Rupali Singh, B. Optom
Paediatric and CVI Optometrist, Dr. Shroff Charity Eye Hospital, New Delhi, India
According to the World Council of Optometry (WCO), “Optometry is a healthcare profession that is autonomous, regulated education. Optometrists are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, diagnosis and management of disease in the eye, and the rehabilitation of conditions of the visual system”. (1) However still, most of the time, people are unaware of the role of an optometrist and perceive this profession as only prescribing and selling glasses. The role of an optometrist is very crucial in low vision rehabilitation and vision therapy.
Pertaining to vision therapy, optometric vision therapy involves highly specific, sequential, sensory-motor-perceptual stimulation paradigms and regimens.(2) Its purpose is to improve accommodative and vergence anomalies using scientifically based exercises like manipulations of target blur using flippers and lens rack, disparity, and proximity with the help of a prism bar.(2) Dichoptic therapy, perceptual learning, anaglyph glasses, or some specific video games are very effective in the treatment of anisometropic amblyopia to improve visual acuity when it is compared with only glasses or traditional patching therapy. (3) The main purpose of vision therapy is to simultaneously improve the function of accommodation and vergence and the optometrist’s role is the most important in it. So, it is very important to increase awareness about vision therapy among the general population, where most of them suffer from asthenopic symptoms like headache, and nausea and can get relief from vision therapy.
Figure 1: Vision assessment of a child
Figure 2: Squint assessment with Syanaptophore
Regarding the optometric role in Low vision rehabilitation, it should be considered a very important part of the eye care system. A person is called low vision, when his visual acuity is less than 6/18 to the perception of light or visual field less than 10 degrees from the point of fixation in a good eye even after correcting refractive error and surgical treatment. (4) The goal is to maximize an individual’s functional vision. In doing so, a patient’s functional visual acuity will be enhanced, resulting in increased independence and improved quality of life. Optometrists enhance functional vision by dispensing low-vision devices like telescopes and magnifying glasses and suggesting lifestyle and environmental modifications such as increased illumination that needs to be done. (5) Apart from this they also teach patients to use a cane and guiding devices such as google talk for mobility and orientation. (5)
Figure 3 (a): Near optical low vision devices Figure 4 (b): Distance optical low vision devices
Post-traumatic brain injury, patients may develop squint which leads to diplopia and homonymous hemianopia. An optometrist can correct diplopia by prescribing prism glasses. (6) Apart from a prism, it is also prescribed by optometrists to expand the field of view to some extent in homonymous hemianopia patients. (7)
Figure 5: Fresnel Prism Glass
Optometrists can also play a huge role in community ophthalmology. In many small villages optometrists not only prescribe corrective lenses but also treat mild to moderate diseases like conjunctivitis.(8) Many tertiary hospitals organise camps in rural areas where an optometrist is sent for cataract screening and correcting refractive errors.(8)
An optometrist can also play a very important role in enhancing the cosmetic appearance of the patient also. Coloured contact lenses are the latest modalities which are very popular among the patient.(9) Different coloured contact lenses with prescribed power are also available. Apart from this optometrists also prescribe cosmetic contact lenses to enhance cosmetic appearance in case the patient is having deep corneal opacity.(9)
Optometrists are the primary eye care providers, and it is very important that proper awareness among the population is made about this profession which in turn will help in appropriate referral as well as timely diagnosis.
Note: All pictures are taken in Dr Shroff’s Charity Eye Hospital with proper consent from the patient for using it in any research paper.
- Smith, D. P. (2002). The 75th anniversary of the World Council of Optometry: Seventy‐five years of advancing eye care by optometrists worldwide. Clinical and Experimental Optometry, 85(4), 210-213.
- Press, L. J. (Ed.). (1997). Applied concepts in vision therapy, with accompanying disk. Mosby Incorporated.
- Iwata, Y., Handa, T., Ishikawa, H., Goseki, T., & Shoji, N. (2018). Comparison between amblyopia treatment with glasses only and combination of glasses and open-type Binocular “Occlu-Pad” device. BioMed Research International, 2018.
- Leat, S. J., Legge, G. E., & Bullimore, M. A. (1999). What is low vision. Optom Vis Sci, 76, 198-211.
- Stelmack, J. (2001). Quality of life of low-vision patients and outcomes of low-vision rehabilitation. Optometry and Vision Science, 78(5), 335-342.
- Simonsz, H. J., Van Els, J., Ruijter, J. M., Bakker, D., & Spekreijse, H. (2001). Preliminary report: prescription of prism-glasses by the Measurement and Correction Method of H.-J. Haase or by conventional orthoptic examination: a multicenter, randomized, double-blind, cross-over study. Strabismus, 9(1), 17-27.
- Apfelbaum, H. L., Ross, N. C., Bowers, A. R., & Peli, E. (2013). Considering apical scotomas, confusion, and diplopia when prescribing prisms for homonymous hemianopia. Translational vision science & technology, 2(4), 2-2.
- Oster, J., Culham, L. E., & Daniel, R. (1999). An extended role for the hospital optometrist. Ophthalmic and Physiological Optics, 19(4), 351-356.
- Dowaliby, M. S. (1955). Aesthetic consideration of eyewear in relation-ship to facial and other characteristics. Optometry and Vision Science, 32(7), 383-385