OPTOMETRY; A PRIMARY HEALTHCARE PROFESSION OF THE EYE AND A CAREER WITH VISION.
WRITTEN BY ABIAKALAM UGONNA PETER. (National Secretary, Nigerian Optometric Students’ Association)
In 1921, one of the American universities started a Doctor of Optometry (OD) program which lasts for a period of 6years. Since then other countries have joined. The practice of optometry has undergone a lot of metamorphosis since its inception. In the United Kingdom (UK), Optometry is more developed. In Germany, it is not as developed as in UK. In the United States of America they currently run a 6 year OD program in about 20 schools and colleges which means that optometry is developed in the United States.
Optometry has been defined and explained by different professional organizations, by various schools of thoughts and various authorities and some of these definitions are limited by time and space while others have been accepted as the standard representing the concept of Optometry as given by the world council of Optometry, which is the international body that governs the practice of Optometry in the world. The term Optometry is less than a century old but the service offered by the profession has been rendered for a longer period of time. In this article, I will attempt to define the modern day optometry as given by different professional organizations and different authorities.
The act 34 of the 1989 laws of the federal republic of Nigeria, it defines Optometry as a health care profession specializing in the art and science of vision care and whose scope of practice include: Eye examinations to determine refractive errors and any other departure from the optimally healthy and visually efficient eye. Correction of refractive errors using spectacles, contact lenses, low vision aids and other optical devices. Corrections of errors of binocularity using visual training. Management of minor ocular and eye infections which do not pose a threat to the integrity of the visual system and ocular first aid.
The dictionary of optometry and visual sciences (7thedition, 2004) defines optometry as an autonomous health care profession involved in the services and care of the eye and visual system and enhancement of visual performance.
The world council of optometry (W.C.O) defines optometry as the primary health care profession of the eye and visual system which provides comprehensive eye and vision care which includes refraction and dispensing, the detection or diagnosis and management of diseases in the eye and the rehabilitation of conditions of the visual system.
The Dorland’s illustrated medical dictionary (30th edition) defines optometry as the professional practice consisting of the examination of the eye to evaluate health and visual abilities, diagnosis of eye diseases and conditions of the eye and visual system and provision of treatment by such means as the prescription of eye glasses and contact lenses, the use of vision therapy, low vision aids, drugs and certain surgical procedures.
The American Optometric Association (A.O.A) defines doctors of optometry as independent primary health care providers 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 examine the internal and external structures of the eye to diagnose eye diseases like glaucoma, cataract and retinal disorders, systemic diseases like hypertension and diabetes and vision conditions like near sightedness (myopia), far sightedness (hypermetropia), astigmatism and presbyopia.
In addition, optometrists also do testing to determine the patient’s ability to focus and co- ordinate the eyes and to judge depth and see colours accurately, they prescribe eyeglasses and contact lenses, low vision aids, vision therapy and medicine to treat eye diseases. Having given the above definitions by different professional organizations, elucidation of the scope of optometry might aid in the vital role of optometrists in the eye care delivery system and the overall health care delivery system.
At the beginning of the 20th century sight testing and fabrication of suitable lenses for the individual patient was all that optometric practice stood for, but today the optometric examinations transcends beyond this and includes; Tests for refractive status which involves the determination of the refractive state of the eye and this is done either objectively or subjectively. External eye examination using the pen torch or the more sophisticated slit lamp bio microscope. Examination of the internal structures of the eye to determine the integrity of the internal ocular structures using the ophthalmoscopes and the fundus camera. Visual field examinations using various visual field instruments, such as the Bjerum tangent screen. Determination of the intraocular pressure of the eye using the tonometer and various other practices.
OPTOMETRY : A primary health care profession of the eye.
