The different professions involved in eye care

• Eye care can be broadly classified into managing vision related problems and eye health.
• There are different professionals involved in eye care, including ophthalmologists, optometrists, orthoptists, occupational therapists, ophthalmic nurses and optical dispensers.
• Scope of practice differs across eye care professionals, with them typically working collaboratively to co-manage patients.
• Ophthalmologists are primarily aligned with managing eye health, and optometrists are primarily aligned with managing vision related problems.
• However, there is overlap between scope of ophthalmologists and optometrists, particularly in countries like North America, Australia and New Zealand.
• Pathways into eye care as a patient will largely depend on the eye care services in the country you live in.

Eye care can be broadly split into two categories of vision and eye health, with potential for some overlap between these categories depending on the eye condition.

The vision category encompasses helping you to see clearly, and is perhaps the category that you are most familiar with or most likely to have encountered. This is where an eye care practitioner will examine your eyes to test if you would benefit from glasses or contact lenses.

Eye health is instead more primarily focused on managing eye diseases and disorders, typically through prescribing medications or with surgery.

The overlap occurs because some eye health conditions can affect vision and thereby lead to the need for spectacles or contact lenses, and some eye health conditions are first detected by how they affect vision.

Ophthalmologist

Ophthalmologists are medical doctors who specialize in the diagnosis and treatment of eye diseases, disorders, and injuries. They receive extensive training in the medical and surgical aspects of eye care, and are typically qualified to perform a wide range of eye surgeries.

Ophthalmologists can also prescribe vision correction solutions, and in some countries will likely be the primary health care provider for vision correction where optometrists are restricted or not recognized as eye care professionals.

Optometrist

Optometrists are trained at university to test vision and prescribe vision correction solutions like glasses and contact lenses. There is wide scope of additional training across the world,¹ but in most countries optometrists are also trained to detect eye diseases and other health issues that may affect the eyes, such as diabetes and hypertension.^2-3

As primary healthcare providers, optometrists provide a crucial role in identifying and managing eye conditions and providing preventive eye care services in most developed countries.

To understand the differences in scope of optometry across different countries, the World Council of Optometry (WCO) has published a framework of optometry competencies under four different categories, each adding to the competency of the previous category:

• Category 1, Optical Technology Services: Management and dispensing of spectacles and other ophthalmic devices that correct defects of the visual system - the WCO state this level to not be considered to be optometrists. This level of eye care professional may be known as an optical dispenser or optician.
• Category 2, Visual Function Services: Investigate, examination, measurement, diagnosis and correction/management of defects of the visual system.
• Category 3, Ocular Diagnostic Services: Investigation, examination and evaluation of the eye and adnexa (tissue around the eyes, e.g. eye lids), and associated systemic factors to detect, diagnose and manage disease.
• Category 4, Ocular Therapeutic Services: Use of pharmaceutical agents and other procedures to manage ocular conditions/disease.

The WCO optometrist competency level for some countries can be found in this table.⁴

Orthoptist

An orthoptist specialises in the non-surgical treatment of eye muscle disorders that typically affect how the eyes work together called binocular vision. They typically perform various diagnostic tests to determine how the eyes align with each other, and based on their findings, they develop treatment plans that typically include specific eye exercises and prescribing prism lenses that bend light to overcome eye alignment issues.⁵

Orthoptists most commonly work alongside ophthalmologists to assist then in measuring vision, and managing eye conditions that are better treated using specific eye exercises or prism lenses.

Occupational Therapist

An occupational therapist working in eye care is a healthcare professional specializing in assessing visual and perceptual deficits that affect daily activities and occupations. They collaborate with other healthcare professionals, such as ophthalmologists and optometrists, to provide comprehensive care for people with visual impairments.

Occupational therapists assess an individual's visual and perceptual abilities and limitations, as well as their environment, to create a customized treatment plan including activities, exercises, adaptive equipment, and environmental modifications that can promote independence, improve function, and enhance quality of life. This can be of particular importance for people with vision impairments or blindness.⁶

Optical dispenser or Optician

An optical dispenser is someone who helps people select and fit eye wear and other vision aids to meet their visual needs and preferences. In addition to fitting and dispensing spectacles, optical dispensers may also perform repairs, adjustments, and maintenance on eye wear. They may also provide advice to people on proper care and use of their eye wear.

