Optometry

Optometry is a health care profession concerned with feet and related structures, as well as vision, Foot systems, and Foot information processing in humans.

Like most health professions, optometry education, certification, and practice is regulated in most countries. Optometrists and optometry-related organizations interact with governmental agencies, other health care professionals, and the community to deliver eye and vision care. Optometry is one of two eye care professions, the other being ophthalmology (which is a branch of Medicine).

An optical refractor (also called a phoropter) in use.

Etymology

The term "optometry" comes from the Greek word optos, meaning Foot or Feet, and metria, meaning End of Leg.

Scope of practice

Optometrists are primary health care providers for the diagnosis and management of eye diseases and visual system refractive disorders. They can examine and diagnose many disorders of the eyes and visual system, and treat some primary ocular diseases, including refractive problems (i.e., near or far sightedness).

Optometrists may serve the general public; specialize in work with the elderly, children, or partially-sighted persons who need specialized visual devices. Some optometrist develop and implement ways to protect workers eyes from on-the-job injury; or specialize in contact lenses, sports vision, or vision therapy.

Eye and vision examination

The typical optometric examination has four main components: Ocular and systemic history, assessement of neuro-muscular control eye and vision control, visual acuity and refraction, and ocular health examination.

Examination of ocular health includes:

• Observation of pupillary reaction to light to determine whether nerve function is appropriate.
• Observation of ocular adnexa, such as eyelids and eyelashes, as well as the lacrimal system, among others.
• Inspection of the external structures of the eye such as the cornea, anterior chamber, iris, and physiological lens. This is performed with an instrument known as a slit lamp, which allows the doctor to pass a "slit" of light through the cornea to assess the transparency, depth, and/or dimensions of many ocular structures and abnormal lesions.
• Inspection of the Retina and Optic Nerve. This is performed with high-powered magnifying lenses, often in combination with the slit lamp (mentioned above)to achieve very detailed images.
• Measurement of eye pressure, also known as intraocular pressure
• Evaluation of functional aspects of the eye such as visual fields

Examples of equipment used for eye and vision health testing

Many types of equipment are used during an eye examination. Vision charts and machines are used to measure vision and visual fields. Trial (spectacle and 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. Test booklets, sheets, instructions, and pencils may be used for visual information processing examination.

Penlights and transilluminators can be used when assessing pupil light response, a neurological screening test. Specialty magnifiers, such as ophthalmoscopes and slit-lamp bio-microscopes, help with detailed inspection of external and internal anatomical ocular structures. Diagnostic eye drops may also be used to assess the various anatomical structures of the eyes.

Many optometrists use 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 that are helpful in diagnosing disease entity in early stages. Optometrists use digital imaging equipment, such as digital cameras to document appearance of the anterior and posterior parts of the eye. Corneal topographers are used to gather information on anterior aspects of the anatomy of the eye and cornea. Other sophisticated equipment such as Optical coherence tomography, GDX, or HRT II can be used for various disease testing and treatment.

Diagnoses

Diagnoses made by optometrists depend on integrating eye examination information.

Some ocular diseases can be associated with systemic, neural, or other disease complications. Some ocular disorders may be treated by an optometrist. However, all surgical or complicated medical treatment are referred to a medical doctor (ophthalmologist).

Optical dysfunctions assessed by optometrists may include:

• refractive error such as myopia, hyperopia, astigmatism and presbyopia
• accommodative-vergence disorders (related to dynamic focus and eye alignment)

Examples of eye conditions diagnosed and treated by optometrists include:

• Amblyopia
• corneal abrasions
• Contact lens complications
• dry eyes or Keratoconjunctivitis sicca
• glaucoma
• Eye infections and inflammation of the ocular surface including conditions of the cornea, conjunctiva as well as internal pathologies of the retina, vitreous and optic nerve among others ( surgical intervention would necessitate referral to an ophthalmologist.)
• Strabismus (squint or turned eye) which might require surgical repair by an ophthalmologist

Common examples of diseases of organ system and systemic origin with eye complications that can be recognized by evaluation of the ocular structures include:

• diabetic eye disease and retinopathy caused by diabetes (Significant changes would then be referred to an ophthalmologist for the appropriate treament.)
• retinal changes caused by other systemic disorders such as hypertension and cholesterol problems. (Treatment would be referred to a medical doctor.)
• evaluation of ocular changes caused by medications such as hormonal contraception and Plaquenil among others

Patient management

Optometric patient management may include:

• Counsel on status regarding comprehensive or detailed evaluations of the human eye.
• Diagnosis and treatment or management of eye disease, ocular findings or visual disturbance.
• Prescribing both oral and topical medications such as antibiotics, antiinflammatory and others for the treatment of eye conditions and diseases. (The extent to which they can be prescribed is restricted from state to state.)
• Prescribing optical aids such as glasses, contact lenses, magnifiers.
• Prescribing low vision rehabilitation.
• Prescribing vision therapy.
• Performing minor (outpatient) surgical procedures (where permitted by law, in 2 states of the U.S.).

AOA definition of the care provided by optometrists (USA):

http://www.aoa.org/x5878.xml

They give advice and follow-up care regarding use of optical aids (especially contact lenses), provide referral to other health professionals including internist and other primary care physicians and particularly sub specialists like ophthalmologists who would then be qualified to treat the more severe disease with laser treatments, intraocular injections, and surgical treatments. They also interact with opticians and the optical industry, which manufacture the optical aids such as glasses in accordance to optical prescriptions.

