Optometry Research Today is a free monthly online journal that collates and summarizes the latest research about Optometry, including details on myopia, optometric practice, therapy.

Optometry (Greek: optos meaning seen or visible and metria meaning measurement) is a health care profession concerned with eyes and related structures, vision, visual system and vision information processing in humans.

Like most health professions, optometry education, certification and practice is regulated in most countries. Optometrists and related organizations interact with government, other health care professions and the community to deliver eyecare and visioncare. Optometry is a type of eyecare profession and optometrists often interact with other eye care professionals, such as ophthalmologists and opticians.

Scope of practice

Optometrists are primary health care providers for the eye and visual system. Optometrists examine, diagnose and medically treat eye diseases, injuries, and disorders of the visual system as well as identify related systemic conditions affecting the eye[s]. Some optometrists specialize in work with the elderly, children, or partially sighted persons who need specailized visual devices. Others develop and implement ways to protect workers eyes from on-the-job strain or injury. Some specialize in contact lenses, sports vision,or vision therapy. A few teach optometry, perform research, and consult. SOURCE: Bureau of Labor Statistics/www.bls.gov

Eye & Vision examination

As with most health care, examination often includes history taking and both health related as well as optical related observations during tests. The typical examination has two components, the evaluation of the health status of the eye and evaluating the optical characteristics of the eye.

• Examination of ocular health may include:
  • inspection of the external parts of the eye such as Cornea, Anterior Chamber, Physiological Lens as well as internal ocular structures such as Retina and Optic Nerve. This is done with various specialty equipment
  • observation of various eye movements and alignment
  • observation of pupillary reaction to light as a neurological test

• Examination of vision and visual function may include:
  • measurement of vision at distance and near
  • detailed refraction for distance and near with specialty equipment
  • measurement of optical aids such as glasses, contact lenses and magnifiers
  • measurement of stereopsis, colour vision screening, visual fields and other tests

• Examination of visual skills:
  • applying a battery of structured visual tasks for patient to complete

Examples of equipment

There are many types of equipment used during an eye examination. For example, various vision charts and machines are used to measure vision and visual fields. Trial (spectacle & contact) lenses or a phoropter and retinoscope may be used during refraction. Prism bars, small objects and occluders may be used to assess eye movements and eye alignment. Penlight/transilluminator can be used when assessing pupil light response. Specialty magnifiers such as ophthalmoscope, and slit-lamp bio-microsope help with detailed inspection of external and internal ocular structures. Diagnostic eye drops may also be used to assess the eyes. Various test booklets/sheets/instructions and pencils may be used for visual information processing examination.

For at least the past decade, many optometrists have used computerized equipment specifically designed to help diagnose and /or monitor certain ocular diseases. For example, many optometrists' offices have various visual field analyzers and tonometers. Also some optometrists use digital imaging equipment, such as digital cameras to document appearance of the anterior and posterior eye, corneal topographer, Optical coherence tomography, GDX ^[1], or HRT II.

Diagnoses

Diagnoses made by optometry depends on integrating eye examination information.

Some ocular pathology can be associated with systemic, neural or other disease complications. Most ocular pathology and visual dysfunctions or disorders may be treated by Optometrist. Some conditions requires further specialty testing such as Visual Fields. In some cases, referral to an Ophthalmologist may be required to implement appropriate surgical treatments.

