optometry

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Optometry. The word “optometry,” from the Greek optos and metron meaning “visible” and “measure,” was apparently first used in the 1890s to describe a profession that today encompasses doctors trained and licensed to diagnose and treat diseases and disorders of the visual system. Colonial merchants selling European‐made spectacles and lenses launched what would become professional optometry in the United States. Two developments by Americans, bifocal lenses and better spectacle frames, helped move optometry from a vendor trade toward a recognized profession by making fitting and selecting eyeglasses more complicated. In 1760, Benjamin Franklin instructed a London firm to make him spectacles with two types of lenses fitted together, thus inventing bifocals. Late in the eighteenth century, American inventors, like those overseas, began patenting lighter‐weight rims and springs and pads for comfort, as well as improved construction techniques.

Nineteenth‐century American optometry made further advances with the growth of optical companies, the development of new diagnostic equipment, and cooperative efforts by prescriber‐purveyors of spectacles to gain professional status as optometrists. Many of the diagnostic advances, such as Bausch and Lomb's 1902 retinoscope and the improved opthalmoscopes made in 1905 by the New Jersey‐based DeZeng Standard Company, extended technology developed earlier in Europe. More grounded in American soil were the optical companies, which also influenced an emergent profession of opticians. Denied traditional supplies from Europe during the Revolutionary War, American manufacturers and merchants built a domestic industry. John McAllister, a Philadelphia cane and whip manufacturer who began selling spectacles in 1783, became the first U.S. optician and his firm, the first American optical company. Several frame‐making factories followed, often begun by jewelers or by European‐trained immigrants. When the Civil War again disrupted glass imports from Europe, the American Optical Company and other firms began production of their own lenses. In consultation with those who sold spectacles, American Optical and Bausch and Lomb, among others, developed improved sets of trial lenses to determine patient prescriptions. By 1904 the United States was exporting lenses to Europe.

With improved tools and clinical expertise, practitioners who once labeled themselves refracting or applied opticians now identified themselves as more highly trained optometrists; took steps to establish optometry's professional identity and prestige; and launched specialized periodicals such as Johnson's Eye Echo (1886), The Optician (1891), Optical Journal (1895), and Optical Review (1907).

With professionalization came controversies over licensing laws and government regulations. Until the late nineteenth century, the field had no official standards of practice, education, or competency. In 1896, seeking stricter controls over who could prescribe eyeglasses, Charles F. Prentice and Andrew Jay Cross formed the Optical Society of New York. As other state societies arose, practitioners lobbied legislatures for regulatory statutes. Minnesota imposed the first regulations, in 1901, and by 1925 all the states and the District of Columbia had passed such legislation.

Inspired by the early lobbying efforts, periodical editors, officials of state organizations, and practitioners founded the American Association of Opticians in New York City in 1898. Initially, anyone interested in optics could join, but the retail merchants soon dropped out and over the next decade stricter education and professional standards resulted in a more exclusive membership. In 1910 the organization was renamed the American Optical Association, and in 1919, the American Optometric Association. In 1929 it launched its own AOA Organizer, renamed the Journal of the American Optometric Association in 1930.

In 1915 the National Board of State Examiners in Optometry (established by the national association in 1919) set two twenty‐six‐week school terms as a minimum education standard for certification. This reflected a continuing emphasis on education as one guarantee of quality care. Around 1900, America had an estimated sixty optometry schools of varying quality; by 2000, fewer than twenty were accredited by the Council on Optometric Education. Four‐year programs included anatomy, pharmacology, pathology, vision screening, optics, and applied lens technology. Graduates needed to pass a state board examination to practice, and nearly all states required continuing‐education courses for license renewal.

The scope of optometric practice expanded in the 1970s as some states authorized optometrists to treat certain eye diseases with pharmaceuticals. By 1989 all states had authorized specifically trained optometrists to use drugs for diagnostic purposes. By 2000, changing Medicare regulations, the growth of managed‐care systems, and cooperative networks with ophthalmologists and other specialists were altering optometric practices. But America's thirty thousand optometrists, 25 percent of whom were women, still performed over 60 percent of the nation's primary eye examinations.
See also Health Maintenance Organizations; Medicare and Medicaid.

Bibliography

James R. Gregg , The Story of Optometry, 1965.
James R. Gregg , American Optometric Association, 1972.
Robert Koetting , The American Optometric Association's First Century, 1997.

Diane D. Edwards

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

optometry , eye-care specialty concerned with eye examination, determination of visual abilities, diagnosis of eye diseases and conditions, and the prescription of lenses and other corrective measures. In most states optometrists may prescribe drugs for the treatment of eye diseases. The principal concern of early optometrists was the prescription of corrective lenses for defects of vision due to refractive error. Modern optometry also includes the fitting of contact lenses and of telescopic eyeglasses as an aid to the near-blind, as well as the field of orthoptics, i.e., the practice of strengthening the eye muscles and improving their coordination by eye exercises. Prescriptions for corrective lenses provided by an optometrist are often brought to an optician , who grinds and fits the lenses.

The word optometry came into use in 1904 with the organization of the American Optometric Association. Until this time people bought eyeglasses from traveling vendors whose activities were not supervised. With the passage of optometry laws, this method of dispensing glasses was prohibited. Optometrists must now fulfill certain educational requirements and be examined and licensed by the state. Some of the schools of optometry in the United States are affiliated with colleges or universities. Optometry is a specialty requiring a four-year postgraduate professional degree. See also ophthalmology ).

op·tom·e·try / äpˈtämitrē/ • n. the practice or profession of examining the eyes for visual defects and prescribing corrective lenses. DERIVATIVES: op·to·met·ric / ˌäptəˈmetrik/ adj.

optometry Testing of vision in order to prescribe corrective eyewear, such as spectacles or contact lenses. It is distinct from ophthalmology.

optometry (op-tom-itri) n. the practice of testing the visual acuity of eyes and prescribing lenses to correct defects of vision.

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