optometry

optometry (meaning measurement of sight) is the science of measuring visual acuity to determine refractive errors of the eyes, and prescribing and fitting appropriate corrective lenses (in spectacles or as contact lenses). The term ‘optometrist’, imported from the US, has virtually displaced the original word ‘optician’ in the UK.

Optometrists also have to deal with patients who have poor vision for whatever reason, prescribing special lenses or low-vision aids, which help them to lead independent lives. This is essential work in a world increasingly dominated by the visual image in television, films, advertising, and the Internet.

Certain occupations require legally-defined minimum acuity levels, particularly those concerned with flying, or driving trains, cars, heavy goods vehicles, buses — or any public service vehicle. In some cases, public service drivers with refractive errors are obliged to wear glasses, not contact lenses, so that an inspector can tell at once if corrective lenses are in use.

When the National Health Service (NHS) was inaugurated in Britain in 1948, the Supplementary Ophthalmic Service (SOS) was also started, with the intention that eventually all the sight testing would be done in hospitals. In 1958 the Opticians Act established the General Optical Council (GOC), which included a few doctors but was not part of the NHS. The GOC is the statutory body for opticians/ optometrists, with regulatory functions concerning approval of training courses, qualifications, registration, and discipline, similar to those of the General Medical Council for doctors. By 1968 it was apparent that the SOS would never be integrated with the NHS as previously hoped, and the General Ophthalmic Service (GOS) replaced the SOS. Family doctor committees now control the provision of relevant services by dentists, pharmacists, local general practitioners, and the GOS.

Optometry courses lasting three years are taught in eight university departments and schools in the UK. Subjects taught for the BSc degree include anatomy, physiology, visual optics and perception, binocular vision, occupational optics and lighting, clinical practice, pharmacology, microbiology, ocular disease, communication skills, and professional and legal matters. After a pre-registration year and pre-qualifying examination, the student must become a member of the College of Optometrists, the professional body, to start in practice.

The vast majority of sight tests are performed by optometrists. These include measurement of visual acuity and refraction, visual field screening, measuring intra-ocular pressure, and ophthalmoscopy (viewing the interior of the eye with an ophthalmoscope), as and when required. It is a matter of political decision as to which groups of patients may be entitled to a free sight test.

In some areas of the UK, special, shared care clinics to deal with the visual problems of diabetes and glaucoma have been set up to provide the optometric expertise required for hospitals and general practices. Simple consideration of the fact that there are approximately ten times as many optometrists as consultant ophthalmologists in this country, combined with increasing prevalence of these diseases, confirms the need.

Finally, a small but growing number of optometrists forsake the commercial world and work in university departments of visual science, gaining higher degrees and doing valuable research on vision, the optics of the eye, contact lens design, and related topics.

Peter Fells

See also eyes; refractive errors.