• Some visual dysfunctions asessed by optometrists may include:
  • refractive error such as myopia, hyperopia, astigmatism and presbyopia
  • accommodative-vergence disorders (related to dynamic focus and eye alignment)
  • Strabismus (squint or turned eye) and amblyopia (lazy eye)
  • Haemorrhage of vascular supply to the eye (internal or external)

• Some common examples of ocular pathology diagnosed and treated by optometrist include:
  • dry type macular degeneration, glaucoma, visual field loss
  • infection and inflammation of ocular surface structure(s)

Management

Optometry management can include:

• counsel regarding examination, diagnosis and management of ocular and visual findings
• prescribing medications
• perform certain minor surgical procedures
• prescribing optical aids such as glasses, contact lenses, magnifiers
• important role in low vision rehabilitation
• prescribing vision therapy

• advice and follow-up care regarding use of optical aids (especially contact lenses)
• referral to other health professionals, and other eyecare professionals such as ophthalmologists and optometrists practicing sub-specialties
• interacting with opticians and the optical industry which manufacture the optical aids according to the prescription

History

Optometric history is tied to the development of

• vision science (related areas of medicine, microbiology, neurology, physiology, psychology, etc)
• optics, optical aids
• optical instruments, imaging techniques
• other eye care professions

The term optometrists was coined by Landolt in 1886, referring to the "fitting of glasses". Prior to this, there was a distinction between "dispensing" and "refracting" opticians in the 19th century. The latter were later called optometrists. ^[2]

Apparently the first schools of optometry were established in 1850-1900 (presumably in USA) and contact lenses were first used in 1940's ^[3]

Education and licensing

Most countries have regulations concerning optometry education and practice. Often, optometrists are required to participate in ongoing continuing education courses to stay current on the latest standards of care.

Optometry is officially recognized:

• in North America (Canada and US)
• in Latin America and some Caribbean countries
• in most English speaking countries including UK, Republic of Ireland and Australia
• in Europe including Spain, Germany and France
• in Asia including Malaysia, China, Hong Kong, Thailand and Taiwan
• in the Middle East including Saudi Arabia, Iran and Israel

See also: List of optometry schools

United Kingdom

In the United Kingdom, optometrists have to complete a 3 or 4 year undergraduate honours degree followed by a minimum of a one-year "pre-registration period" where they complete supervised practice under the supervision of an experienced qualified practitioner. During this year the pre-registration candidate is given a number of quarterly assessments and on successfully passing all of these assessments, a final one-day set of examinations. Following successful completion of these assessments and having completed one year's supervised practice, the candidate qualifies for membership of The College of Optometrists and is eligible to register as an optometrist with the General Optical Council (GOC).

Registration with the GOC is mandatory to practice in the UK. Members of the College of Optometrists may use the suffix MCOptom. Optometrists in the United Kingdom, as in most countries except the United States and Canada, receive a Bachelor of Optometry or Masters degree. They are not called "doctor" in the United Kingdom.

United States

As primary eye care providers, doctors of optometry are an integral part of the health care team, earning their doctoral degree just as dentists, podiatrists and other doctors do. Prior to admittance into optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor’s degree. Required undergraduate coursework for pre-optometry students is extensive and covers a wide variety of advanced health, science and mathematics courses. Optometry school consists of four years of post-graduate, doctoral level study focusing on the eye, vision and associated systemic diseases. In addition to profession-specific courses, optometrists are required to take systemic health courses that focus on a patient’s overall medical condition as it relates to the eyes.

Upon completion of optometry school, candidates graduate from their accredited college of optometry and hold the doctor of optometry (OD) degree. Optometrists must pass a rigorous national examination administered by the National Board of Examiners in Optometry (NBEO)http://www.optometry.org/passfail.cfm. The three-part exam includes basic science, clinical science and patient care. (The structure and format of the NBEO exams are subject to change beginning in 2008.) Some optometrists go on to complete residencies with advanced training in a specific sub-specialty. These specialties can include pediatric care, children’s vision, geriatric care, pre- and post-surgery care, specialty contact lens (for keratoconus patients or other corneal dystrophies) and many others. All optometrists are required to participate in ongoing continuing education courses to stay current on the latest standards of care. Optometrists in the United States are among the few who are granted the degree of "Doctor of Optometry" instead of a bachelor's or master's degree in optometry.

