This post is written by Michelle Mehta a lecturer in Optometry at City and a recent student on EDM122 Digital Literacies and Open Practice. She has licensed her work under CC-BY SA and writes……

Open Access and its Importance in Optometry

I am a Contact Lens Optician, currently working as a Professional Services Consultant for a specialist contact lens manufacturer, UltraVision, and a Visiting Clinical Tutor at City, University of London.  Both of these roles involve education within optometry.  While my role at City involves the support of teaching at undergraduate level, my role with UltraVision involves education of current practitioners and making sure they are up to date with current products and methods within our profession.  In order to do this, there is a necessity to be able to source the latest trials data and research within optometry.

One of the things that struck me while studying this module was the various meanings of the term ‘open’ and indeed ‘open access’ (OA).

According to JISC, ‘open access means making research publications freely available so anyone can benefit from reading and using research’¹.  They state that this means more than simply making research available to read, but also allowing others to reuse that research; for example, by allowing its content to be analysed.

According to UNESCO, ‘open access means free access to information and unrestricted use of electronic resources for everyone’².  It states that any kind of digital content can be OA to include text, data software, audio, video and multimedia.

The Budapest Open Access Initiative, released to the public in February 2002, stated that removing access barriers to research ‘will accelerate research, enrich education, share the learning of the rich with the poor and the poor with the rich, make this literature as useful as it can be, and lay the foundation for uniting humanity in a common intellectual conversation and quest for knowledge’.³

OA is a new way for academics to publish and achieve a worldwide audience.  Its purpose is to make publications freely available online to all users at no cost as opposed to the traditional subscription model in which readers have access to scholarly information by paying a subscription⁴.  OA publications usually carry less restrictive copyright and licencing barriers than printed works, for both users and authors alike.  This means that anyone can read, download, copy, distribute, print search for information, or use it within education or in any other way within the legal agreements.  This method of publication allows authors to receive a wider audience, allows readers to access the most recent work in a given field and means that funders can finance a much broader works and reach a wider audience.

A piece of research carried out by Nagaraj and Bhandi, at Mangalore University in India in 2017,⁵ in which they researched the advantages and disadvantages of OA journals, found that researchers gave priority to factors such as the quality of the peer review and impact factor before selecting an OA journal for publishing.  They also found that 80% of researchers agreed that there is a fundamental benefit in open access publishing.  They wanted to explore the factors that influenced publications in OA journals and ascertain the perceived advantages and disadvantages of OA journals by physics researchers.

Among the advantages they found was that OA journals drive innovative research articles.  As OA journals are free to access, it went without saying that they had more readers.  They also found that OA journals lead to higher visibility, as many researchers use Google as their main search engine, where OA is going to give higher visibility.  Finally, they also found that OA increased the number of citations.

Although OA journals provide full-text access to users, they did find that there were some disadvantages.  One of the factors found to have constrained authors from publishing in OA journals was the impact factor; among research scholars, 47% of participants agreed that OA journals have a low impact factor.  Authors agreed that article processing charge is an added expense; the copyright policies also varied among publishers and many do not have a clear copyright policy.

When it comes to healthcare, OA publishing can add value to a number of health and social care professionals and their work in the health services.  Many peer-reviewed research is published in subscription journals, which are only accessible to those in institutions, or those who are willing or indeed able to pay the required subscription fees.  This causes research to lose its impact as it’s only being made available to a small number of people.  OA provides a constructive solution to this problem⁶.  A worthy goal is to allow dissemination of important medical and scientific information to promote scientific advances and improvement in medical care⁷.  The increase of access to research and allowing more contribution opportunities for publishing by junior authors and developing countries is made more possible with OA.

One of the barriers to access to research has been the pressure on academics on how often they publish and the prestige of the journals they publish in.  Some, for example, will insist that there should be a minimum number of publications in a respected journal with a higher impact factor, but these journals tend to be older and non-OA journals.  The objective of OA is not to replace existing journals but rather to maximise research impact and access.

