An optometrist examining a patient with a slit lamp biomicroscope.
|BSc (Hons) Optometry/ BOptom (Hons) (UK)
Doctor of Optometry (US)
Optometry is a healthcare profession concerned with the eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists are trained to prescribe and fit lenses to improve vision, and in some countries are trained to diagnose and treat various eye diseases.
In the United States, Canada, and Ghana, optometrists are known as doctors of optometry (abbreviated as OD), and are held to the same legal standards as physicians, whereas optometrists in the United Kingdom (also known as ophthalmic opticians) are regulated by the General Optical Council under the Opticians Act 1989 and distinguished from medical practitioners. The National Health Service provides for the medical, ophthalmic (covering optometry), dental and other ancillary needs of every person in the UK.
In all U.S. states, optometrists are doctors (optometric physicians) practicing optometric medicine (medical optometry). They are licensed to diagnose and treat diseases of the eye through topical, diagnostic, and therapeutic drugs. They can prescribe oral drugs and perform injections. Doctors of optometry are also able to perform certain types of laser surgery in three states, Oklahoma, Kentucky, and Louisiana. In countries where the practice of optometry is statutorily regulated, patients are referred, if and when necessary, to family physicians and medical specialists such as ophthalmologists, neurologists and others for further investigation and treatment.
- 1 Origin
- 2 History
- 3 Training, Licensing, Representation and Scope of Practice
- 3.1 Africa
- 3.2 Asia
- 3.3 Australasia
- 3.4 Europe
- 3.5 North America
- 3.6 South America
- 4 See also
- 5 References
- 6 Sources
- 7 External links
The term "optometry" comes from the Greek words ὄψις (opsis; "view") and μέτρον (metron; "something used to measure", "measure", "rule"). The word entered the language when the instrument for measuring vision was called an optometer, (before the terms phoropter or refractor were used). The root word opto is a shortened form derived from the Greek word ophthalmos meaning, "eye." Like most healthcare professions, the education and certification of optometrists is regulated in most countries. Optometric physicians and optometry-related organizations interact with governmental agencies, other healthcare professionals, and the community to deliver eye- and vision-care.
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. The British scientist and historian Sir Joseph Needham, in his Science and Civilization in China, discusses the occasional claim that spectacles were invented in China. He states that the belief may have been based on a source that was modified during the Ming dynasty (14th - 17th century), that the original document made no references to eyeglasses, and that the references that were there[which?] stated the eyeglasses were imported.
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". Spectacles were manufactured in Italy, Germany, and the Netherlands by 1300.
In 1907 Professor Berthold Laufer, who was a German American anthropologist, stated in his history of spectacles 'the opinion that spectacles originated in India is of the greatest probability and that spectacles must have been known in India earlier than in Europe'.
But Joseph Needham stated in his "Science and Civilization" that the paper by Laufer had many inconsistencies, and that the references in the document used by Laufer were not in the original copies but added during the Ming dynasty.,
However, the German word brille (eyeglasses) is derived from Sanskrit vaidurya. Etymologically, brille is derived from beryl, Latin beryllus, from Greek beryllos, from Prakrit verulia, veluriya, from Sanskrit vaidurya, of Dravidian origin from the city of Velur (modern Belur). Medieval Latin berillus was also applied to eyeglasses, hence German brille, from Middle High German berille, and French besicles (plural) spectacles, altered from old French bericle
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.
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 early twenty-first century however, marking the distinction with dispensing opticians, it had become the internationally accepted term.
Training, Licensing, Representation and Scope of Practice
Optometry is officially recognized in many jurisdictions. Most have regulations concerning education and practice. Optometrists, like many other healthcare professionals, are required to participate in ongoing continuing education courses to stay current on the latest standards of care.
The Ghana Optometric Association (GOA) regulates the practise of Optometry in Ghana. 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 title MGOA.
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 Brien Holden Vision Institute are supporting partners.
In Nigeria, optometry is regulated by the Optometry and Dispensing Opticians Registration Board of Nigeria established under the Optometry and Dispensing Opticians ( Registration ETC ) Act of 1989 (Cap O9 Laws of Federation of Nigeria 2004). The Boards publishes from time to time lists of approved qualifications and training institutions in the federal government gazette. The Doctor of Optometry degree is awarded after a six-year training at one of the accredited universities in Imo, Edo and Abia states.
