An optometrist sometimes gets confused with other medical professionals who specialize in disease or disorders of the eye. An optometrist is a health care specialist who specializes in examining and treating disorders of the eyes. This includes defects in vision, eye injuries and diseases or any abnormality related to the eyes. You may have heard an optometrist also referred to as an optician or an ophthalmologist; however, they each have unique roles and responsibilities in their respective occupation. Optometrists were previously known as ophthalmic opticians.
An optometrist is a healthcare professional who provides primary vision care ranging from sight testing and correction to the diagnosis, treatment and management of vision changes (AAPOS, 2011). An optometrist is not a considered a physician or a medical doctor, although they do obtain a doctor of optometry (OD) degree. The main responsibilities of an optometrist are to perform eye and vision testing, prescribe and dispense eye glasses or contacts (or other corrective lens), detect eye abnormalities and they may prescribe medications for some eye infections or diseases.
You may have also heard the terms ophthalmologist and optician along with optometrist. There is a difference between the three, although all three specialize in eye and vision care.
Ophthalmologist
An ophthalmologist is also referred to as an eye doctor. They are licensed medical or osteopathic doctors who specialize in eye and vision care. An ophthalmologist has a higher level of training and specialization than an optometrist, and they practice both medicine and surgery. This type of eye doctor diagnoses and treats all eye diseases, performs eye surgery and prescribes and fits eyeglasses and contact lenses to correct vision problems (AAPOS, 2011). Some may also conduct scientific research to investigate causes and cures of certain eye diseases or vision disorders.
Some ophthalmologists may also have a sub-specialty in a particular eye disorder or surgical eye care. Sub-specialties may include glaucoma, retina, cornea, pediatrics, neurology or plastic surgery. An ophthalmologist completes 8 years of medical school, and if they choose a sub-specialty, they will have an additional two years of medical training.
Optician
An optician is a technician who is trained to design, verify and fit eyeglass lenses and frames, contact lenses and other devices to correct eyesight (AAPOS, 2011). An optometrist or ophthalmologist will write a prescription, and the optician uses that prescription to design the corrective lenses, but they do not perform eye testing or write prescriptions themselves. An optician should not diagnose or treat disease of the eye, as they are not trained or licensed to do so.
What Does an Optometrist Do?
Optometrists are licensed to detect, diagnose and treat diseases and disorders of the eye. They perform the same activities as an ophthalmologist, with the exception of performing surgery. An optometrist may work in a hospital, clinic, educational institutions or in a research laboratory, or they may work elsewhere in the ophthalmic industry. Most optometrists work in clinical practices, hospitals and public health centers.
Optometrists in Clinical Practice
In a clinical practice, an optometrist will perform general eye examinations, document the patient’s medical history, and check the patient’s eyes for refractive errors and visual acuity. Depending on the test result, they may then prescribe corrective lenses. Optometrists perform many other functions in addition to visual testing.
An optometrist may perform the following in a clinical practice (Khetropal, 2017):
Observance of eye disease: Using an ophthalmoscope, optometrists detect diseases of the eyes such as glaucoma, macular degeneration, and other eye function diseases such as diabetes and hypertension. If irregularities persist in the detection, the patient will undergo additional testing.
Prescribing drugs for diseases: For management of ocular disorders and treatment of glaucoma, optometrists are certified to prescribe topical forms of pharmaceutical drugs including antibiotics, antihistamines, non-steroidal anti-inflammatory, and some scheduled analgesics. Only optometrists in Florida, New York, and Massachusetts can prescribe the oral form of these drugs.
Independent prescribing: Optometrists, after certification by an independent prescribing qualification, are authorized to prescribe all licensed drugs except parenterals (injectables), although this practice is typically only followed among optometrists in the United Kingdom.
Contact lens professionals: Optometrists who are professionals in handling contact lenses for abnormal shape of cornea also prescribe special contact lenses such as toric and varifocal lenses for patients.
