Monday, January 25, 2010

Optometrists Ophthalmologists & Opticians (The Three O's)

I am an optometrist and I have been in practice in Westwood Village, a suburb of West Los Angeles, since 1971. Patients will still refer to me as an ophthalmologist or optician from time to time. I think the reason that there is confusion among the public is due to the fact that there is a great deal of overlap in terms of what the three professions provide. All are involved with various aspects of vision care. In addition, the definition of optician and optometrist varies from country to country. In some countries, optometrists can only refract (test vision) and provide eyeglasses and contact lenses. They can not treat eye diseases or do eye health evaluations. Opticians can refract in some countries and not in others. In the United States, opticians can fill prescriptions for eyeglasses and contact lenses but they cannot refract and test vision. Optometrists in the United States can treat eye infections, dry eyes, eye allergies, and eye diseases as well as test vision and refract. This has not always been the case. When I graduated from optometry school optometrists did not have the ability to treat eye diseases. We were trained to detect them, but we always had to refer out to a medical doctor when we detected a medical problem. If the problem was an eye problem, we would refer to the appropriate ophthalmologist. If the problem was with a general medical condition such as hypertension or diabetes, we would refer to an internal medicine specialist or general practitioner.

Things have changed over the years. The scope of practice of optometry has expanded. The laws that govern the practice of optometry have changed over the years to include the treatment of eye diseases and eye medical problems. This has occurred on a state by state basis. Here in California, once optometrists were granted an increased scope of practice, they had to take and extended number of additional hours of specialized education and pass a comprehensive examination. In addtion, they had to work side by side with ophthalmoligists according to a schedule specified by the state Board of Optometry before they could begin utilizing their new skills. Optometrists can now treat eye diseases such as glaucoma. We can treat eye infections and eye allergies as well as dry eyes. This increased treatment capability was originally only available within the realm of ophthalmology. If optometrists do detect or diagnose a problem that is beyond our expertise, the patient is referred to the appropriate medical practitioner.

Optometrists are well connected with the best medical specialists in their respective areas. Patients that are referred out for specialty care are then referred back to the referring optometist for continued care. This is called "co-management".

So, is it still confusing for patients to understand the difference between "The Three O's"? The answer is probably yes. Due to the overlap of services that is frequently provided is is only normal that patients can confuse "The Three O's". It is up to the optometrist, the ophthalmologist and the optician to fully explain the services that can be offered to their patients.

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