passfail

Optometry

[op-tom-i-tree]

Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision 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).

Etymology

The term "optometry" comes from the Greek word optos, meaning eye or vision, and metria, meaning measurement.

Scope of practice

Optometrists are primary health care providers for the diagnosis management and treatment of eye diseases and visual system refractive disorders. Optometrists examine and diagnose many disorders of the eyes and visual system, including refractive (i.e., near or far sightedness) and disease related conditions.

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 eye 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.

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. Most ocular disorders may be treated by an optometrist. However, all major surgical procedures are referred to or co-managed with an 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.
Strabismus (squint or turned eye) which may require vision therapy or surgical repair depending on the severity.

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 co-managed with an ophthalmologist for appropriate treament).
retinal changes caused by other systemic disorders such as hypertension and cholesterol problems. (Patients would then be referred to their primary care physician for appropriate treatment).
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 (American Optometric Association) definition of the care provided by optometrists (USA):

http://www.aoa.org/

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.

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

Optometrists provide a wide range of care, including:

Detect and diagnose eye diseases such as glaucoma, cataracts, retinal disorders, lid disorders, and infections such as conjunctivitis.
Prescribe medication to treat eye diseases.
Evaluate and treat vision conditions such as nearsightedness, farsightedness, astigmatism and presbyopia.
Perform minor surgical procedures such as removing foreign objects from the eye.
Provide pre- and post-operative care, especially for glaucoma, laser, refractive, and cataract patients.
In some instances, perform laser, refractive or glaucoma surgeries.

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

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 generally complete a 4 year bachelors degree, then complete a mandatory 4 year program that leads to a Doctorate in Optometry (O.D.) degree. Some American optometrists are also referred to as 'Optometric Physicians' depending on the state in which they practice.

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 systemic diseases.

Upon completion of optometry school, candidates graduate from accredited college of optometry and hold the Doctor of Optometry (O.D.) 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.

Sub specialties

There are currently nine sub-specialty residencies offered by various schools of optometry in the United States

Cornea and contact lenses
Family practice optometry
Geriatric optometry
Glaucoma
Low vision rehabilitation
orthoptic practice
Ocular disease
Pediatric optometry
Primary care optometry
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 who are involvded primarily in those areas. 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.