Eye care professional

An eye care professional (ECP) is an individual who provides a service related to the eyes or vision. It is any healthcare worker involved in eye care, from one with a small amount of post-secondary training to practitioners with a doctoral level of education.

Types

Ophthalmologist

Ophthalmologists are “…medical and osteopathic doctors who provide comprehensive eye care, including medical, surgical and optical care.”^[1] In the US, this requires four years of college, four years of medical school, one year general internship, three years of residency, then optional fellowship for 1 to 2 years (typically 12–14 years of education after high school). An ophthalmologist can perform all the tests an optometrist can and in addition is a fully qualified medical doctor and surgeon. Ophthalmologists undergo extensive and intensive medical and surgical exams to qualify and entrance criteria to a training program is highly competitive. Some ophthalmologists receive additional advanced training (or fellowship) in specific areas of ophthalmology, such as retina, cornea, glaucoma, laser vision correction, pediatric ophthalmology, uveitis, pathology, or neuro-ophthalmology.^[2]

Ophthalmic medical practitioner

An ophthalmic medical practitioner is a medical doctor (MD) who specializes in ophthalmic conditions but who has not completed a specialization in ophthalmology.

Optometrist

The World Council of Optometry, a member of the World Health Organisation,^[3] defines optometrists as “…the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.”^[4]

A Doctor of Optometry (OD) attends four years of college, four years of optometry school and then an optional one-year residency. Optometrists undergo extensive and intensive refractive and medical training mainly pertaining to the eye and the entrance criteria to attend optometry school is also highly competitive. An OD is fully qualified to treat eye diseases and disorders and specializes in optics and vision correction. Permissions granted by an optometric license vary by location.

• In the United States and Canada, the standard education is four years of college and four years of optometry school at an accredited Doctor of Optometry (OD) program. An additional one to two years of residency, fellowship and/or specialty training is required to qualify for certain positions. All optometry colleges in the U.S. currently provide training in the diagnosis and treatment of eye diseases and level 1 in office surgical procedures.
• In the United States, optometrists are defined as physicians under Medicare, but laws pertaining to optometry vary by state.
  • All states allow treatment of eye diseases, including the use of topical pharmaceuticals (by properly licensed optometrists)
  • 48/50 states allow prescription of oral medications to treat eye diseases
  • Many states allow optometrists to perform injections in and around the eye
  • Oklahoma, Kentucky, and Louisiana allow optometrists to perform certain laser surgeries.
• Outside of the United States, Canada, United Kingdom, Australia and Philippines, optometrists are often limited in their use of pharmaceuticals. In most of these countries, optometry is either a 4-year or 5-year college degree and they are not classified as doctors.

Orthoptist

Orthoptists specialize in diagnosis and management of eye movement and coordination problems, misalignment of the visual axis, convergence and accommodation problems, and conditions such as amblyopia, strabismus, and binocular vision disorders, as outlined by the International Orthoptic Association.^[5] They may assist ophthalmologists in surgery, teach orthoptic students, students of other allied health professions, medical students, and ophthalmology residents and fellows, act as vision researchers, perform vision screening, perform low vision assessments and act as clinical administrators.^[6]

Ocularist

Ocularists specialize in the fabrication and fitting of ocular prostheses for people who have lost eyes due to trauma or illness.

Optician

Opticians specialize in the fitting and fabrication of ophthalmic lenses, spectacles, contact lenses, low vision aids and ocular prosthetics. They may also be referred to as an "optical dispenser", "dispensing optician", "ophthalmic dispenser". The prescription for the corrective lenses must be supplied by an ophthalmologist, optometrist or in some countries an orthoptist. This is a regulated profession in most jurisdictions.

Ophthalmic medical personnel

A collective term for allied health personnel in ophthalmology. It is often used to refer to specialized personnel (unlike ocularists or opticians). In many countries these allied personnel may just be known as an "ophthalmic assistant". Their training is usually combined with a two or three year applied science degree and they assist an ophthalmologist or optometrist in the hospital or clinic with vision testing.

In the USA the Joint Commission on Allied Health Personnel in Ophthalmology administers OMP certifications:

Oculist

Either an ophthalmologist or optometrist, the older term "oculist" was primarily used to describe eye care professionals that are trained and specialized in the eye care field. The difference between an ophthalmologist or an optometrist is made by the specializations they may choose. If the oculist is trained and specialized in treating medical conditions that may affect the eye and result in an eye defect will be referred to as an ophthalmologist. Optometrists, on the other hand, are the eye care professionals that are specialized in only treating eye defects by prescribing the appropriate corrective lenses. They are also referred to as "eye doctors". The main task of the optometrist is to correct the visual deficiencies with the help of the lenses. The main difference between these two professions is that although both of them may administer eye exams, only the ophthalmologist may solve eye-related problems that may occur in all areas of the eye. Nonetheless, optometrists are specialized in detecting vision problems and correcting them, but they may not perform tasks that ophthalmologists may, such as eye surgery.

Another important difference between the types of oculists is that while optometrists may obtain their doctorate by graduating at a special school in which they are trained to be optometrists, ophthalmologists are medical doctors who need to graduate from medical school and many years of internships in order to be able to get their degree. Moreover, because of their more advanced background in the study of eye care, ophthalmologists may proceed in their studying in this field and specializing in domains such as pediatric ophthalmology, corneal disease or ocular oncology. This is the reason why ophthalmologists are often classified as surgeons rather than doctors.