In 1958, two schools of optometry were established, one at Gandhi Eye Hospital, Aligarh in Uttar Pradesh and other one at Sarojini Devi Eye Hospital, Hyderabad in Andhra Pradesh, under second five-year plan by Director General of Health Services of Government of India. These schools offered diplomas in optometry courses of two years duration validated by State Medical Faculties. Subsequently four more schools were opened across India situated at Sitapur Eye Hospital, Sitapur in Uttar Pradesh, Chennai (formerly Madras) in Tamil Nadu, Bengalooru (formerly Bangalore) in Karnataka and Thiruvananthapuram (formerly Trivandrum) in Kerala. Elite School of Optometry (ESO) was established in 1985 at Chennai and was the first to offer a four-year degree course.
Academic degrees such as Bachelor of Optometry, Master of Optometry and Doctor of Philosophy in Optometry are awarded in India by the universities recognised by University Grants Commission (India), a statutory body responsible for the maintenance of standards of higher education in India. Optometrists across India are encouraged to register with the Optometry Council of India, a self-regulatory body registered under the Indian Company Act.
In 2010 it was estimated that India needs 115,000 optometrists; whereas India has approximately 9000 optometrists (4-year trained) and 40,000 optometrists (2-year trained). In order to prevent blindness or visual impairment more well trained optometrists are required in India. It should be noted that definition of optometry differs considerably in different countries of the world. India needs more optometry schools offering four-year degree courses with a syllabus similar to that in force in those countries where practice of optometry is statutorily regulated and well established with an internationally accepted definition.
It takes four years to complete a Degree in Optometry. Today, optometry courses are well received by citizens. More universities and higher education studies are about to implement the courses. e.g. National Institute of Ophthalmic Sciences in Petaling Jaya whereby it is the academic arm of The Tun Hussein Onn National Eye Hospital.
Optometry is taught as a five/four-year Doctor/ Bachelors/ Bachelors with Honors course at many institutions notable among which are Department of Optometry & Vision Sciences (DOVS) FAHS, ICBS, Lahore, Pakistan Institute of Community Ophthalmology (PICO) Peshawar, College of Ophthalmology & Allied Vision Sciences (COAVS) Lahore and Al-Shifa Institute of Ophthalmology Islamabad. After graduation the optometrists can join a four-tiered service delivery level (Centre of Excellence, Tertiary/Teaching, District headquarter and sub-district /Tehsil headquarters). M.Phil in Optometry is also available at select institutions such as King Edward Medical University, Lahore Department of Optometry & Vision Sciences (DOVS) FAHS, ICBS, Lahore started bridging programmes for Bachelors/ Bachelors with Honors to become Doctor of Optometry OD, Post Professional Doctor of Optometry(PP-OD), Transitional Doctor of Optometry(t-OD). Optometry is not yet a regulated field in Pakistan as there is no professional licensing board or authority responsible for issuing practice licenses to qualified optometrists which creates great difficulty for Pakistani optometrists specially who wish to register abroad.
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 and Integrated Philippine Association of Optometrists, Inc. (IPAO).
In Saudi Arabia optometrists must complete a five-year doctor of optometry degree from Qassim university and King Saud university .
Tertiary education for optometrists takes 3 years at the following institutions.
Singapore Polytechnic - Diploma in Optometry Singapore Polytechnic
Ngee Ann Polytechnic - Diploma in Optometry Ngee Ann Polytechnic
Since later 1990, Thailand has set goal to provide more than 600 optometrists to meet the minimal public demands and international standards in vision cares. There are more than three university degree programs in Thailand. Each program accept students that have completed grade 12th or the third year in high school (following US education model.) These programs offer "Doctor of Optometry" degree to graduates from the program that will take six years to complete the courses. Practicing optometrists will also required to pass licensing examination (three parts examinations) that is administrated through a committee under the Ministry of Public Health.
Nowadays, the number of practicing optometrists in Thailand is still less than one hundred. However, it has projected that the number of practicing optometrists in Thailand will greatly increase within the next ten years. In theoretical scenario, the number of optometrists should be able to meet minimal public demands around 2030 or earlier.
