Difficulties in Defining ‘Optometry’

A scan of the Canadian Orthoptics Society website reveals some interesting observations, if not downright peculiar ones:

The site is managed by an ophthalmologist in Quebec, a Province currently known for its aggressive and hubristic medical stance against anything attached to optometry, developmental optometry in particular. The definitions of eye care professionals on the site reflect, unsurprisingly, the anti-optometry stance typical of ophthalmology and Canadian medical orthoptics. To wit, from http://www.tcos.ca/english/faq.php, Optometry, a profession of doctors with a tradition rooted in 300 years of science and clinical practice, is reduced to ” a licensed health professional trained to detect and correct focusing errors, to screen for eye disorders and to prescribe treatment for specific eye conditions.”

Optometry is listed second to last in what appears to be a ‘care hierarchy’ and there is no recognition of the fact that optometrists are primary eye and vision health doctors. As one might expect, nowhere is there a mention of any specialties in optometry.

The truth is optometrists have in visual rehabilitation and management what ophthalmologists have in surgery. Both manage disease, and there is a growing degree of collaboration between the professions in this regard. Orthoptics is a subcomponent of comprehensive vision rehabilitation training. Orthoptists are not doctors.

Suffice it to say that while this marginalizing description of the doctor of optometry’s role may not have been intentional, it certainly has the appearance of being balanced more in favour of professional bias than of fact and professional good will. With respect to what is best clinical and scientific practice, and best public policy, this would not be the preferred perspective driving decisions. For one, there incremental costs to patients and healthcare budgets when patients do not receive the full and adequate rehabilitation or vision management care they need. Not that ophthalmology or medical orthoptics can’t provide this, but there are many elements of care these two professions cannot or do not provide simply due to training and exposure.

In contrast to the brief description offered by the TCOS FAQ page, the American Optometric Association defines optometry somewhat more precisely. From http://www.aoa.org/about-the-aoa/what-is-a-doctor-of-optometry?sso=y:

Doctors of Optometry (O.D.s/optometrists) are the independent primary health care professionals for the eye.  Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.

Doctors of Optometry prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures.

  • Optometrists counsel their patients regarding surgical and non-surgical options that meet their visual needs related to their occupations, avocations, and lifestyle.
  • An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice.
  • Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

This last definition comes closer to describing the optometrist’s role and background. Elsewhere, at the COVD.org website, a somewhat more evolved definition of the developmental optometry specialty is presented, but is once again lacking.

There are a number of other optometric specialties, including visual performance optimization for sports and for neurological rehabilitation, and specialized optical solutions for varied commercial and therapetic applications. These all matter, and denying them to patients is ill-advised.

Before doctors begin to deign to represent patient and public health best interests, we must first show that we are well-informed and unbiased in our recommendations for care. The FAQ page at the TCOS Canada website represents an opportunity for Canadian ophthalmology and medical orthoptics: To show a non-hubristic interest in clinical science, and begin to educate their own and the public regarding the truth of the fundamental role optometry plays in rehabilitation, treatment of strabismus and amblyopia, and child learning and development conditions. So, while discussions abound in orthoptics about how many hours to patch a strabismus, the vision development OD’s perspective will be considerably more evolved than this.

VTOD’s are always happy to teach and to show. Canadian ophthalmologists and orthoptists are always welcome to attend on-going events to learn more about the complementary benefits of a full and robust vision rehabilitation program. One such event will be held in September 2015, the Calgary Vision Event. Many other are available, so follow this listing at the Canadian Optometrists in Vision Therapy and Rehabilitation website. I will personally donate a pair of tickets to any two MD’s in vision or neuro-rehabilitation who wish to attend the Calgary event.

It boils down to this: Either all vision rehabilitation OD’s are insane and delusional, or MD’s are just not reading the research. Both positions are hard to rationalize scientifically and clinically.

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