Optometry as a primary health care profession of the eye means that optometrists are the first point of contact in the eye care delivery system. As primary health profession, optometrists form an integral part of the health care team and an entry point into the health care system. Optometrists are skilled in the co-management of care that affects the eye health and vision of their patients and an excellent source of referral to other health care professionals. Comprehensive care of the visual system is and has continued to be the foundation of optometry. However, as medical knowledge has advanced, so has understanding of the eye, vision, ocular diseases and related systemic diseases. The definition of “primary care” and “primary care optometry” include the components: visual care, ocular health and care associated with related systemic disorders.
As primary care providers representing an entry point into the health care system, optometrists are responsible for more than the visual needs of their patients. While optometry has increased its scope of practice, ophthalmology has become increasingly subspecialized, yet the patient receives appropriate treatment or care consistent with standards, begging the question: Is optometry actually an eye profession with some interest in systemic diseases or will time and technology demonstrate optometry to be a primary care health profession with specialized interest in the visual system?
The accepted components of a comprehensive ophthalmic examination demonstrate the systemic nature of modern optometry. Along with the chief complaint and the history of present illness, the review of systems help the optometrist determine systemic concerns, particularly symptoms related to eye care. Ocular-related constitutional symptoms may include fever, change in weight, and malaise. Diplopia, ocular pain and redness, sub conjunctival hemorrhage, and persistent or transient loss of vision may indicate systemic disorders.
Related systemic diseases seen in optometric practices are large in number. Conditions may include diabetes mellitus and other endocrine disorders such as hyperthyroidism, hypothyroidism, Cushing’s disease and Addison’s disease. Optometrists are specifically cited as important members of teams caring for patients with diabetes. Vascular diseases such hypertension, carotid artery diseases, coronary artery disease, vertebral-basilar disease, blood disorders such as Sjogren’s syndrome, rheumatoid arthritis (RA), systemic lupus erythromatosus (SLE), giant cell arthritis (GCA), and sarcodiosis, frequently have ocular manifestations. Further examples of systemic conditions with ocular relevance include cancer-melanoma, basal cell carcinoma, breast or lung cancer metastasis, infectious diseases such as presumed ocular histoplasmosis syndrome (POHS), Lyme disease, toxoplasmosis, HSV, herpes zoster virus (HZV), epidemic keratoconjunctivitis (EKC),sexually transmitted diseases (STD’s) , and dermatological conditions such as rosacea and dematitis.
A career with vision.
Due to the fact that while refractive error is amongst the most common causes of blindness and visual impairment, it is also the easiest to “cure”. Refractive error can be simply diagnosed, measured and corrected and the provision of spectacles is an extremely cost-effective intervention, providing immediate correction of the problem.
Throughout the world optometry has been the major provider of vision correction, but usually from a private practice setting. Public health optometry has not reached the communities that are in most need in any organized way. Despite this, on their own initiative, thousands of private optometrists worldwide have regularly visited communities in need to provide vision care and dispense spectacles. The opportunity now is for optometry to develop a concerted effort to create local capacity in these communities, in collaboration with its partners in vision 2020, through service delivery by creating human resources and by helping to develop the infrastructure needed, the three cornerstones of the vision 2020 program.
In the first planning meeting of the informal group on refractive error, the participants endorsed the inclusion of the correction of visually disabling refractive error for the elimination of avoidable blindness- vision 2020, “The right to sight”, and emphasized the need to deliver refraction services as an integral part of the general health care system and comprehensive eye care.
The need for glasses is also a public eye health opportunity not to be missed. Refractive care provides excellent access to the population for screening of more serious eye problems, such as cataract and diabetes. Primary care screening by optometrists takes care of more immediate interventions required and referral for more “complicated” care is “classical” health care delivery.
Furthermore, preventable blindness is one of our most tragic and wasteful global problems. Optometry is an essential part of the team that will eliminate this tragedy by understanding global eyecare needs and delivering effective and sustainable vision care to people in need, thereby ensuring their fundamental right to sight.
Finally, I will conclude by saying that the understanding of the fact that optometrists should be the first point of contact in cases of eye and vision problems is a headway towards promoting good eye health and prevention of blindness.
THANKS AND GOD BLESS.
(BRINGING THE WORLD INTO FOCUS)