Australia currently has five recognised courses in optometry:
- Bachelor of Vision Science and Master of Optometry (BVisSci MOptom), Deakin University
- Bachelor of Medical Science (Vision Science) and Master of Optometry, Flinders University
- Bachelor of Optometry Bachelor of Science (BOptom BSc), University of New South Wales
- Bachelor of Vision Science and Master of Optometry, Queensland University of Technology
- Doctor of Optometry, Melbourne University (post-graduate)
To support these courses the Australian College of Optometry provides clinical placements to undergraduate students from Australian Universities and abroad.
New Zealand currently has one recognised course in optometry:
- Bachelor of Optometry (BOptom), The University of Auckland
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. 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.
There is no regulatory framework and optometrists are sometimes trained by completing an apprenticeship at an ophthalmologists' private office.
Hellenic Ministry of Education founded the first department of Optometry at Technological Educational Institute of Patras in 2007. After protests from the department of Optics at Technological Educational Institute of Athens (the only department of Optics in Greece, until 2006), the Government changed the names of the departments to "Optics and Optometry" and included lessons in both optics and optometry. Optometrists-Opticians have to complete a 4-year undergraduate honours degree. Then the graduates can be admitted to postgraduate courses in Optometry at universities around the world.
Institute of Vision & Optics - http://ivo.gr The Institute of Vision and Optics (IVO) of the University of Crete focuses on the sciences of vision and is active in the fields of research, training, technology development and provision of medical services. Professor Ioannis Pallikaris has received numerous awards and recognitions for the Institute’s contribution to ophthalmology. In 1989 performed the first LASIK procedure on a human eye.
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 Dublin Institute of Technology. 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.
The Italian Government does not legally recognise optometry as a health profession; anyway the highest court recognize that "optometry can be practiced, given that there are no law that prohibit it". It is taught at seven universities: Padua, Turin, Milan, Lecce, Florence, Naples and Rome, as three years course (like a BSc) of "Scienze e tecnologie fisiche" as sector of the Physics Department. Additionally, there are courses available at some private institutions (as at Vinci Institute near Firenze, that starts courses in 1969) which offer advanced professional education for already qualified opticians (most of the Italian optometrists are also qualified opticians, i.e. "ottico abilitato"). The fitness-to-practice is granted by the study title itself (i.e.: "titolo abilitante") after an exam; there are no professional councils nor registry nor regulatory bodies, other than the government Ministry of Health itself.
In Norway the optometric profession has been regulated as a healthcare profession since 1988. After a three-year bachelor program one can practice basic optometry. At least one year in clinical practice qualify for a post-degree half-year sandwich course in contact lens fitting, which is regulated as a healthcare specialty. A separate regulation for the use of diagnostic drugs in optometric practice was introduced in 2004.
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 Helmholtz 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 scope of practice for optometrists in Russia includes: refraction, contact lens fitting, spectacles construction and lens fitting (dispensing), low vision aids, foreign body removal, referrals to other specialists after clinical condition diagnoses (management of diseases in the eye).
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 (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 Statutory body, the GOC, is mandatory to practice optometry in the UK. Members of the College of Optometrists (incorporated by a Royal Charter granted by Her Majesty Queen Elizabeth II) may use the suffix MCOptom. Ten universities offer Optometry in the UK: Anglia Ruskin, Aston, Bradford, Cardiff, City, Glasgow Caledonian, Hertfordshire, Manchester, University of Plymouth and Ulster University at Coleraine.
In 1990 a survey of the opinions of British medical practitioners regarding the services provided by British optometrists was carried out by Agarwal at City University in London. A majority of respondents were in favour of optometrists extending their professional role by treating external eye conditions and prescribing broad spectrum topical antibiotics through additional training and certification.
Since 2009, optometrists in the UK have been able to undertake additional postgraduate training and qualifications which allow them to prescribe medications to treat and manage eye conditions.
In Canada, in order to obtain their professional designation, doctor of optometry degree, optometrists typically must complete minimum three years undergraduate education, and a four or five year university program in optometry accredited by the Accreditation Council on Optometric Education. There are two schools of optometry located in Canada and 20 in the United States that are accredited and recognized in Canada. The two Canadian schools of optometry accredited are at the University of Waterloo and at Université de Montreal. Upon completion of their optometry education, they are also required to satisfy the provincial requirements of the province or territory they are intended to practice. These requirements include a national examination administered by the Canadian Examiners in Optometry, and licensure by the provincial or territorial governing body.
