Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists (also known as ophthalmic opticians[1][2][3][4]) are licensed medical professionals trained to prescribe and fit lenses to improve vision, and to diagnose and treat various eye diseases. In most U.S. states optometrists are licensed to treat eye diseases through topical therapeutic agents and oral drugs, and 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.
Like most professions, the practice of optometry education, 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.
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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."
In the United States, optometry is currently regulated by state boards that determine their scope of practice, which may vary somewhat from state to state. Optometrists have been successful in expanding their practice scope to include medical therapy, including oral medications (such as antivirals, antibiotics, and oral steroids), topicals, and injections.[5] In Oklahoma and Kentucky, optometrists can perform laser surgery.
Within the healthcare system, optometrists function as primary eye care providers who are especially experienced in fitting contact lenses and glasses prescriptions. Optometrists also have the ability to treat a wide variety of eye diseases through the administration of topical, oral and injectable medicines (depending on the state) although their scope is limited to the eye. Optometrists may be trained in some surgical techniques, including those for foreign body removal, corneal injury, eyelid & lacrimal disease, 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 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.
Behavioral optometry is a related area of non-strabismus vision therapy that some optometrists practice. Generally ophthalmologists and orthoptists do not practice this because it is not based upon scientific, peer reviewed studies. It generally involves intense therapy that requires at least a weekly visit with eye exercises at home. In some cases it can improve eye movement control beyond what eyeglasses alone can do. This practice has been debunked several times in history, most recently by Barrett, et al.[6] This is akin to what many now know as the Seeing Clearly Method, which itself is a rehashing of the Bates Method that was originally published in 1920.[7]
Optometric history is tied to the development of
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, O.D., Ph.D., shows they may have originated independently in the late 13th century in Italy as stated in a manuscript from 1305 AD where a monk from Pisa named Rivalto stated "It is not yet 20 years since there was discovered the art of making eyeglasses".[8] Spectacles were manufactured in Italy, Germany, and the Netherlands by 1300 AD.
Benito Daza de Valdes published the third book on optometry in 1623, where he mentioned the use and fitting of eyeglasses. 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.[9]
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.[10]
A pilgrim named Peter Brown is believed the first person to wear a pair of glasses in the U.S. However, for a long time eyeglasses were only made in Europe, which made them expensive and difficult to find. The first man to buy a pair of eyeglasses in the U.S. was John McAllister Sr., from Philadelphia Pennsylvania, in 1783. McAllister, with his son, John McAllister Jr. started making eyeglasses in the U.S. in 1811. Their business continued until the 20th century. The family also taught refraction, and one of their students, James W. Queen began his own business in 1853.[8]
Two other early optometrists, Benjamin Pike and James Prentice, studied in England and came to the US in 1847. They trained their sons, and James's son, Charles Prentice, had an important role in the development of optometry in the U.S.[8]
The American Optometric Association formed on January 11, 1922 after Morris Steinfeld held a meeting with seven optometrists to discuss whether optometry should be a business or a profession. At the end of this meeting, they formed the American Academy of Optometry with the vision to transform the entire body optometric to a profession with a scientific basis.[11] The American Optometric Society formed in August 2009. Doctors were concerned that policy decisions by the AOA leadership did not represent the desires of the majority of the profession, and were not in profession's best interests.
The first optometry schools were established in 1850–1900. The first schools of optometry in the U.S. began in the late 19th century, with the Illinois College of Optometry in 1872, and the New England College of Optometry in 1894. In 1914, Ohio State University began a optometry program after Professor Charles Sheard gave a presentation to the Ohio State Optical Association, who helped him financially to open the program. It started as a two-year course, which later became a four-year degree program. Until 1937, the program was called Applied Optics, then the name changed to Optometry.[12]
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 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 currently has three recognised courses in optometry:
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.
In Canada optometrists hold a Doctorate of Optometry degree and are licensed by the boards in the provinces they wish to practice. There are two schools of optometry, one at the University of Waterloo and the other at Université de Montreal.
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.
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.[14] 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).
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.
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.[15]
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.[16] 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.[17]
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.
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.
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[18] and Integrated Philippine Association of Optometrists, Inc. (IPAO).
In Russia optometry education has been accredited by the Federal Agency of Health and Social Development. 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.
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 extremely 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.[19]
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).[20] 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.
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