Optometry is the profession of examining the eye for defects, diseases or faults of refraction, and prescribing pharmaceuticals, corrective lenses or exercises to treat these conditions. Doctors of optometry (O.D.s) are trained and licensed to detect and treat ocular symptoms and diseases.
Description
Doctors of optometry are primary health care professionals who examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures, as well as diagnose related systemic conditions. They prescribe glasses, contact lenses, low visionrehabilitation, vision therapy, and medications, as well as perform certain surgical procedures.O.D.s need eight to 10 years of preparation for their profession—four years to earn the doctor of optometry
degree, and one to two years of residency in training. Oklahoma, as of 2001, was the only state where O.D.s were allowed by law to perform laser refractive surgery. Other states also were considering similar measures.
The profession of optometry also routinely includes diagnosing and treating the ocular complications of diseases such as diabetes and hypertension; rehabilitating patients with brain injury or stroke; providing low vision services for the partially sighted. This includes vision therapy for patients with amblyopia and strabismus (crossed eyes). O.D.s also take an active co-management role with ophthalmologists (M.D.s) in the pre- and post-operative treatment of patients after laser refractive surgery and cataract surgery.
Primary care
All O.D.s treat diseases and dispense corrective lenses for astigmatism, hyperopia, and presbyopia. They monitor the patient's depth perception and ability to focus and see color. Many optometrists choose primary care or "family practice" because it gives them the biggest diversity of patients.
Some of these primary care O.D.s specialize in contact lens fittings. Recent advances have allowed patients previously restricted from wearing contact lenses to wear a number of types of lenses. Astigmatic and presbyopic patients require more specialized contact lens fitting which these specialists can provide. Sometimes otherO.D.s or ophthalmologists will refer their patients to these contact lens specialists. These O.D.s also are more familiar with infections and irritants caused by contact lenses and how best to treat them.
Some O.D.s specialize in certain other areas of optometry, as well as in contact lenses. These specialties include:
Low vision/vision rehabilitation
Some O.D.s focus mainly on low vision services and work in tandem with ophthalmologists, rehabilitation specialists, and government and private agencies. They sometimes work together to determine the best optical devices that improve the quality of life for patients with limited vision. These patients are referred to these optometric specialists usually after a colleague has performed an initial evaluation. The O.D. and members of the specialized
team take the routine exam one step further by utilizing magnifiers, specialized charts, telescopes, colored filters, lenses, prisms, computerized devices, lights, and closed-circuit televisions designed to maximize vision. The low vision specialist is up-to-date on the latest vision aids and treatments so that his patients can lead more productive lives.
Vision therapy (developmental vision)
Vision therapy is a specialty where O.D.s concentrate on how eyesight affects human behavior. Vision therapy specialists work with physicians, psychologists, educators and parents to treat learning disorders, for example, dyslexia, by helping patients with hand-eye and other motor coordination. These specialists also treat patients suffering from amblyopia and strabismus. Some of these patients are adults; many are school-age children.
Pediatric optometry
This is a popular optometric specialty. Common vision problems in children include myopia, amblyopia and strabismus. These specialists work with parents and children, and school systems, counseling them on proper treatment as well as nutrition.
Geriatric optometry
As patients age, the frequency of ocular disease increases. Specialists can detect and treat macular degeneration, glaucoma and diabeticeye conditions. They also can detect cataracts and co-manage these patients post-operatively with an ophthalmologist.
With the geriatric population expected to increase dramatically due to aging baby boomers, more optometrists will find an expanding need to serve this population, and possibly increase the number of O.D.s who might decide to choose this specialty.
Some O.D.s focus on these patients in an existing practice, while others serve patients in nursing homes or clinics with large numbers of elderly patients.
Research and consulting
Some vision companies, especially contact lens manufacturers, seek out optometrists to help them with new product development or to refine existing products. Other optometrists conduct research in a clinical or educational setting.
Work settings
O.D.s may have private, group or partnership practices in hospitals and eye clinics. There are also commissioned posts for optometrists in the military. Government agencies seek advice from O.D.s for health advisory committees, and corporations rely on optometrists for consultation on new products.
Optometrists practice mainly in solo private practices or in a group private practice with other O.D.s. Their offices are located in office buildings, medical parks, storefronts and shopping malls. Some O.D.s opt for working for or franchising chain "superstores" that offer a big selection of frames and quick-turnaround for patients.
With the rise of laser refractive surgery, O.D.s are increasingly becoming a part of ophthalmologists' group practices. In these instances, the O.D. is usually not a coowner of the practice, but an employee instead. Some refractive laser centers keep O.D.s on staff strictly for comanaging the large volume of refractive surgery patients.
Education and training
O.D.s must complete high school and a bachelor's degree before admission to a four-year optometry school. The pre-optometry student's courses should include physics, organic chemistry, biology or zoology, physiology, statistics, geometry and calculus. These students also need to score in the top percentages of the Optometric Admissions Test before being accepted to an optometry program. Admission to these accredited programs is limited, so it is important for students to maintain a high undergraduate grade point average and achieve a high score on the admissions test to earn a slot at these schools.