There is high value of OA to patients and health care professionals.  Publishers allow free access to their journal content in developing countries, making it implicit that OA has both value and has a positive impact on patient care.  A key example of this would be in the fight against Ebola.  This demonstrates the value of OA to publish scientific research for immediate patient care.  Many publishers are allowing free and unrestricted access to scientific and medical databases and journals to West Africa, where this battle continues⁷.

Overall, it has been shown that health research is significantly beneficial due to its capabilities to advance research, evaluate and improve the service and empower the profession.  As a result, research should be an imperative component of all health professional’s work.  OA provides an innovative and more accessible way for these professionals to engage in research.  The opportunity for medical students, academic physicians, community physicians and international authors to contribute to and learn from OA journals is priceless.

So, what about the relevance of OA in the field of Optometry?  In 2014, the University of Waterloo in Canada, wrote an article in their School of Optometry and Vision Science Newsletter, in which they stated ‘as practicing optometrists, access to evidence-based research to answer clinical questions is particularly important, in order to provide the best possible support to patients’⁸.  They went on to state that the prohibitive cost of subscription rates for many vision sciences journals, providing access to important medical information makes OA literature increasingly valuable.

An independent and vibrant profession commits to discovery as a basis of better patient care and optometry is no exception.  Some recent discoveries in our field are breath-taking and the increasing awareness in health care, including optometry, of the advantages of accepting the challenge of translating these discoveries to patient care is becoming ever more eveident.^9. Through more formalised research and discovery, the profession’s knowledge base expands and tools for diagnosis and management of patients becomes more useful and more sophisticated; and like other healthcare professions, optometry is moving to a more formalised clinical application of research results in what is termed ‘evidence-based’ practice.

Applications in clinical research trials form the basis of the kind of research that is becoming increasingly a component of healthcare, including optometry.  In its most rigorous form, we have the outcomes of randomised clinical trials which are applied quantitively to populations of patients.  This is considered the best of what is commonly described as evidence-based medicine.⁹ One of the most recent of these applications would be in what the profession is terming its very own pandemic, known as progressive myopia, leading to its treatment, myopia management.

When my own son, was first described as one of those children with progressive myopia and a clinician friend of mine had advised me to consider myopia management strategies for him, not only was I not familiar with this, but many of my peers and colleagues had not heard of this either and were very dubious.  Five years later, through the availability of results of clinical trials, as well as promotion of awareness in the profession, treating, or at least discussing myopia management, with the parents of these children, is now becoming best practise.

In addition to this, educators are also acutely aware that optometry is a rapidly evolving discipline and that courses and clinical knowledge must be kept up to date.  Constant changes in healthcare make a static lecture that changes little from year to year of diminishing value to students.  Aging books, while very worthwhile for foundational knowledge, cannot keep up with the rapid changes.¹⁰   With this in mind, the hope would be that the discovery of new knowledge will happen under the OA model.

Likewise, students, who are often unable to afford paying subscription fees, gain great advantage when information is freely available.  It enables them to read complete publications, helping them to maintain the evidence basis for what they are being taught.  It also helps to reduce the misuse of abstract-only referencing.  As many online researchers will know, access to articles beyond their abstract is often blocked by what is known as ‘paywalls’.  What makes this worse is that if the article turns out to be not what the researcher was looking for, there is no ‘returns policy’.

The optometric profession is seeing exciting discovery that is surely going to impact future practice and place optometry in an even stronger position to provide better care.  This is made more possible when the results of this discovery are made accessible to educators, students and existing practitioners, enabling them to keep up to date with latest trials and advances, which in turn enables them to give the most up to date patient care and treatment.