Optometrists in Hospitals
An optometrist working in a hospital may perform the same duties as an optometrist in a clinical setting, but they typically have other duties and responsibilities as well. In most cases, they provide outpatient eye care within the hospital.
In addition, an optometrist may provide low vision care those will irreversible loss of or damage to their vision. They may prescribe vision exercises that may improve their eyesight. Binocular vision care is required for patients with binocular abnormalities, and this typically requires vision therapy. Patients with cataracts may see an optometrist for pre- or post-surgery counseling.
Optometrists employed by a hospital may also be involved in researching vision disorders due to neurological effects in patients with binocular vision and other vision disorders. They may also educate and train new employees in the optometry field and medical students and residents.
Signs and Symptoms Presented to Optometrists
Bulging of one or both eyes; Dark curtain or veil that blocks your vision; Decreased vision, even if temporary; Diabetes mellitus; Distorted vision; Double vision; Excess tearing; Eyelid abnormalities; Family history of eye disease; Halos (colored circles around lights); High blood pressure; HIV or AIDS; Injury to the eye; Loss of peripheral (side) vision; Misaligned eyes; New floaters (black "strings" or specks in the vision) and/or flashes of light; Pain in the eye; Thyroid disease-related eye problems (Graves' disease); Unusual red eye. (AAPOS, 2011).
How to Become an Optometrist
Since an optometrist is not a licensed medical doctor, they do not have to complete quite as much training as an ophthalmologist, but they do need to complete an undergraduate degree and an accredited 4-year optometry program. When the optometry program is completed, an aspiring optometrist will need to be licensed in the state they wish to practice before they can begin to treat patients. Residency programs are not required, but they offer additional training and allow an optometrist to focus on a sub-specialty area.
Undergraduate Degree
A future optometrist must first complete an undergraduate degree, which typically takes 4 years to complete. Although there is no specific major that is required to be accepted into a Doctor of Optometry program, there are admission requirements that should be considered when selecting an undergraduate major. Admission requirements for an optometry program include college coursework in English, math, physics, chemistry and biology. Many students choose to major in a science to prepare for the optometry program admissions test.
The Optometry Admissions Test (OAT) measures the student’s academic ability and scientific comprehension. The test consists of four sections: natural sciences, reading comprehension, physics and quantitative reasoning. Most students take the OAT during their junior year in college. Some students may be accepted into an optometry program after completing their 3rd year of college, and they finish their undergraduate degree in the optometry program, although this is not frequent.
Doctor of Optometry Degree
In order to become a licensed optometrist, a 4-year optometry program at an accredited school of optometry must be completed. The Accreditation Council on Optometric Education of the American Optometric Association is the accrediting organization for these programs. Each optometry program may have slightly different requirements, so applicants should understand the specific requirements of the program they wish to apply to.
An optometry program consists of classroom and laboratory training in a variety of subjects including health and visual sciences, pharmacology, optics, vision science, biochemistry and systemic diseases. Students will also receive clinical training to diagnose and treat disorders and diseases of the eye or eyesight.
Residency Programs
A one-year residency program is optional for an optometrist who has completed a doctor of optometry degree. This allows optometrists to gain additional clinical training and education in a sub-specialty area such as pediatric or geriatric optometry, vision therapy and rehabilitation, low-vision rehabilitation, cornea and contact lenses, refractive and ocular surgery, primary eye care optometry and ocular disease.
Certification and Licensing
Before an optometrist can legally treat patients, they must be licensed in the state they wish to practice in. To be licensed, they must have a Doctor of Optometry degree from an accredited optometry school and they must pass a national written examination and a national, regional or state clinical examination. Typically, both the clinical and written examinations take place throughout the Doctor of Optometry program and residency.
An additional state examination may be required, depending on the respective state. Most state examinations consist of content specific to state laws and regulations. A license to practice optometry must be renewed frequently, usually every 1 to 3 years. To maintain their license, an optometrist must accumulate continuing education credits throughout the year.