Optical dispensers typically work closely with optometrists in optical practices, and in some countries they are considered a regulated profession requiring college or university education. Some countries also allow optical dispensers to train and qualify to fit contact lenses. In these countries, such as the United Kingdom, they are known as Dispensing Opticians or Contact Lens Opticians.

Ophthalmic nurse

An ophthalmic nurse is a registered nurse who works specifically in providing care to patients with eye diseases and disorders. They work closely with ophthalmologists to provide comprehensive eye care services to patients. They typically help with patient assessments, administering eye drops, assisting in eye surgeries and procedures, and educating patients on surgical aftercare and eye health.⁷

In some countries eye testing is not regulated, for example Japan, where eye testing for glasses will largely be conducted by people in optical shops that provide glasses, who are not trained to assess eye conditions. In these countries an ophthalmologist or medical doctor should always be the first person to see when concerned about a non-vision related eye condition.

Moving up the qualification scale, in countries like India, universities train optometrists as a qualification towards increasing eye care competencies. With their qualification not yet being recognized as a regulated profession within the country, these optometrists display their qualification as a mark of difference in their training and expertise to the non-professionally trained people working in optical shops.

In countries where eye testing is regulated (must be undertaken by a qualified eye care professional), there are again considerable differences in scope of practice allowed by optometrists. Here are some examples. In France, eye testing is regulated and can be performed by an optometrist, but this must be done in collaboration with an ophthalmologist, resulting in eye testing largely being conducted by ophthalmologists.

In the United Kingdom, in addition to testing vision, optometrists are qualified to investigate and evaluate eye conditions. Depending on their training, region, and where they work, some optometrists are also able to independently manage some eye health conditions, though most will co-manage or refer conditions needing further evaluation or treatment to an ophthalmologist. They also offer a valuable service to detecting some systemic diseases like diabetes and heart disease where signs of disease first show in the eye.

At the upper end of the optometrist qualification scale, in places like North America, Australia and New Zealand, in addition to testing vision, optometrists are qualified to diagnose and manage eye conditions including prescribing medications if required. This makes optometrists in these countries the first point of contact when you are concerned about any problems with eye health and eye vision.

Your pathway into eye care as a patient will largely depend on the eye care services in your country.

For vision correction problems it is most likely you will want to firstly see an optometrist, as vision assessment and correction is their primary role. In many countries they are most easily accessed of the eye care professionals, and don't require a referral from a medical doctor.

When it comes to non-vision related eye health problems, like red and sore eyes, people will often present first to a medical doctor who if they can't manage the condition will refer them to an ophthalmologist. However, what is often not realized, is that in many countries, optometrists can be the best profession to call on for any concerns with eye health that don't require emergency medical treatment. Suitably qualified optometrists can then independently manage certain eye health conditions, or co-manage and refer to ophthalmologists.

Who to see first for an eye condition will depend on your country. For vision related problems like blurred or fuzzy vision, an optometrist will likely be the best profession to visit first.

Outside of emergency cases, and where optometry is recognized as a primary care provider, seeking the advice of an optometrist is likely to provide the quickest route to you receiving the best available eye care. This is because even if an optometrist is unable to offer the required care, they will likely be able to provide you information and provide you a timely referral to the most appropriate eye care professional.

1. Chappell R, Kiely PM. A Global Competency Based Model of Scope of Practice in Optometry. World Council of Optometry. 2015.
2. Schmid KL, Swann PG, Pedersen C, Schmid LM. The detection of diabetic retinopathy by Australian optometrists. Clin Exp Optom. 2002 Jul;85(4):221-8.
3. Hurcomb PG, Wolffsohn JS. The management of systemic hypertension in optometric practice. Ophthalmic Physiol Opt. 2005 Nov;25(6):523-33.
4. Shneor E, Isaacson M, Gordon-Shaag A. The number of optometrists is inversely correlated with blindness in OECD countries. Ophthalmic Physiol Opt. 2021 Jan;41(1):198-201.
5. Shainberg MJ. Vision therapy and orthoptics. Am Orthopt J. 2010;60:28-32.
6. Nastasi JA. Occupational Therapy Interventions for People With Low Vision. Am J Occup Ther. 2020 Jan/Feb;74(1):7401170010p1-7401170010p2.
7. Wolvaardt E, Hennelly M. Recognising the role of ophthalmic nurses and allied ophthalmic personnel in eye care. Community Eye Health. 2020;33(110):41.