Optometry

Definition of optometry and optometrist

The World Council of Optometry, World Health Organisation and about 75 optometry organisations from over 40 countries all over the world adopted the following definition, to be used to describe optometry and optometrist.

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/diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system.

History

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. 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 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 World Council of Optometry has a web resource that provides basic information on eye care providers for more than 46 countries.

Africa

In 1993 there were four countries in Africa with optometric teaching institutes: Ghana, Nigeria, South Africa and Tanzania.

Ghana

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.

Mozambique

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.

Nigeria

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.

India

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.

In 2013 it was reported in the Indian Journal of Ophthalmology that poor spectacle compliance amongst school children in rural Pune resulted in significant vision loss.

In 2015 it was reported in the Optometry and Vision Science that, optometrists need to be more involved in providing core optometry services like binocular vision and low vision.

Training in India

At present there are more than fifty schools of optometry in India. 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.

The 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.

Malaysia

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.

Pakistan

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. This creates difficulty for Pakistani optometrists who wish to register abroad. University of Lahore has recently launched Doctor of optometry (OD).

Philippines

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).

Saudi Arabia

In Saudi Arabia optometrists must complete a five-year doctor of optometry degree from Qassim University and King Saud University .

Singapore

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

Thailand

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

Australia currently has five recognized courses in optometry:

To support these courses the Australian College of Optometry provides clinical placements to undergraduate students from Australian Universities and abroad.

in 2016, almost 5000 optometrists in general practice were licensed with their regulatory body,the Optometry Board of Australia. Of these, approximately 2300 were registered with the scheduled medicines endorsement, which enables them to prescribe some medicines for the treatment of conditions of the eye.

New Zealand

New Zealand currently has one recognised course in optometry:

In July 2014, the Medicines Amendment Act 2013 and Misuse of Drugs Amendment Regulations 2014 came into effect. Among other things, the changes to the Act name optometrists as authorised prescribers. This change enables optometrists with a therapeutic pharmaceutical agent (TPA) endorsement to prescribe all medicines appropriate to their scope of practice, rather than limiting them to a list of medicines specified in regulation; this recognises the safe and appropriate prescribing practice of optometrists over the previous nine years.

Europe

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.

France

There is no regulatory framework and optometrists are sometimes trained by completing an apprenticeship at an ophthalmologists' private office.

Germany

Optometric tasks are performed by ophthalmologists and professionally trained and certified opticians.

Greece

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.

Since 2015, a Master of Science (MSc) course in Optometry is offered by the Technological Educational Institute of Athens.

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 he performed the first LASIK procedure on a human eye.

Hungary

Optometrists education takes 4 years in the medical universities in Hungary, and they will get a Bachelor of Science degree. They work in networks and retail stores and private optics, very few are located in the Health Care care system as ophthalmologists as an assistant.

Ireland

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.

Italy

The Italian government does not legally recognise optometry as a health profession. Optometric tasks are performed by ophthalmologists and optometry has been declared illegal and not existing since July 2016. Before this decision the highest court used to recognize that "optometry can be practiced, given that there are no law that prohibit it". It is taught at seven universities: Padua, Turin, Milan, Salento, Florence, Naples and Rome, as three years course (like a BSc) of "Scienze e tecnologie fisiche" as sector of the Physics Department, but you cannot practice this discipline being illegal. Additionally, courses are available at some private institutions (as at Vinci Institute near Firenze) that 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, which does not recognize this title.

Norway

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.

Russia

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).

United Kingdom

Licensing

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. Registration with 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.

The National Health Service provides for the medical, ophthalmic (covering optometry), dental and other ancillary needs of every person in the UK.

Training

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. 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, University of Portsmouth

Additionally, the Institute of Optometry in London offers a post-graduate professional doctorate in optometry in partnership with London South Bank University.

Scope of Practice

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 that allow them to prescribe medications to treat and manage eye conditions. There are currently three registerable specialties:

Canada

Training

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.

Licensing

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.

Representation

In Canada the profession is represented by the Canadian Association of Optometrists. In the province of 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 increased to include prescribing certain oral and topical drugs, ordering lab tests, ordering and applying ultrasound tests, and treating certain types of glaucoma.

United States

Optometrists in the United States are doctors of optometry (O.D.) who function as primary eye care providers. While optometrists traditionally specialize in refractive vision correction through eyeglasses and contact lenses, the practice of optometry has now developed significant overlap with general ophthalmology, the branch of medicine involving the health of the eyes and visual system. Optometrists are licensed to diagnose and treat many common diseases of the eye through oral, topical, diagnostic, and therapeutic medications. Doctors of optometry are also currently able to perform certain types of laser surgery in Oklahoma, Kentucky, and Louisiana.

Scope of Practice

Within the United States healthcare system, optometrists function as primary eye care providers who are especially experienced in fitting contact lenses and eyeglass prescriptions while also treating and managing common eye diseases such as glaucoma and dry eye syndrome. Optometrists are also known as optometric physicians (O.D.), held to the same standard as other government regulated health care practitioners participating in Medicare. Ophthalmologists are medical eye physicians and surgeons (M.D. or D.O.) who have completed medical school, ophthalmology residency, and specialty fellowship in certain divisions of ocular surgery (example: cornea, retina, glaucoma, etc.). Opticians are eye care professionals who fit and dispense vision correcting lens prescriptions written by optometrists and ophthalmologists.

Today's optometrists manage the majority of primary eye care and medical eye care in the United States. They conduct routine comprehensive eye exams, prescribe refractive eyeglass and contact lens prescriptions, and manage many common eye diseases and conditions (example: glaucoma, diabetic retinopathy, dry eye syndrome, red eye, anterior uveitis, etc.). When their patients require tertiary care and surgical management, optometrists often refer and co-manage with ophthalmology. When systemic conditions are suspect, today's optometrists will also co-manage medical cases with other medical specialties including internal medicine, emergency medicine, neurology, rheumatology, dermatology, pediatrics, oncology, and radiology.

Optometrists in the United States are licensed to treat eye diseases with:

Optometrists in the United States may also be trained in certain surgical procedures, including ocular foreign body removal, corneal epithelial debridement, removal of "lumps and bumps" around the eyes, ocular injections, and even certain laser surgeries including YAG capsulotomy, laser trabeculoplasty, and peripheral iridotomy.

The scope of practice in optometry varies state to state and is individually regulated. For example:

Regulation

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.

Licensing

The American Optometric Association (AOA) represents optometrists nationally in the United States. 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 (including general, organic, and biochemistry + laboratories), two semesters of physics and biology + laboratories, 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.

Education and Training

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 (O.D.) and are able to apply for licensure to practice optometry in the state of their choosing after passing three national board examinations. Optometrists must pass all national board examinations administered by the National Board of Examiners in Optometry (NBEO) during their four years of postgraduate education. This three-part examination includes applied basic science, patient assessment and management, and clinical skills performance testing. Some optometrists go on to complete one to two-year residency and fellowship training in a specific sub-specialty such as ocular disease, cornea and specialty contact lens, pediatric eye care, vision therapy and rehabilitation, refractive and ocular surgical co-management, low vision, neuro-optometry, and traumatic brain injury vision rehabilitation. All optometrists are required to fulfill continuing education requirements to stay current regarding the latest standards of care.

Argentina

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.

Brazil

The Brazilian Government does not state rules about optometry, 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 Brazilian law, however, there is an explicit recommendation that the one prescribing corrective lenses are prohibited to sell them. This restricting rule to the ophthalmologists has keeping the optic shops away from Hospitals and Eye Care Clinics since 1930, and it has to be reviewed before any further regulation for the optometrists.

Colombia

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).