In Canada, regulatory of professions is within provincial jurisdiction. Therefore, regulation of optometry is unique to individual provinces and territories. In Ontario, optometrists are licensed by the College of Optometrists of Ontario.
In Ontario, the Ontario Association of Optometrists is the designated representative of optometrists to the provincial government.
Scope of Practice:
Optometrists in Canada are licensed to prescribe topical and oral medications; however, the exact medications that they are licensed to prescribe varies province by province. In Ontario, optometrists are able to prescribe drugs to treat normal tension glaucoma (a type of primary glaucoma), transient intraocular pressure elevations, an acute glaucoma crisis, and dacryocystitis. In Alberta, optometrists will soon have their scope of practice increase to include prescribing certain oral and topical drugs, ordering lab tests, ordering and applying ultrasound tests, and treating certain types of glaucoma.
Scope of Practice:
Within the healthcare system, optometrists function as primary eye care providers who are especially experienced in fitting contact lenses and glasses prescriptions while treating diseases such as glaucoma and dry eye disease. Optometrists are known as optometric physicians too, and students are also known as student optometric physicians. Opticians are more retail-based in America. They generally dispense corrective eyewear, and in some cases also construct the corrective eyewear.
Optometrists can also treat their patients that have eye diseases with:
- Oral medications (such as antivirals, antibiotics, oral steroids and pain medications)
- Topical medications such as prescription eye drops to treat glaucoma or red eye.
- Injectable medications.
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 and others.
The scope of practice in optometry varies as it is regulated by each state. For example:
- In Oklahoma and Louisiana, 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.
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. The Association of Regulatory Boards of Optometry (ARBO) assists these state board licensing agencies in regulating the practice of optometry.
The American Optometric Association (AOA) represents 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 21 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.) titles. The four-year program includes classroom and clinical training in geometric, physical, physiological and ophthalmic optics, specialty contact lens evaluation and fitting, ocular anatomy, ocular disease, ocular pharmacology, neuroanatomy and neurophysiology of the vision system, pediatric visual development, gerontology, 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 human anatomy, systemic diseases, general pharmacology, general pathology, microbiology, sensory and perceptual psychology, biochemistry, statistics and epidemiology.
Upon completion of an accredited program in optometry, graduates hold the doctor of optometry degree and are able to practice optometric medicine. Optometrists must also pass a national examination administered by the National Board of Examiners in Optometry (NBEO) during their four years. 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 residency and fellowship training in a specific sub-specialty such as ocular disease, neuro-optometry, cornea and contact lens, low vision, traumatic brain injury vision rehabilitation, vision therapy and rehabilitation, refractive and ocular surgery, pediatric eyecare, and geriatric eyecare. All optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of care.
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.
The Brazilian Government does not legally recognize optometry as a profession, and the Brazilian Council of Ophthalmology recommends against its official legal recognition.
The CBOO (Brazilian Council of Optics and Optometry), which is affiliated to the WCO (World Council of Optometry), represents Brazilian optometrists. In conjunction with organizations representative weight of Brazilian companies, including the National Commerce Confederation for goods, services and tourism (CNC), through the CBÓptica/CNC, its defense arm of optometric and optical industry, are defending the right of free and independent practice of optometrists, even if it is against the interests of ophthalmologists.
The Federal Supreme Court (STF), the Brazilian Court of Justice and the Superior Court of Justice (STJ), another important National Court, ruled several processes granting inquestionable victories to optometrists.
Opticals, Optometry Centres and Optometry Clinics have nowadays operating permission granted by the health authorities since 2008, when the first Judgement in Supreme Courts grateful for the work of the professionals of optometry.
In Colombia optometry education has been accredited by the Ministry of Health. The last official revision to the laws regarding healthcare standards in the country was issued in 1992 through the Law 30. 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).
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-  American Optometric Association
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- AOA (February 27, 2012). "Prescription of narcotic medications for treatment of eye diseases". aoa.org (American Optometric Association).
- AOA (February 27, 2012). "Treatment of glaucoma by state". aoa.org (American Optometric Association).
- Hedger, Brian (April 13, 2009). "Several states face battles over optometry scope of practice". amednews.com (American Medical Association).
- KOA (February 27, 2012). "New laws allowing ODs to perform surgery". kyeyes.org (Kentucky Optometric Association).
- http://www.cboo.org.br, www.sindioptica-go.com.br
- Consejo Nacional de Acreditación
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