Optometrists are primary health care practitioners of the eye and the visual system who provide comprehensive eye and vision care, which includes refraction and dispensing, detection/diagnosis and management of disease in the eye and the rehabilitation of conditions of the visual system.
Public do not know who optometrist are yet because of the overlap of the scope of practice between ophthalmologist, optometrist and ophthalmic assistants.

ROLES OF OPTOMETRIST:
The roles of optometrist is to provide full spectrum of speciality services such as refraction, binocular vision tests, low vision aids and rehabilitation, prescribing ophthalmic lens designs, spectacles, contact lenses and involvement in new advancement of myopia control.

A) REFRACTION:

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Refraction is the most important activity in the clinical work of an optometrist and the first factor to consider in case of binocular vision and accommodative disorders and the first condition treated in such cases. Refractive errors primarily includes nearsightedness, farsightedness and astigmatism and can be corrected with spectacles, contact lenses or permanently by LASIK

B) CONTACT LENSES:

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CONTACT LENS TRIAL

Besides optical correction, contact lenses can be used for therapeutic, drug delivery and cosmetic purpose. Some of the eye conditions like severe dry eye, keratitis, keratoconus are better treated with contact lenses. Optometrist conducts a proper anterior surface assessment including the tear film, corneal diameter and curvature, lens fit and refraction before prescribing the contact lenses. Optometrists are specialized in contact lenses prescribing as well as managing the complications related to the lens wear.

C) LOW VISION REHABILITATION:

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Low vision rehabilitation is a multidisciplinary approach where people from different background work together to improve person’s visual needs. low vision team usually comprises of ophthalmologist, low vision specialist who are often optometrists, occupational therapist, orientation and mobility specialist, social workers and counselors. When a patient is referred into a low vision rehabilitation clinic, a low vision evaluation is performed by an optometrist. The low vision specialist assesses whether the patient get benefitted from optical devices i.e spectacle magnifiers, stand magnifiers, hand magnifiers, telescope and non-optical devices i.e. large prints, absorptive glasses, typoscope

D) BINOCULAR VISION:

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The coordination of two eyes the depth of perception and comfortable vision for near, intermediate and far is very important.
Having a snellen visual acuity6/6 does not mean your eyes are working in a coordinated manner. Symptoms like headache ,asthenopia and blurred vision after few mins of near work may be related to binocular vision disturbances and those problems can be diagnosed by performing a proper orthoptic evaluation which includes history (according to the symptoms),phoria measurement(measurement of amount of deviation that is kept latent), MEM, accommodative facility, fusion test, NRA, PRA, NPC, NPA, NFV, stereopsis, amplitude of accommodation, PFV and treatment option is provided by the optometrist according to the binocular vision anomaly.

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E) MYOPIA CONTROL:
Myopia control measures are important because it may help reduce the risk of vision threatening complications which are associated with high myopia later in life including glaucoma, cataracts, retinal detachment , myopic maculopathy, myopic macular degeneration and even blindness. Myopia control measures are prescribed by optometrist which are of four primary catagories i.e low dose of atropine, multifocal contact lenses, multifocal eye glasses and ortho-k lenses.

F) PRE-OPERATIVE CATARACT AND REFRACTIVE SURGERY COMANAGEMENT:

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As a primary eye care provider optometrist often are the first to recognize, diagnose and educate the patient regarding the presence of cataract. Optometrist establish enduring relationship with the patient and become particularly acquained with their medical history. Optometrist look into for any coexisting ocular conditions (eg dry eye, recurrent uveitis,, pseudoexfoliation syndrome, glaucoma) and ensure those conditions are stable prior to referring the patient for surgical consultation to the ophthalmologist and also optometrist are involved in taking the measurements and to decide the power of IOL implants used in the surgery.Before the laser vision correction optometrist performs an overall eye examination to determine if the eyes are healthy enough for the surgery and determine what kind of correction is needed. A measurement of the curvature of the eye and a map of cornea is done using a corneal topographer.Various other tests including refraction, wavefront analysis, contrast sensitivity testing, colour vision testing,dry eye testing,pupil evaluation are performed to see for patient’s compatibility for the surgery.

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G) SPORTS VISION:
Optometrist in expertise in sports vision can throughly assess your unique visual system and can recommend the proper eye glasses or contact lenses or design vision therapy program to maximize your visual skills for your specific sports.

REFERENCES:
1.WCO(World council of optometry)
2.Journal of optometry-The role of refraction in vision research.
3.Dinesh kaphle et.al, 2019,Optometry in Nepalese context:The profession beyond providing refraction services.
4.Review of optometry,2015;Principles and protocols of cataracts comanagement.

-Subekshya Khanal

Vision Specialist

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