optometry

An optical refractor (phoropter) in use

Optometry is a health care profession concerned with the health of the eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists (also known as ophthalmic opticians outside the United States and Canada^{[1][2][3][4][5][6]}) are licensed medical professionals trained to prescribe and fit lenses to improve vision, and to diagnose and treat various eye diseases. In the United States and Canada optometrists are considered Doctors of Optometry^{[7][8][9][10][11][12]} and are held to the same legal standards as any physician.^[13][14] In all U.S. states optometrists are licensed to diagnose and treat diseases of the eye through topical diagnostic and therapeutic drugs^[15][16] and oral drugs in 47/50 states.^[17] Doctors of Optometry are also able to perform certain types of laser surgery in some states. In other countries patients are referred to other healthcare professionals, such as ophthalmologists, neurologists and general medical practitioners for further treatment or investigation.

The term "optometry" comes from the Greek words ὄψις (opsis; "view") and μέτρον (metron; "something used to measure", "measure", "rule"). The root word opto, is a shortened form derived from the Greek word, ophthalmos, meaning, "eye." Like most professions, the practice of optometry education and certification 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.

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 history of optometry can be traced back to the early studies on optics and image formation by the eye. The origins of optometric science (optics, as taught in a basic physics class) date back a few thousand years BC as evidence of the existence of lenses for decoration has been found. It is unknown when the first spectacles were made, but the British scientist and historian Sir Joseph Needham stated in his research that the ancient Chinese invented the earliest eyeglasses 1000 years ago and were also mentioned by the Venetian Marco Polo in his account of his travels in ancient China. Alternatively, research by David A. Goss in the United States, shows they may have originated independently in the late 13th century in Italy as stated in a manuscript from 1305 where a monk from Pisa named Rivalto stated "It is not yet 20 years since there was discovered the art of making eyeglasses".^[18] Spectacles were manufactured in Italy, Germany, and the Netherlands by 1300.

Benito Daza de Valdes published the third book on optometry in 1623, where he mentioned the use and fitting of eyeglasses. In 1692, William Molyneux wrote a book on optics and lenses where he stated his ideas on myopia and problems related to close-up vision. The scientists Claudius Ptolemy and Johannes Kepler also contributed to the creation of optometry. Kepler discovered how the retina in the eye creates vision. From 1773 until around 1829, Thomas Young discovered the disability of astigmatism and it was George Biddell Airy who designed glasses to correct that problem that included spherocylindrical lens.^[19]

Although the term optometry appeared in the 1759 book A Treatise on the Eye: The Manner and Phenomena of Vision by Scottish physician William Porterfield, it was not until the early twentieth century in the United States and Australia that it began to be used to describe the profession. By the late twentieth century however, marking the distinction with dispensing opticians, it had become the internationally accepted term.

Licensing

Optometry is officially recognized in many jurisdictions. Most have regulations concerning 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.

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.

Australia

Australia currently has three recognised courses in optometry:

• Bachelor of Optometry Bachelor of Science (BOptom BSc), University of New South Wales
• Bachelor of Vision Science and Masters of Optometry, Queensland University of Technology
• Doctor of Optometry, Melbourne University (post-graduate)

These courses are developments of prior course offerings at these institutions that have been expanded along with the increased scope of practice for optometrists in Australia, specifically the ability to prescribe certain therapeutic agents.

New courses are being developed at Flinders University in South Australia, which accepted students in a science degree in 2010, to begin the post graduate component of the course in 2013. A second new course is expected at Deakin University in Geelong, Victoria at the beginning of 2012.

To support these courses the Australian College of Optometry provides clinical placements to undergraduate students from Australian Universities and abroad.

Canada

In Canada optometrists must complete at least 3 years of undergraduate education and a four year Doctor of Optometry degree from one of two Schools of Optometry (one at the University of Waterloo and the other at Université de Montreal). Furthermore, they must pass board licensing examinations to demonstrate their professional skills and knowledge.

Optometrist in Canada are licensed to prescribe topical and oral medications, however, the exact medications that they are licensed to prescribe varies province by 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 in the country was issued in 1992 through the Law 30.^[20] Currently there are eight official universities that are entitled by ICFES to grant the Optometrist certification. The first optometrists arrived in the country from North America and Europe circa 1914. These professionals specialized in optics and refraction. In 1933, under Decrees 449 and 1291, the Colombian Government officially set the rules for the formation of professionals in the field of optometry. In 1966 La Salle University opened its first Faculty of Optometry after recommendation from 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 the private sector (such as Bausch & Lomb).

Europe

Currently, optometry education and licensing 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.^[21]

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 standardized practice and education guidelines within EU countries.^[22] The first examinations of the new European Diploma in Optometry were held in 1998 and this was a landmark event for optometry in continental Europe.^[23]

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 to enter the register of the Opticians Board [Bord na Radharcmhaistoiri]. Optometrists must be registered with the Board 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. Some feel that 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.

United Kingdom

In the United Kingdom, optometrists have to complete a 3 or 4 (Scotland) year undergraduate honours degree followed by a minimum of a one-year "pre-registration period", (internship), where they complete clinical practice under the supervision of a qualified and experienced practitioner. During this year the pre-registration candidate is given a number of quarterly assessments, often including temporary posting at a hospital, and on successfully passing all of these assessments, a final one-day set of examinations (Examination details correct for candidates from 2006 onwards). Following successful completion of these assessments and having completed one year's supervised practice, the candidate is eligible to register as an optometrist with the General Optical Council (GOC) and, should they so wish, are entitled to membership of the College of Optometrists. Registration with the GOC is mandatory to practice in the UK. Members of the College of Optometrists (incorporated by a Royal Charter) may use the suffix MCOptom. Nine universities offer Optometry in the UK: Anglia Ruskin, Aston, Bradford, Cardiff, City, Glasgow Caledonian, Manchester, University of Ulster at Coleraine and University of Plymouth.

