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The Eye Care Professionals

There are two primary providers in the eye care profession. The differences between the two professions are significant and are related to the respective educational and clinical training programs for each profession.

Ophthalmologist
An ophthalmologist is a medical doctor who specializes in diseases of the eye and eye surgery. The initial training for an ophthalmologist is similar to any other medical doctor with a heavy emphasis on disease. Following completion of the MD degree and internship, the physician enters a residency and fellowship training program to specialize in ophthalmology. This period of training can last another 3-8 years. The stress continues to be on disease and the treatment approaches that are emphasized are medication and surgery. Rehabilitation of the visual system using vision therapy, lenses, low vision devices or prism is not an important part of their training. Very few ophthalmologists provide office-based vision therapy in their offices.

Optometrist
An optometrist is a primary health care provider who specializes in the examination, diagnosis, treatment and management of diseases and disorders of the visual system, the eye and associated structures as well as the diagnosis of related systemic conditions. To become an optometrist an individual must graduate from a 4 year college program and then enter a 4 year program in a college of optometry. The emphasis in both didactic and clinical education is different from the ophthalmological residency programs. Although optometrists are also educated to diagnose and treat eye disease, a significant portion of the educational program deals with the concept of vision and its relationship to performance in play, school, work and sports.

The optometrist is taught to evaluate the visual system in a manner that allows diagnosis of those visual conditions that can interfere with performance and affect quality of life. An integral concept in the optometric curriculum that is absent in ophthalmological training is that the status of the visual system is directly related to the environment and how the individual uses his/her eyes. With increased close work such as reading and computer work, the visual system becomes more susceptible to disorders of accommodation, binocular vision and refractive error. In fact, optometric theory suggests that many of the common vision problems that are prevalent in society are actually caused by the excessive close work that all of us experience in modern society. Finally, optometrists are taught that rehabilitation using lenses, prism, low vision devices and vision therapy is indeed an effective alternative to help patients become more comfortable and productive in school and work. Many hours in the typical optometric curriculum are devoted to the study of the use of vision therapy to rehabilitate a wide variety of vision disorders.

Although all optometrists receive this training, only a percentage choose to offer this service in practice. Optometrists who offer vision therapy and rehabilitation in practice often have completed additional residency training or have passed comprehensive examinations designed to assess their level of expertise in these areas. The two organizations that administer such examination are the American Academy of Optometry (Binocular Vision and Perception Section) and the College of Optometrists in Vision Development (COVD).


Optometrists successfully completing the examination process for the American Academy of Optometry are called Diplomates in Binocular Vision and Perception. Approximately 50 optometrists in the United States have achieved this status.

Binocular Vision and Perception Diplomates, American Academy of Optometry

Optometrists successfully completing the examination process for COVD are called Fellows of COVD (FCOVD).

College of Optometrists in Vision Development Directory

There are also other optometrists who have expertise in the area of vision therapy but have not passed the examinations administered by these two organizations. My advice is to first look for an optometrist with one or both of the credentials described above to help you manage your patients. Both organizations maintain lists of these optometrists.

These differences in educational experience and clinical training explain the experiences of many parents and patients therapists relative to the eye care professions. I have often heard patients and parents comment about the frustration they experience when attempting to get for a suspected vision problem. For example, a parent may bring their child for an eye examination because of concern about tracking or eye teaming problems. Depending on the doctor to whom the child is brought it would not be unusual for the child to be sent back with completely contradictory reports. One doctor might suggest that there is no vision problem, visual acuity is 20/20, glasses are unnecessary and the eyes are healthy. The other doctor agrees that acuity is normal, glasses are not required and the eyes are healthy, but reports the presence of a significant binocular vision problem.

This lack of uniformity in vision care is confusing to the public and may lead to lack of identification and treatment of vision disorders. The differences in approach between optometry and ophthalmology are important and even within the optometric profession, philosophical differences may be significant. It is critical, therefore, that parents/patients seeking meaningful information find an eye care professional with training and expertise in the areas of binocular vision, vision and learning and vision therapy. This will most likely require a referral to an optometrist who is either a Fellow of COVD or a Diplomate in Binocular Vision and Perception. Another acceptable credential is completion of a residency in peditaric optometry or vision therapy.

 
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