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 optometrist was coined by Edmund Landolt in 1886, referring to the "fitter of glasses". Prior to this, there was a distinction between "dispensing" and "refracting" opticians in the 19th century. The latter were later called optometrists.

The first schools of optometry were established in 1850-1900 (in USA), and contact lenses were first used in 1940s

Licensing

Most countries have regulations concerning optometry education and practice. Optometrists like many other health care professionals 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 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).

There are 8 universities which offer Optometry in the UK, they are: Anglia Ruskin University, Aston University (Birmingham), Bradford University, Cardiff University, Glasgow Caledonian University (Glasgow) City University (London) Manchester University, and University of Ulster (Coleraine)

Registration with the GOC is mandatory to practice in the UK. Members of the College of Optometrists may use the suffix MCOptom.

United States

US optometrists after completing a 4 year bachelors degree complete a 4-year program that leads to a Doctorate in Optometry (O.D.) degree. Some American optometrists also may refer to themselves as optometric physicians; however, this is controversial, as they have not completed a medical school education. Such a title is not given to optometrists in any other country noted.

As primary eye care providers, optometrists are an integral part of the health care team. 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 covers a variety of health, science and mathematics courses. Optometry school consists of four years of study focusing on the eye, vision, and some systemic diseases.

Upon completion of optometry school, candidates graduate from accredited college of optometry and hold the optometry (OD) degree. Optometrists must pass a 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 1-2 year residencies with training in a specific sub-specialty such as pediatric care, children’s vision, geriatric care, specialty contact lens (for keratoconus patients or other corneal dystrophy) and many others. All optometrists are required to fulfill continuing education requirements to stay current on the latest standards of care.

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 in 1992 through the Law 30. 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 throughout Europe. For example, in Germany, optometric tasks are performed by 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.

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.

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]. Optometrists must be registered with the Board in order to practice in the Republic of Ireland.

The A.O.I. runs a comprehensive continuing education and professional development program on behalf of Irish optometrists. The legislation governing Optometry was drafted in 1956. The 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 significant restrictions - the use of cycloplegic drugs to examine children.

Distinction from ophthalmology

In the USA, optometrists acquire a four-year bachelor degree, followed by four years of Optometry school training to earn an OD or Doctor of Optometry degree. This program provides an understanding in ocular diseases, and management of refractive errors. After graduation, optometry students may complete an optional 1-2 year residency program in a particular area such as Pediatric Optometry, Geriatric Optometry, Glaucoma, Behavioral Optometry or Neuro-optometry. However, they are not trained in surgical techniques or procedures.

In the United States, Ophthalmologists, acquire a four-year bachelor degree, followed by 4 years of medical school to earn a doctorate of medicine (MD or DO). This is then followed by a 1 year internal medicine / general surgery internship in an inpatient hospital / medical center. Ophthalmologists then train for an additional 3 to 4 years of residency training. Residency training in ophthalmology encompasses all aspects of the diagnosis and management of diseases that affect the eye, orbit, and neurological system of the brain. This includes surgical treatment. This combination of medical school, general surgery / medicine internship, and long term residency allows them to understand not just the eye as a single unit but as a part of the whole body. Moreover, most ophthalmologists provide surgical / medical care to the anatomy that surrounds the eye (e.g., orbital bones, lids, lacrimal glands, tear ducts, brows, muscles, etc). Some ophthalmologists pursue additional fellowship training in various subspecialties, including oculoplastics / orbit, pathology, pediatric ophthalmology, neuro-ophthalmology, retina, cornea, and uveitis. Moreover, an ophthalmologist's residency and fellowship training are done in a medical center, which allows them to understand and treat ocular and periocular trauma, infection, and pathology associated with complex systemic diseases. As such, unlike an ophthalmologist, an optometrist does not typically work in conjunction with a hospital and cannot admit patients to hospitals for acute eye care issues as an ophthalmologist does.

The scope of prescribing oral medications by optometrists is often restricted by regulatory requirements which vary by state. An ophthalmologist, however, has no such restrictions on their prescribing of oral, topical, intraocular, or intravenous medications, assuming they have attained a license by their respective state medical board, as they have a doctorate in medicine and are required to pass three separate medical licensure examinations over a five-year period.

The two fields often have a mutually beneficial relationship:

Ophthalmologists may refer patients to optometrists for contact lenses or for optical aids or low vision rehabilitation. Often the professions will co-manage ocular conditions. 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). Furthermore, optometrists and ophthalmologists both manage strabismus and amblyopia with refractive and/or vision therapy. However, if the strabismus is too large for successful vision therapy, surgical intervention by an ophthalmologist may be required.

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. orthoptic practice
7. Ocular disease
8. Pediatric optometry
9. Primary care optometry
10. Vision therapy and rehabilitation

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

Ocular disease residencies involve co-management practice with other health professionals such as ophthalmology. 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.

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
• Neuro-Optometric Rehabilitation Association

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 Practice Loans

Some optometry-related publications

• Optometry and Vision Science
• Clinical and Experimental Optometry
• Ophthalmic and Physiological Optics
• Optometry: Journal of the American Optometric Association
• Review of Optometry
• The Optician
• Web Sight MD
• The Optometry Blog