Eye care professional

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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[edit]

Ophthalmologist[edit]

Ophthalmologists are doctors of medicine (M.D./D.O. - physicians) who specialize in eye care - this includes optical, medical and surgical care. They they do not have a degree specific to eye care, but they have a general medical degree and residency in eye care.”[1] In the US, this usually includes a undergraduate degree, four years of general medical training, 1 year general surgical internship and three years of eye specific training (ophthalmology residency). An ophthalmologist is qualified to practice medicine, perform invasive eye surgery, and provide general medical care (non eye related), which is the practical difference between Optometrists and Ophthalmologists. Some surgeons receive additional training (1-2 year fellowship) in certain areas of the eye such as retina, cornea, etc. Out of all surgical subspecialties, eye care surgery is one of the most specialized as the structures are so small/delicate, as such Ophthalmologists have the longest training requirement of all eye care professionals. [2]

While Ophthalmologists can provide comprehensive care, typically they manage late state eye disease and perform surgery (specialty care).

Ophthalmic medical practitioner[edit]

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

Optometrist[edit]

The World Council of Optometry, a member of the World Health Organization,[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]

Optometrists are Doctors of Optometry (O.D.) - they have a degree specific to eye care (including medicine related to eye care), rather than a general medical degree. Their training typically includes four years of college followed by four years of eye specific training (Optometry school). Some complete an additional 5th year to further their training in a specific area). Optometry school is a specialized program - specific to the eyes and related structures. As such, Optometrists receive their medical eye training (by definition: Ophthalmology) in Optometry school and during internships (hospitals, private practices, universities, VA's etc). They do not complete a general medical program before Optometry school just like Ophthalmology does not complete a Optometry program before residency. Education is provided by professors (Ph.D's), fellow Optometrists (O.D's) and physicians (M.D.'s). Often, Optometry students and Ophthalmology residents work together to co-manage medical cases. Optometrists are trained and licensed to practice medicine with respect to eye care, as in the USA and Canada - they are fully qualified/state licensed to manage any eye disease and prescribe medications, topical (eye drops) or by mouth (PO). They are also qualified to prescribe some schedule controlled substances and order imaging tests (CT/MRI) as physicians do. They are also qualified to perform non-invasive surgical procedures and some laser treatments in some states. Moreover, Optometrists have the most formal optical training of any eye care professional - 3 years of Optometry college includes formal classroom training up until National Board exams. However, Optometrists do not perform invasive surgery, or provide general (non eye-related) medical care like Ophthalmologists do.

  • In the United States, with respect to eye care, Optometrists are considered physicians under Medicare,[5] 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, Arkansas and Louisiana allow optometrists to perform certain laser surgeries.
  • Outside of the United States, Canada, United Kingdom, Australia, and the Philippines, Optometrists may be limited in their use of pharmaceuticals. In these countries, Optometry is either a 4- or 5-year college degree.

Orthoptist[edit]

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.[6] 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.[7]

Ocularist[edit]

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

Optician[edit]

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[edit]

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[edit]

Oculist is an older term that was primarily used to describe eye care professionals that are trained and specialized in the eye care field, specifically ophthalmologists and optometrists. The term is no longer used in the United States.

Vision therapist[edit]

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's 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 use 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[edit]

Ophthalmologists generally provide speciality eye care and manage late stage eye disease (often only mitigated with surgery). Optometrists typically provide comprehensive eye care - including medical, up to a moderate stage (managed with prescription medications). There is considerable overlap in scope of practice between professions. Optometrists are licensed to provide exactly the same medical care as Ophthalmologists, but not invasive surgery/ocular injections.

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[8][failed verification]. Orthoptists are primarily found working alongside ophthalmologists and optometrists 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).[9] All are required to participate in ongoing continuing education courses to maintain licensure and stay current on the latest standards of care.

See also[edit]

References[edit]

  1. ^ "About the Academy". American Academy of Ophthalmology. Archived from the original on 19 December 2014. Retrieved 13 January 2015.
  2. ^ "Ophthalmologist vs. Optometrist Similarities and Differences".
  3. ^ "Our partners". World Council of Optometry. Retrieved 13 January 2015.
  4. ^ "Who is an optometrist?". World Council of Optometry. Archived from the original on 17 December 2014. Retrieved 13 January 2015.
  5. ^ "Doctor & other health care provider services | Medicare.gov". www.medicare.gov. Retrieved 2017-11-01.
  6. ^ "About Us". International Orthoptic Association. Retrieved 13 January 2015.
  7. ^ "The Orthoptist". International Orthoptic Association. 2001. Archived from the original (Word Document) on July 31, 2009.
  8. ^ http://www.ranzco.edu/orthoptists-and-prescribing-in-nsw/view?searchterm=None
  9. ^ Georgievski, Z; Koklanis, K; Fenton, A; Koukouras, I (November 2007). "Victorian orthoptists' performance in the photo evaluation of diabetic retinopathy". Clinical & Experimental Ophthalmology. 35 (8): 733–738. doi:10.1111/j.1442-9071.2007.01576.x. PMID 17997777. S2CID 8661627. (subscription required)