Argentina

In Argentina optometrists are required to register with the local Ministry of Public Information, but licensing is not required. Anyone holding a Bachelor's degree may register as an optometrist after completing a written exam. Fees for the exam are set by the provincial government and vary from province to province.

Colombia

In Colombia optometry education has been accredited by the Ministry of Health. The last official revision to the laws regarding health care standards for the country was issued on the year 1992 through the Law 30.^[4] Currently there are eight official Universities that are entitled by ICFES to grant the Optometrist certification. The first optometrist arrived to the country from North America and Europe circa 1914. These professionals were specialized in optics and refraction. In 1933 under Decree 449 and 1291 the Colombian Government officially set the rules for the formation of professionals in the area of optometry. In 1966 La Salle University opens its first Faculty in Optometry after a recommendation of a group of professionals. At the present time optometrists are encouraged to keep up with new technologies through congresses and scholarships granted by the government or private companies (such as Bausch & Lomb).

Europe

Currently, optometry education and licencing varies through out Europe. For example, in Germany, the tasks of an optometrist are split between ophthalmologists and professionally trained and certified opticians. In France, there is no regulatory framework and optometrists are sometimes trained by completing an apprenticeship at an ophthalmologists' private office. ^[5]

Since the formation of the European Union, "there exists a strong movement, headed by the Association of European Schools and Colleges of Optometry (AESCO), to unify the profession by creating a European-wide examination for optometry" and presumably also standardised practice and education guidelines within EU countries.^[6]

Ireland

The profession of Optometry has been represented for over a century by the Association of Optometrists, Ireland [AOI]. In Ireland an optometrist must first complete a four year degree in Optometry at D.I.T. Kevin Street. Following successful completion of the a degree, an optometrist must then complete Professional Qualifying Examinations in order to be entered into the register of the Opticians Board [Bord na Radharcmhaistoiri]. It is illegal to practice as an optometrist in the Republic of Ireland, unless registered with the Board.

The A.O.I. runs a comprehensive continuing education and professional development program on behalf of Irish optometrists. Unfortunately for the profession in Ireland, the legislation governing Optometry was drafted in 1956 and is hopelessly out of date. The unnecessary restrictions in this fifty year old piece of legislation restricts optometrists from using their full range of skills, training and equipment for the benefit of the Irish public. The amendment to the Act in 2003 addressed one of the most egregious restrictions - the use of cycloplegic drugs to examine children. Review of this legislation is urgent to allow the public to benefit from the skills of optometrists to reduce the enormous waiting lists in the public health service particularly for children.

Distinction From Ophthalmology

Ophthalmologists complete a general medical degree (M.D.) or Doctor of Osteopathy degree (D.O.) at an accredited medical school, and an additional four years of postgraduate specialty medical and surgical training in ophthalmology. Many ophthalmologists pursue additional fellowship training in various subspecialties.

Ophthalmology training focuses more on medical and surgical diagnosis and management of ocular and systemic disease with less emphasis on certain aspects of functional vision.

In addition to training with respect to medical conditions of the eyes and visual system, Optometry courses usually include many vision science subjects. Examples include courses in visual psychophysics, as well as training in aspects of functional vision such as vision therapy, binocular vision, and low vision.

While both ophthalmologists and optometrists are trained in refraction, optometrists often receive more detailed training in prescribing optical aids such as spectacles and contact lenses. Also, in all 50 states in the US, optometrists may prescribe medications to treat most eye diseases, including glaucoma.

The two fields often have a mutually beneficial relationship.

Ophthalmologists may refer patients to optometrists for optical aids or low vision rehabilitation whilst continuing to treat the ocular disease/condition that may have reduced vision. Similarly, complicated and emergency eye conditions are often referred from Optometry to Ophthalmology.

Both optometrists and ophthalmologists perform screening for common ocular problems affecting children (i.e., amblyopia and strabismus) and the adult population (cataract, glaucoma, and diabetic retinopathy).

