Optometry

Overview
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 (medical doctors) and opticians.



Scope of practice
Doctors of optometry (ODs), are primary health care professionals for the eye, serving patients in nearly 6,500 communities in the United States alone. 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. Optometrists prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, and contact lenses. Optometrists can detect and diagnose eye diseases and disorders including glaucoma, cataracts and diabetic retinopathy. In all 50 of the United States, optometrists are licensed to prescribe medications to treat ocular diseases. Optometrists in Oklahoma may perform certain minor laser procedures.

Eye & vision examination
As with most health care, examination often includes history taking and observations during tests.


 * Examination of ocular health may include:
 * inspection of the external and internal ocular structures with various specialty equipment
 * observation of various eye movements and alignment
 * observation of pupillary reaction to light


 * 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.

Another less common example of equipment used in optometry is Fresnel goggles which disables the patient from focusing, and thus is a tool to evaluate patients with Balance disorders

Recently many optometrists have began using equipment specifically designed to help treat certain diseases. For example, in states where O.D.'s are licensed to treat glaucoma you may find equipment that helps the O.D. to document a sick retina such as a Optical coherence tomography, GDX, or HRT II. Many offices have various visual field analyzers including a Humphrey Visual Field Analyzer.

Diagnoses
Diagnoses made by optometry depends on integrating eye examination information.

Some ocular pathology can be associated with systemic, neural or other disease complications. Some ocular pathology and visual dysfunctions or disorders may require further specialty testing. Hence, referral may be required to refine diagnoses and/or to implement appropriate treatment.


 * 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)


 * Some common examples of ocular pathology diagnosed by optometry:
 * cataract, macular degeneration, glaucoma, visual field loss
 * infection and inflammation of ocular structure(s)
 * haemorrhage of vascular supply to the eye (internal or external)

Management
Optometry management can include:
 * counsel regarding examination, diagnosis and management of ocular and visual findings
 * prescribing medications, and perform certain surgical procedures (in some countries)
 * prescribing optical aids such as glasses, contact lenses, magnifiers
 * prescribing low vision rehabilitation
 * prescribing vision therapy


 * advice and follow-up care regarding use of optical aids (especially contact lenses)
 * referral to other health professionals, often including medical doctors, 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.

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

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 most English speaking countries including UK 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 and Iran

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). The three-part exam includes basic science, clinical science and patient care. 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. Although optometry training in the United States is similar to that of the United Kingdom and many other countries, 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.

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.

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.

Distinction From Ophthalmology
Ophthalmologists complete a general medical degree (M.D.) at an accredited medical school, and an additional four years of postgraduate specialty medical and surgical training in ophthalmology. Ophthalmologists can manage ocular diseases (or ocular conditions) with medical and/or surgical treatments. Similar to optometry, there are also various sub-specialties within ophthalmology.

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. Ophthalmology training focuses more on dicks and medical and surgical management of ocular and systemic disease with less emphasis on functional 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. Hence optometrists are often more concerned with optical and vision therapy treatments.

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. 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 may refer to ophthalmology for further assessment and medical treatment of ocular disease or condition. Optometrists and ophthalmologists sometimes co-manage treatment of strabismus and amblyopia with a combination of vision therapy, medical or surgical treatment.

See also Ophthalmology

Sub-specialties
There are currently nine sub-specialty residencies offered by various schools of optometry in the United States :
 * 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.

Organizations

 * World Council of Optometry


 * 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

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

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