Job Prospects
The employment outlook for optometrists is very good; the U.S. Bureau of Labor Statistics (BLS), projects that employment in the optometry field will grow approximately 27% though the year 2024. The median annual earnings for optometrists in 2015 were $103,900.
The History of Optometry
Ancient Origins
The origins of optometry and optometric science begins with evidence of lenses worn for decoration around 3,000 BC. Throughout the late BC and early AD period, Greek authors documented information about burning glass and concepts of light travel in relation to angles of incidence and reflection. In addition, other Greek scientists and mathematicians documented the process of image formation by the eye, with Johannes Kepler documenting the first accurate description of image formation in the retina (Goss, 2003).
The Origin of Spectacles
The exact origin and inventor of spectacles are unknown (Goss, 2003). According to Goss (2003), spectacles probably originated in the late 13th century in Italy, as a manuscript from 1305 AD mentions prior discoveries of the art of making eyeglasses. In the year 1263, Roger Bacon first mentioned lenses for use for those with weakness of sight. It is possible that the creator of the first spectacles kept his methods secret to avoid competition; but by 1300 AD, there were spectacle businesses in Italy, Germany and the Netherlands (Goss, 2003). Most spectacles were created from either leather and wood.
In 1604, Johannes Kepler first described the function of the retina and how concave lenses and convex lenses correct vision defects, followed by Willebrord Snell’s discovery of the law of refraction in 1621. Just two years later, the first book of optometry was published in Spain. This was the very first publication to describe optometric principles, and it was titled “The Use of Eyeglasses” and was written in Spain by Daza de Valdes.
The first use of the term “optometrist” is credited to Landolt in 1886, which he used to describe the fitting of glasses. The term became popular in the early 20th century. Before then, optometrists were referred to as opticians. The word “optometry” is often credited to a man in Holland by the name of Verschoor, who used the word in a thesis dissertation on refraction principles.
The Development of Optometry in the United States
As the story goes, a Pilgrim by the name of Peter Brown wore the first pair of eyeglasses in North America around 1620. The glasses were brought over from Europe and at the time, they were extremely uncommon thus extremely expensive.
In 1783, a whip and cane maker located in Philadelphia began to make and sell spectacles. John McAllister, Sr. is credited with the beginnings of the American optical industry (Goss, 2003). His son, John McAllister, Jr., joined the business in 1811, and they continued their family eyeglass business selling gold and silver spectacles until the early 1900s.
At the time, there was not a high demand for eyeglasses or vision testing. The McAllister family began to educate others on refraction and how to make and sell eyeglasses. Notable among the students was James W. Queen, who started his own optical business in 1853 (Goss, 2003). Optical businesses began to separate into two forms: dispensing eyeglasses and refracting opticians. Refracting opticians performed vision testing and prescribed a refractive lens that would correct the patient’s vision.
Benjamin Franklin also contributed to the development of optometry in the United States. He invented the first split bifocal lenses in 1784. In 1798, John Dalton described the first theory of color blindness. In 1801, Thomas Young was the first to measure an astigmatism, and in 1827, George Biddell Airy published what would be the first design and successful lens creation to correct an astigmatism. Thomas Young was also the first to map the normal visual field.
The Late 1800s
The McAllister family education on refraction led to the separation of lens prescriptions and the dispensing or selling of eyeglasses. This led to both areas developing independently. James Prentice arrived in the United States with his son, Charles, in 1847. James Prentice received optics training in England, and he began teaching his son the business when they arrived in America. Several years later, Charles Prentice would become known as the Father of American Optometry.
The first ophthalmoscope was invented in Germany by Herman von Helmholtz in 1851. This instrument allowed von Helmholtz to see into the interior of the human eye. The development of the ophthalmoscope allowed for huge advances in the field of optometry, because doctors could now see the structure and design of the inner eye and analyze its functions to provide more accurate diagnoses. Five years later, von Helmholtz published the Handbook of Physiological Optics, which was translated into English in 1924.