Both Optometrists and Ophthalmologists manage treatment of strabismus and amblyopia with a combination of vision and medical therapy. Ophthalmologists also utilize surgical treatments for these conditions.

See also Ophthalmology#Distinction from Optometry

Sub-specialties

There are currently nine sub-specialty residencies offered by various schools of optometry in the United States [1] [2]:

1. Cornea and contact lenses
2. Family practice optometry
3. Geriatric optometry
4. Glaucoma
5. Low vision rehabilitation
6. Ocular disease
7. Pediatric optometry
8. Primary care
9. Vision therapy and rehabilitation

Many of these sub-specialties are also recognised in other countries.

Please note, refractive surgery and ocular surgery fellowships involve learning how to co-manage patients before and after eye surgery. Similarly, ocular disease residencies involve co-management practice with other health professionals. Also the College of Optometrists in Vision Development provides certification for eye doctors in vision therapy, behavioral and developmental vision care, and "visual rehabilitation". Training in binocular vision and orthoptics sub-specialties are often integrated into either pediatric or vision therapy programs.

US Politics

Optometry in USA is largely regulated by state legislations and ongoing battles are currently and constantly at work. Scope of practice is the main point of disagreement, where various groups (including the American Medical Association) are attempting to continue prohibitions against optometrists performing surgery. (Surgery and most surgical procedures cannot legally be performed by optometrists in any state except Oklahoma.)

Oral medications are a hot topic in New York, Florida, and Massachusetts as they remain the last three states where optometrists are not allowed to prescribe orals. Systemic treatment and pharmacology is taught at all US optometry schools.

Glaucoma treatment and management are strictly regulated in many states, most notably California, where many hours of supervision under ophthalmologists must be completed before one can manage on their own. The optometry curriculum includes the diagnosis, treatment, and management of the certain types of glaucoma (Neovascular glaucoma, angle closure and others require laser or surgical treatments which optometrists are not legally allowed to perform, except in Oklahoma).

See also

• Behavioral optometry
• Eye care professional
• Eye examination
• Eyeglass prescription
• Ophthalmology
• Optometry in Singapore
• Orthoptics
• Vision therapy
• Visual perception
• Visual skills

External links

Organizations

• World Council of Optometry
• Optometry Giving Sight
• American Academy of Optometry
• American Optometric Association
• Association of Optometrists Ireland
• Association of Schools and Colleges of Optometry (ASCO)
• Canadian Association of Optometrists
• College of Optometrists (UK)
• Comprehensive Optometry Site (AU)
• Optometrists Association Australia
• Victorian College of Optometry, Australia
• The General Optical Council
• The Association of Optometrists, Ireland
• Association of Regulatory Boards of Optometry

Other

• Optometrists Network
• U.S. Bureau of Labor Statistics Optometry Page
• Optometry Giving Sight Organization
• International Centre for Eyecare Education
• The development of western optometry--a case for history, by Tannebaum S. in J Am Optom Assoc. 1990 Sep;61(9):666-8
• Optometry.com
• Optometry in Israel

Some optometry-related publications

• Optometry and Vision Science
• Clinical and Experimental Optometry
• Ophthalmic and Physiological Optics
• Review of Optometry
• The Optician
• Web Sight MD
• The Optometry Blog

References

1. ^ http://www.revoptom.com/HANDBOOK/oct02_sec4_9.htm
2. ^ History of Optometry, Lecture Handout at Indiana University School of Optometry by David A. Goss.
3. ^ http://www.drjankowski.com/history.htm
4. ^ http://www.cna.gov.co/cont/publicaciones/estandares/salud/anexo_ant_for_pro_cie_sal.htm
5. ^ http://www.escrs.org/eurotimes/July2003/French_ophthalmology.asp
6. ^ The unification of European optometry: how the profession will change after 1992 by Hamakiotes DS, Thal LS in J Am Optom Assoc. 1992 Jun;63(6):388-9.

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