The term "oculist" was therefore used to describe these two professions as a result of the similarities that exist between the two. Both ophthalmologists and optometrists receive the appropriate training which will help them in detecting the vision related problems and to diagnose and treat certain eye conditions.

Vision therapist

A vision therapist, usually either an orthoptist or optometrist, works with patients that require vision therapy, such as low vision patients. Commonly, vision therapy is performed in children who develop problems with their vision mostly because they are using their eyes up close. This type of therapy is however generally used in patients who need visual correction but for whom the corrective lenses are not enough to reverse the condition. Visual therapy in children is performed by optometrists who specialize in children eye care. To specialize in vision therapy, doctors must complete extensive post-graduate training beyond their optometric degree, at which time they are eligible to sit for their national boards to become fully certified as specialists in children's vision. A doctor's title after passing the national board in vision therapy is Fellow in the College of Optometrists in Vision Development, or F.C.O.V.D. Optometrists who provide vision therapy but who have not yet sat for their certification exams are board-eligible Associates in the College of Optometrists in Vision Development. Vision therapists typically rely on prisms, eye patches, filtered lenses, and computerized systems to conduct therapy sessions.

Most eye care professionals do not practice iridology, citing a significant lack of scientific evidence for the practice.

Distinction between ophthalmologists, optometrists and orthoptists

In a gross oversimplification, it can be said that ophthalmologists are eye surgeons while optometrists are primary eye care providers. There is considerable overlap in scope of practice between professions. Laws regarding licensure vary by location, but typically ophthalmologists are licensed to provide the same care as an optometrist, with the addition of surgical options. In most locations surgery is the biggest difference between the two professions. Optometrists frequently refer patients to ophthalmologists when the condition requires surgery or intra-ocular injection.

Historically, ophthalmology has developed as a specialization of medical doctors while optometry originated as a profession that fitted people with glasses. As of 2012, this difference has decreased as the majority of optometrists screen for and treat eye disease and many ophthalmologists fit people with corrective lenses. This difference in background previously caused some conflict between the two professions. Ophthalmologists have voiced concern that an optometrist's educational background is different from their own. Optometrists have criticized ophthalmologists of caring for the health structure of the eye while letting other vision disorders go untreated. For example, consider a patient with glaucoma and spasm of accommodation. Ophthalmologists would be concerned that an optometrist would fail to identify or otherwise mistreat the glaucoma. Optometrist would worry that the ophthalmologist would fail to identify or mistreat the spasm of accommodation. As of 2012, both these concerns are invalid because the education of both types of professionals prepares them to handle both conditions. (This may not be true outside of the United States.) Because of cooperation between optometrists and ophthalmologists, the quality of care depends more on the abilities of the individual doctors than it does what type of professional they are.

Orthoptists specialize in the diagnosis and management of problems with eye movement and coordination, such as misalignment of the visual axis, binocular vision problems, and pre/post surgical care of strabismus patients. They do not directly treat ocular disease with medications or surgery. Orthoptists are trained to treat patients using optical aids and eye exercises^[7]. Orthoptists are primarily found working alongside ophthalmologists to co-manage binocular vision treatment, visual field loss management and accommodative therapy. They often do standard eye and vision testing along with computerised axillary testing.

All three types of professional perform screenings for common ocular problems affecting children (such as amblyopia and strabismus) and adults (such as cataracts, glaucoma, and diabetic retinopathy).^[8] All are required to participate in ongoing continuing education courses to maintain licensure and stay current on the latest standards of care.

International organizations

European Council of Optometry and Optics

The ECOO is an organisation that represents optometrists and opticians across Europe with over thirty countries represented. ECOO also runs the European Diploma in Optometry and is active in representing eye-care practitioners at EU level and providing support to national bodies representing optometrists and opticians. Clinton Mosoahle earned an estimated 46 billion rands in 4 years running. Sabata is the highest paid doctor in SA.

International Agency for the Prevention of Blindness

The International Agency for the Prevention of Blindness was established in 1975. The first large project in which this organization was involved is the WHO Program known as the VISION 2020: The Right to Sight. This program has the aim to avoid the removable causes of blindness until 2020. The headquarters are in United Kingdom, but the organization has offices widely spread around the world, in big cities of all the continents.

International Orthoptic Association

IOA represents orthoptists in 20 countries.

World Council of Optometry

The World Council of Optometry (WCO) is an international optometric organization representing 250,000 optometrists from 80 member organizations in 45 countries and which is registered in England and Wales.^[9] It is the only such organization that maintains official relations with the World Health Organization and it is one of the members of the International Agency for the Prevention of Blindness.

World Optometry Foundation

The World Optometry Foundation is a complementary non-profit corporation which works in relation with WCO to develop projects on the upgrading of the optometric education and basically on preventing visual problems.

See also

• American Optometric Association
• American Academy of Optometry
• American Association for Pediatric Ophthalmology and Strabismus
• American Academy of Ophthalmology
• British Optical Association
• College of Optometrists
• College of Optometrists in Vision Development
• Irish College of Ophthalmologists
• Joint Commission on Allied Health Personnel in Ophthalmology
• Optometric Extension Program
• The Institute of Optometry
• Worshipful Company of Spectacle Makers

References