The eye chart that optometrists still use today to test patient’s vision was first developed in 1862 by Herman Snellen. He devised test types and eye charts to measure visual acuity. Ten years later, the first educational institution for optometry began to develop at the Illinois College of Optometry. Charles Prentice made his most significant contribution to optometry in 1886, when he developed the first prism diopter system to measure lens power. The first contact lenses were made in 1888, the same year William Boehne published his Handbook for Opticians. Boehne was also a member of the American Optometry Association.
In 1895, Charles Prentice was almost jailed for charging a fee for eye exams, because optometrists were not recognized as a medical practice. The next year, Prentice submitted a document requesting states to recognize optometry as health care professionals (the first state recognition occurred in 1910). This led to the establishment of the American Association of Opticians in 1898, although the name was changed to the American Optical Association in 1910. Nine years later, the name changed again to the American Optometric Association (AOA).
The 1900s
The establishment of the AOA led to increasing educational opportunities involving optometry. Columbia University was the first to offer college courses in optometry in 1910. The first Doctor of Optometry (O.D.) degree was awarded by the Pennsylvania College of Optometry in 1923. Two years later, the first international optometric fraternity, Beta Sigma Kappa, was founded.
The concept of routine eye examinations was introduced by Charles Sheard in 1928, which later developed into the case analysis approach to refractive issues. This year was also significant because the state of New York passed a bill allowing optometry school graduates to participate in state board examinations. Previously, the United States Supreme Court approved a ruling disqualifying optometry as an area of medical practice. Also in 1928, the Oklahoma Optometric Association was established, and it became a private organization in 1936.
In 1951, the National Board of Examiners in Optometry (NBEO) offered the first national board examination for optometry. The following year, Otto Wichterle developed the first soft contact lens, which is the prototype contacts made today are based on. Throughout the 1960s and 70s, many states passed legislature identifying optometry as a legitimate health care field and allowing professionals in this field to prescribe medication.
Coverage for optometry services was not permitted under Medicare until 1981, when Congress passed a bill allowing reimbursement for certain eye procedures. The reimbursements were expanded when additional legislation was passed in 1986. Optometry continues to be a respected health care field, and it has become a standard health care recommendation to have your eyesight checked at least once a year.
The First Licensure Laws for Optometrists
The first United States medical licensure law was passed in the late 1700s. Most states established their own medical boards by 1895. The first state licensure law for optometrists was passed in the state of Minnesota in 1901, with all states and the District of Columbia implementing their own laws by 1924.
Optometry has incorporated knowledge of optics, mathematics, psychology, and other sciences, as well as developing its own literature in clinical practice and vision science (Goss, 2003). Optometry has been the leader in investigations on clinical lens application, non-strabismic binocular vision problems, contact lenses, low vision, role of vision in learning, etc. (Goss, 2003).
Optometry has now evolved to the use of lasers to correct eyesight among other medical advances. Although an optometrist is not considered a medical doctor, they make significant contributions to the health of their patient’s eyes which contributes to a higher quality of life. In 2009, the American Board of Optometry (ABO) was established as the official organization for optometry board certification. While certification is optional for practicing optometrists, it does offer an additional professional network and exposure to the latest advances in this health field.
The profession of optometry is expected to grow significantly in the future. Many practicing optometrists are extremely satisfied with their occupation, and it offers a decent salary. Optometrists working in a private practice tend to work normal business hours, while those working in hospitals may have various shift work, depending on their responsibilities. Since optometrists do not perform surgery, they are not typically called on in emergency or late-night situations. Most optometrists enjoy their work, as they are in a relatively low-stress environment and they get to improve their patients’ quality of life.
References
AAPOS - American Association for Pediatric Ophthalmology and Strabismus. Difference between an Ophthalmologist, Optometrist and Optician, 2011. Retrieved October 3, 2017 from: https://www.aapos.org/terms/conditions/132
History of Optometry David A. Goss, O.D., Ph.D. Lecture Handout Lectures in V578, Public Health Policy and the Optometric Profession November 18 and 20, 2003.
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