Eye care professionals

An eye care professional is an individual who provides a service related to the eyes or vision. It is a general term that can refer to 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 of eye care professionals

Current terminology

• Ophthalmologist – An eye surgeon who is a Doctor of Medicine or a Doctor of Osteopathic Medicine (MD or DO). 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).
• Ophthalmic medical practitioner – A medical doctor (MD) who specializes in ophthalmic conditions but who has not completed a specialization in ophthalmology.
• Optometrist – A doctor of Optometry (OD) treats eye diseases and disorders and specializes in optics and vision correction. Permissions granted by an optometric license vary by location:
  • In the United States, 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)
    • 47 states allow prescription of oral medications to treat eye diseases
    • Some states allow optometrists to perform injections in and around the eye
    • Oklahoma and Kentucky allow optometrists to perform certain laser surgeries.
  • Outside of the United States, 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 (except in the Philippines).
• Orthoptist – Specializes in diagnosis and management of ocular motility, amblyopia and binocular vision disorders, as outlined by the International Orthoptic Association. 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.
  • In many countries orthoptic education requires an undergraduate degree for program entry followed by a couple years of postgraduate studies in orthoptics
  • In other countries orthoptics is offered as an Masters degree.
• Ocularist – Specialize in the fabrication and fitting of ocular prostheses for people who have lost eyes due to trauma or illness.
• Optician – Specializes 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 orthoptist in the hospital or clinic with vision testing.
  • In the USA the Joint Commission on Allied Health Personnel in Ophthalmology administers OMP certifications:
    1. Certified Ophthalmic Assistant (COA) – entry level
    2. Certified Ophthalmic Technician (COT) – intermediate level
    3. Certified Ophthalmic Medical Technologist (COMT) – advanced level

Older terminology

• Oculist – Either an ophthalmologist or optometrist. The term "oculist" was primarily used to describe eye care professionals that are trained and specialized in the eye care field. This is in fact a general term that can denote an ophthalmologist or an optometrist at the same time. The difference between these two types of oculists 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. Firstly, 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 – 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.

The distinction between ophthalmologist, optometrist and orthoptist

The American Academy of Ophthalmology describes an ophthalmologist as follows:

A medical doctor who specializes in all aspects of eye care including diagnosis, management, and surgery of ocular diseases and disorders.

An optometrist is defined by the World Council of Optometry (a member of the World Health Organisation) as follows:

Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection of disease in the eye, and the rehabilitation of conditions of the visual system.

The World Health Organization defines the eyecare work of an orthoptist as:

The study and treatment of defects in binocular vision resulting from defects in the optic musculature or of faulty visual habits. It involves a technique of eye exercises designed to correct the visual axes of eyes not properly coordinated for binocular vision.

Two important distinctions are evident in these definitions:

• Ophthalmologists are medical doctors and have attended medical school and specialize in surgical as well as medical care of the eye, optometrists are eyecare professionals who have attended optometry school that specialize in the refractive and primary medical care of the eye and vision, while orthoptists are eyecare professionals who have attended orthoptic school and specialize in the binocular vision and pre/post surgical care of strabismus patients.

• Second, ophthalmologists are responsible for surgical treatment. Both ophthalmologists and optometrists treat ocular disease. Optometrists "provide comprehensive eye and vision care, which includes refraction and detection/diagnosis and limited management of disease in the eye." Optometrists refer to ophthalmologists patients requiring treatments such as ocular surgery, intraocular injections, and lasers. Orthoptists primarily work alongside ophthalmologists to co-manage binocular vision treatment, but also often do comprehensive eye and vision testing.

There are also important similarities. Both optometrists and ophthalmologists treat patients with medications, optical aids and eye exercises; orthoptists treat using optical aids and eye exercises. All perform screenings for common ocular problems affecting children (such as amblyopia and strabismus) and the adult population (such as cataracts, glaucoma, and diabetic retinopathy). All are required to participate in ongoing continuing education courses to maintain licensure and stay current on the latest standards of care.

International organizations

• International Council of Ophthalmology
• World Council of Optometry. WCO represents optometrists in 40 countries.
• International Orthoptic Association. IOA represents orthoptists in 20 countries.

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. It is also 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.

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.

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.

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
• Joint Commission on Allied Health Personnel in Ophthalmology
• Optometric Extension Program
• Worshipful Company of Spectacle Makers