Optometry

From Wikipedia, the free encyclopedia

Optometry is a doctoral-degree 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 doctoral-degree professional eye care professions, the other being ophthalmology.

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

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

[edit] Scope of practice

Optometrists, also known as doctors of optometry, are primary health care providers for the eye and visual system. They examine, diagnose, and medically treat eye diseases, non-surgical injuries, and disorders of the eyes and visual system, including refractive problems such as near- or far-sightedness, and identify related systemic medical conditions affecting the eyes and ocular adnexa. In some locations, optometrists may perform laser surgery.

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

[edit] Eye and vision examination

The typical optometric examination has three components: history-taking of both eye-related health and optical and visual functioning-related aspects of the patient, the evaluation of the health status for the detection of eye disease, and evaluating the optical and vision characteristics of the eye and observations during testings.

Examination of ocular health may include:

inspection of the external structures 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
observation of overall health status of adnexal ocular structures such as eyelids and eyelashes, as well as the lacrimal system among others
measurement of eye pressure also know as intraocular pressure
evaluation of functional aspects of the eye such as visual fields

Examination of visual skills:

applying a battery of structured visual tasks for patient to complete to evaluate the functional characteristics of the visual system such as tracking and focusing aspects as well as muscle coordination.

[edit] Pre-optometric education

Prerequisites for admission to optometry schools are similar to those to most medical, osteopathic, and dental programs.^{[citation needed]}

[edit] 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,^[1] or HRT II can be used for various disease testing and treatment.

[edit] Diagnoses

Diagnoses made by optometry depends 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. In some cases, referral to an ophthalmologist may be required for surgical treatment.

Visual 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)

Common examples of ocular pathologies diagnosed and treated by optometrists include:

glaucoma
cataracts
infection 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 might require surgical repair by an ophthalmologist
Haemorrhage of vascular supply to the eye (internal or external)

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

diabetic eye disease and retinopathy caused by diabetes
retinal changes caused by other systemic disorders such as hypertension and cholesterol problems
evaluation of ocular changes caused by medications such as oral contraceptives and Plaquenil among others

[edit] 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 medications such as antibiotics, antiinflammatory and other for the treatment of eye conditions and diseases.
Prescribing optical aids such as glasses, contact lenses, magnifiers.
Prescribing low vision rehabilitation.
Prescribing vision therapy.

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 for surgical consultation, and interact with opticians and the optical industry, which manufacture the optical aids such as glasses in accordance to optical prescriptions.

[edit] 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 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. ^[2]

The first schools of optometry were established in 1850-1900 (in USA), and contact lenses were first used in 1940s ^[3]

[edit] 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

[edit] 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).

There are 6 universities which offer Optometry in England, they are: Anglia Ruskin University, Aston University, Bradford University, Cardiff University, London City, and Manchester University

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.

[edit] United States

US optometrists complete a 4-year program that leads to a Doctorate in Optometry (O.D.) degree. Many optometrists complete a one- or two-year residency to specialize. A sample curriculum is available from the Inter American University School of Optometry. As primary eye care providers, doctors of optometry 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. In addition to profession-specific courses, optometrists are required to take 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 accredited college of optometry and hold the 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 training in a specific sub-specialty. These specialties include 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.

[edit] 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.

[edit] 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.^[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).

[edit] 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. ^[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] ew

[edit] 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.

[edit] Distinction from ophthalmology

Ophthalmologists after obtaining a 4-year bachelor degree, attend medical school for 4 years of medical training to obtain an Doctor of Medicine (MD) or an Osteopathic (DO) degree. Ophthalmologists train for an additional three to four years of residency training. Residency training in ophthalmology encompasses all aspects of diagnosis and management of diseases that affect the eye, orbit, and neurological system of the brain. This includes surgical treatment. Many ophthalmologists pursue additional fellowship training in various subspecialties.

In the USA, optometrists also acquire a 4-year bachelor degree followed by 4 years of Optometry school to earn an OD or Doctor of Optometry degree. While in school, optometry students undergo internship training and after completion of the degree, have options of 1- to 2-year residency programs for further specialization.

Optometrists having completed a residency can further specialize in a particular area such as Pediatric Optometry, Geriatric Optometry, Behavioral Optometry or Neuro-optometry.

Optometry school curriculum in the United States include such courses as vision sciences, health sciences, pharmacology, encompassing diagnosis and management of diseases that affect the eye, orbit, and neurological system of the brain. Examples include courses in visual psychophysics, optics, as well as training in aspects of functional vision such as vision therapy, binocular vision, and low vision. Optometrists are also trained extensively in anatomy, histology, neurology, vision perception. They have a broad understanding of disease etiology, management, and treatment. In general, optometrists can do the same things ophthalmologists do with the exception of managing diseases (e.g. ptosis, strabismus, wet macular degeneration, proliferative diabetic retinopathy, glaucoma, cataracts) that require surgical expertise. Depending on state law, however, many optometrists are licensed to perform minor surgery as well as laser surgery. Some states limit the prescribing of oral medications by optometrists depending on licensure and regulatory requirements.

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 whilst continuing to treat the underlying disease/condition that may have reduced vision. Similarly, complicated and emergency eye conditions are 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).

Optometrists generally manage treatment of strabismus and amblyopia with vision therapy while Ophthalmologists manage these disorders with refractive, orthoptic, medical and surgical therapy.

[edit] Sub-specialties

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

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.

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.

[edit] Etymology

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

[edit] See also

[edit] External links

[edit] Organizations

[edit] Other

[edit] Some optometry-related publications

[edit] References

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