Additionally, the Institute of Optometry in London offers a post-graduate professional doctorate in optometry in partnership with London South Bank University.

Ghana

In Ghana the Ghana Optometric Association (GOA) regulates the practise of Optometry. After the six year training at any of the two Universities offering the course, the O.D degree is awarded. The new Optometrist must write a qualifying exam, after which the optometrist is admitted as a member of the GOA, leading to the award of the certificate MGOA.

Mozambique

The first optometry course in Mozambique was started in 2009 at Universidade Lurio, Nampula. The course is part of the Mozambique Eyecare Project. University of Ulster, Dublin Institute of Technology and International Centre for Eyecare Education are supporting partners.

Philippines

Optometry is regulated by the Professional Regulation Commission of the Philippines. To be eligible for licensing, each candidate must have satisfactorily completed a Doctor of Optometry course at an accredited institution and demonstrate good moral character with no previous record of professional misconduct. Professional organizations of optometry in the Philippines include Optometric Association of the Philippines^[24] and Integrated Philippine Association of Optometrists, Inc. (IPAO).

Russia

This section requires expansion.

In Russia optometry education has been accredited by the Federal Agency of Health and Social Development.^{[citation needed]} There are only two educational institutions that teach optometry in Russia: Saint Petersburg Medical Technical College, formerly known as St. Petersburg College of Medical Electronics and Optics, and The Helmholz Research Institute for Eye Diseases. They both belong and are regulated by the Ministry of Health. The Optometry program is a four-year program. It includes one to two science foundation years, one year focused on clinical and proficiency skills, and one year of clinical rotations in hospitals. Graduates take college/state examinations and then receive a specialist diploma. This diploma is valid for only five years and must be renewed every five years after receiving additional training at state accredited programs.

United States

A Doctor of Optometry examining a patient with a slit lamp biomicroscope.

Doctors of Optometry in the United States are currently regulated by state boards that determine their scope of practice, which may vary from state to state. Within the healthcare system, optometrists function as primary eye care providers who are especially experienced in fitting contact lenses and glasses prescriptions.

Optometrists can also treat their patients that have eye diseases with:

-Oral medications ^[25] (such as antivirals, antibiotics, oral steroids and pain medications^[26])

-Topical medications such as prescription eye drops to treat glaucoma^[27] or red eye for example.

-Injectable medications.^[28]

Optometrists may also be trained in some surgical techniques, including those for foreign body removal, corneal injury, eyelid & lacrimal disease, removal of "lumps and bumps" around the eyes^[29] and others. In Oklahoma, the state optometry board also allows state-certified optometrists to perform surgeries limited to the anterior segment of the eye. In Kentucky, recent legislation permits Optometrists to perform a multitude of laser procedures. In many cases optometrists and ophthalmologists work together in the treatment and management of patients with various eye conditions. Opticians in America generally dispense corrective eye wear, and in some cases also construct the corrective eye wear. The scope of practice in optometry varies as it is regulated by each state.

The American Optometric Association (AOA) and the American Optometric Society (AOS) represent optometrists nationally in the USA. 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. These courses include: four semesters of chemistry to include organic and biochemistry, two semesters of physics and biology, as well as one semester of calculus, statistics, physiology, anatomy, microbiology, and psychology. Additional requirements are imposed by specific institutions. Once completing these courses, admission to an optometry doctorate program requires that candidates score well on the O.A.T., Optometry Admission Tests. There are currently 20 optometry schools in the United States, and admission into these schools is highly competitive.

Optometrists are required to complete a four-year postgraduate degree program to earn their Doctor of Optometry (O.D. - Oculus Doctor) titles. The four-year program includes classroom and clinical training in geometric, physical, physiological and ophthalmic optics, ocular anatomy, ocular disease, ocular pharmacology, neuroanatomy and neurophysiology of the vision system, binocular vision, color, form, space, movement and vision perception, design and modification of the visual environment, and vision performance and vision screening. In addition, an optometric education also includes a thorough study of human anatomy, systemic diseases, general pharmacology, general pathology, microbiology, sensory and perceptual psychology, biochemistry, statistics and epidemiology. There are three new colleges of optometry (Midwestern University Arizona College of Optometry, University of the Incarnate Word School of Optometry, Western University of Health Sciences College of Optometry) that have received the pre-accreditation status of preliminary approval from the Accreditation Council on Optometric Education (ACOE). Programs with "Preliminary Approval" have shown that they are developing within the ACOE's standards. The programs have approval to begin recruiting and admitting students, and to begin offering the program.^[30]

Upon completion of an accredited program in optometry, graduates hold the Doctor of Optometry degree. Optometrists must then pass a national examination administered by the National Board of Examiners in Optometry (NBEO).^[31] 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 one to two year residencies with training in a specific sub-specialty such as pediatric eyecare, geriatric eyecare, specialty contact lens, ocular disease or neuro-optometry. All optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of care.

See also

References

External links

Wikimedia Commons has media related to: Optometry

• World Council of Optometry
• U.S. Bureau of Labor Statistics optometrist page
• State optometry boards