I wanted to establish how many journals there are in the optometric professions that are fully OA.  In my search, I found out that there are one hundred fully OA journals in optometry, according to oa.mg¹¹.  However, of those hundred, only thirty came under the list of the Directory of Open Access Journals (DOAJ).  The DOAJ is ‘a unique and extensive index of diverse open access journals from around the world, driven by a community, committed to ensuring quality content is freely available online for everyone’.¹² In addition to this, I could not see, on that list, any of the optometry journals that many of us in the profession are familiar with here in the UK.

Optometrists in the UK generally gain access to journals through paid subscription.  There is further access, without charge, to journals by professional bodies that they may be member of, although they are paying annual fees to retain this membership.  Clinicians will often not be aware of search engines, such as PubMed or Google Search, which can often give access to some OA articles or trial data; especially those that may have qualified some years back.  This may be different for more recently qualified practitioners who would have used these search engines in their undergraduate studies.

On 4 September 2918, with the support of the European Commission and the European Research Council (ERC), a group of national research funding organisations announced the launch of cOAlition S.  This is an initiative to make full and immediate OA to research publications a reality, which is built around Plan S; this consists of one target and ten principles.

cOAlition S state: “With effect from 2021, all scholarly publications on the results from research funded by public or private grants provided by national, regional and international research councils and funding bodies, must be published in Open Access Journals, on Open Access Platforms, or be made immediately available through Open Access Repositories without embargo”.¹³

It has been found that subscription journals have mostly adapted so that Plan S affected scientists can still publish with them.  The biggest disruption has been with the highly selective journals, which reject most of the papers submitted to them and recoup their costs through subscription fees.  However, in the end they have adjusted by retaining their subscription models but have also announced new OA publishing options.¹⁴

Plan S has already catalysed a shift in the open access landscape.  Journals that previously only offered no route to make peer-reviewed articles immediately open access now do, even if only for authors with Plan S funders.¹⁴

I am a member of a new clinical and research committee set up by the Association of British Dispensing Opticians, who have a number of aims and objectives for members.  One of these is to try and find a way for members to have access to research in a similar way to those in the nursing profession.  Through this module I have learnt how this is changing rapidly and I hope, with the launch of cOAlition S, that more OA will be available to us as a profession, enabling us to give the best patient care, with the support of the most up to date access to research an innovation, and evidence-based treatment.

 

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References

1. An Introduction to Open Access. https://www.jisc.ac.uk/guides/an-introduction-to-open-access
2. UNESCO Open Access Publications. https://en.unesco.org/open-access/what-open-access
3. https://www.budapestopenaccessinitiative.org/read/
4. The Importance of Open Access Publishing. https://www.conference2go.com/blog/the-importance-of-open-access-publishing/
5. Nagaraj, M. N. and Bhandi, M. K. Physics Researchers’ Perception of Advantages and Disadvantages of Open Access Journals: A study. International Journal of Library and Information Studies, 2017, Vol 7, p 132
6. Lawton, a et al. The value of open access publishing to health and social care professional in Ireland. Ariadne. http://www.ariadne.ac.uk/issue/73/lawton-flynn/
7. Wang, J. Z. et al. Open access medical journals: Benefit and challenges. Clinics in Dermatology, 2019, 37, 52-55
8. Sterling, P. Open access and its relevance to practicing optometrists. School of Optometry and Vision Science Newsletter. University of Waterloo, Spring 2013, Vol 17, No.2, p 14
9. Adams, j. The role of research, evidence and education in optometry: a perspective^a. Clinical and Experimental Optometry, 2007: 90: 4: 232-237
10. Kundart, J. Open access publishing: opportunities and challenges. Optometric Eductaion, Volume 38, Number 3/ Summer 2013, p 89-91
11. mg. https://oa.mg/journals/open-access-optometry-journals
12. https://doaj.org/about/
13. https://www.coalition-s.org/about/
14. Else, H. A guide to Plan S: the open-access initiative shaking up science publishing. Nature, News explainer, 08 April 2021, Correction 12 April 2021. https://www.nature.com/articles/d41586-021-00883-6