and allowing services to be provided close to the patient. Due to long distances, sparse population, and limited public eye care services in Lapland, the new division of eye healthcare professionals should be piloted.

Keywords: optometrist, ophthalmologist, healthcare, eye healthcare, social welfare and healthcare reform, wellbeing services county,