The four-year programs focus mainly on clinical and practical teachings. In recent years a few programs have added practice management courses to help optometrists cope with managed care paperwork and increased competition from retail chains. First-year students study human anatomy and physiology and the basic principles of optics. Optometric sciences, ocular physiology and pathology, vision anomalies, and instruments of clinical practice are studied in the second year. Third-year students take those same topics to a higher level and begin studying contact lens fitting and general clinical practice. The student's last year of study includes treating patients under the guidance of teaching optometrists, usually at optometry-school run clinics. Student O.D.s during the fourth year prescribe and fit contact lenses, and diagnose and treat visual system conditions.
During the four years, optometry students also are offered a number of electives that include epidemiology, environmental vision, microbiology, and biostatistics.
Optometry schools usually operate clinics where patients need them most—in inner-city neighborhoods, nursing homes or correctional facilities. This enables care for patients in need while offering fourth-year students an opportunity to detect and treat a number of ocular conditions.
After optometry students complete a four year program but before they can begin practice, they must complete a series of written examinations—at least three written and one practical—for a license in order to practice. These licenses are granted by state boards of optometry. Each state has different requirements. While they are similar, graduating optometry students must check with each licensing board for specific requirements.
Advanced education and training
Recent optometry school graduates sometimes complete master's or doctorate degrees in related medical specialties such as physiological optics, visual sciences or public health. Some of these doctors enter research or education.
Optometrists who want to specialize in certain areas complete a one-year residency after graduation at educational institutions or hospitals. These internships could include pediatric or geriatric optometry, low-vision rehabilitation or vision therapy.
State boards of optometry require a certain number of continuing education credits for practicing optometrists. This training is completed through specialized courses at meetings, optometry schools, optometric journals and the Internet. Continuing education credits must meet specific requirements of each state. The O.D. must check with the state licensing board for specific details.
Future outlook
More women are becoming optometrists than in years previous. As of 2001, about 25% of practicing optometrists were women. That number should rise since 50% of optometry students as of 2001 are women.
A comprehensive study by the American Optometric Association completed in 1997 predicted that there will be at least 4,000 more optometrists than needed by the year 2015. Several factors could affect that prediction.
Geriatric population. The increasing number of elderly patients could mean a highly-increased number of office visits for optometrists. These elderly patients need more frequent examinations for myriad eye diseases and conditions.
Vision plans. Managed care has brought more patients into optometrists' offices in recent years. Before managed care, many patients delayed regular eye exams because of cost. Because comprehensive vision plans routinely pay for regular eye exams, and in some cases contact lenses and eyeglasses, more patients routinely are being seen by O.D.s at a higher rate of frequency.
Retail chains. More eye care patients are utilizing the convenience of these large "superstores" to fulfill their vision needs. These chains sometimes have several optometrists on staff. The need for "corporate optometrists" is expected to grow in the coming years. These positions do not pay as competitively as private practice; but they also do not incur the large debt that opening or purchasing a practice does.
KEY TERMS
Amblyopia—Decreased visual acuity, usually in one eye, in the absence of any structural abnormality in the eye.
Astigmatism—Asymmetric vision defects due to irregularities in the cornea.
Cataract—A cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. This cloudiness can cause a decrease in vision and may lead to eventual blindness.
Glaucoma—Disease of the eye characterized by increased pressure of the fluid inside the eye. Untreated, glaucoma can lead to blindness.
Presbyopia—A condition affecting people over the age of 40 where the system of accommodation that allows focusing of near objects fails to work because of age-related hardening of the lens of the eye.
Refraction—Method of determining the optical status of the eyes. Lenses are placed before the patient's eyes while reading from an eye chart. The result is the eyeglass or contact lens prescription.
BOOKS
Belikoff, Kathleen, M. Opportunities in Eye Care Careers, 2nd ed. Lincolnwood, IL: Contemporary Publishing Company, 1998.
ORGANIZATIONS
American Academy of Optometry 6110 Executive Boulevard, Suite 506 Rockville, MD 20852. (301) 984-1441 Fax(301) 984-4737 aaoptom@aol.com. htttp://www.opt.org.
American Optometric Association. 2420 North Lindbergh Boulevard, St. Louis, MO 63141. (800) 365-2219. <http://www.aoanet.org/>.
Council on Optometric Practitioner Education 4401 East West Highway, Suite 205 Bethesda, MD 20814-4521. (800) 758-COPE (2673) (301) 913-0641 Fax (301) 913-2034. COPE@copeonline.org. <http://www.copeopt.org>.
National Board of Examiners in Optometry. 4340 East West Highway, Suite 1010, Bethesda, MD 20814. (301)652-5192. nbeo@optometry.org. <http://www.optometry.org>.
OTHER
McClure, Lawrence H., Ph.D. "The Evolution of Optometry." Optometric Management Online. <http://www.optometric.com/archive_results.asp?loc=article=70066&sub=1146>.
