Eye Care Professionals (ECP’s)

You wouldn’t take your car to be repaired at a lawyer’s office, not my lawyer anyway. Then again, if you need a great lawyer, he’s your guy. The point is this: Find the expert you need and benefit from their years of study and experience. Or fool yourself wasting your time with half-baked solutions.

Eyes, vision, glasses… it’s all very complicated and we’re just not taught about it in school, and most of us get zero training in these areas during our professional training. Still, vision remains the most important tool we all rely on to make it through our lives. This short series is designed to get you going on your awakening to what vision is and why is matters to children especially, and especially now during the confined times of COVID-19 computer-based learning.

This post offers a brief outline of the various ECP’s, or Eye Care Providers, and which one will best answer your needs. Across Alberta, Canada, North America, your best first stop will be your family optometry clinics who can do the measuring and diagnosing of primary disorders and offer immediate solutions.

your best first stop will be your family optometry clinics who can do the measuring and diagnosing of primary disorders and offer immediate solutions.

Eye Care Professionals: Whom Should You See?

One of the greatest mistakes a person can make is to see a surgeon for a common eye concern, a functional vision problem, or a child learning concern that is suspected to be eye or vision related. ‘Specialists’ are just that – really good at some things – and they will not often be able to consider a broader view for the money charged. On the other end of the spectrum, a basic vision screening offered by some discount optical shops will also cost a lot more in time if even basic concerns are not addressed properly – even garden variety farsightedness (hyperopia) can become a serious problem if not adequately addressed. Here is a brief summary of ECP’s, Eye Care Professionals, and why you might want to see them. 

Optometrist: Optometrists are doctors with ‘OD’ degrees, having at least a four-year degree in biological or health sciences, and then four more years in optometry school studying eye health, disease, and visual function. An optometric physician is akin to a vision mechanic and assesses eye health, the health of your visual pathway, and manages the details of visual function. Optometric studies in leading schools emphasizes various aspects of neurology, ophthalmology, optics and human visual physiology, orthoptics, and human behaviour. Optometry has a number of sub-specialties that help people improve visual performance for sport or high-performance tasks such as flying jet aircraft, and there are developmental optometrists who work with visual rehabilitation for pediatric populations or for brain injury patients. Optometrists will do minor surgical procedures locally and refer more complicated disease and surgical needs to ophthalmology. If you have an eye or vision concern, family optometrists are your best bet to start for both service, costs, and referrals. Beware: Not all optometrists have a full complement of service offering, so ask about specialities before you proceed. 

Developmental (Behavioural) Optometrists:  These are optometrists (OD’s) with additional training during and after doctoral studies. “VTOD’s”, or doctors in optometry who practice Vision Therapy/Rehabilitation, offer advanced diagnostics and treatment options for troubled visual function and development. Like a mechanic who listens to and measures different aspects of a car engine to diagnose and fix a problem, developmental optometrists break vision down into its various elements to fix whatever might be in disorder. This starts with looking for eye or nervous system disease, then moves on to look at the finer points of how the eyes work and how the brain perceives. VTOD’s help with many different problems ranging from reading/learning disabilities, to problems with balance and focus after brain injury, reading concerns, myopia progression, and more. Currently, there is no more effective treatment for reading and learning problems than a full sensory reading program combined with visual neuro-rehabilitation. Search for ‘COVD.org’ or ‘noravisionrehab.org’ or simply ‘optometry vision therapy’ to locate a VTOD near you. 

Ophthalmologist: These are doctors with ‘MD’ degrees, having at least a four-year degree in biological or health sciences, and then four more years in medical school studying general human health and disease. Ophthalmology is a specialty with a minimum of 2-4 years training in surgery and advanced management of eye disease, including principles of ophthalmology, some optics and aspects of visual function. Ophthalmologists provide therapeutic and rehabilitative help to people who are having trouble with eye disease and injury. Ophthalmologists will be either generalists or specialists, such as for retinal diseases, problems with the front parts of the eye (‘anterior segment’ specialists, like for cataracts), or problems with the visual nervous system (neuro-ophthalmologists). Ophthalmology aims to ensure good eye health and maintain eyesight but is not generally interested in the finer aspects of visual behaviour or rehabilitation beyond the functional basics of acuity and alignment. Pediatric ophthalmologists will study child vision assessment and surgical techniques for pediatric cases but will rarely consider non-surgical approaches to treatment. If you need surgery or have a serious degenerative eye disease, you likely need an ophthalmologist. 

Orthoptist: Applies optical principles and devices in the measurement and correction of visual function, as directed by a doctor. Orthoptists are primarily interested in measuring deviations of the eyes and measuring these in preparation for surgery or for specialized optical needs. Their rehabilitative role will be limited and consists primarily of patching. Optometrists are trained in orthoptics as part of their general training, and developmental optometrists can often realign the eyes and correct functional visual concerns without surgery.

Optician: Opticians study for one or two years in order to be knowledgeable and proficient with fitting and making prescription glasses and lenses. Lenses must be aligned to within a millimeter, and this is not something you can do over the Internet. Only someone with optician’s training can ensure your glasses fit well and are perfectly aligned.  When you buy glasses, you will likely be dealing with an optician to select, make, and then fit the glasses. As a rule, you should avoid taking medical advice from an optician. Opticians associated with chain stores will often be required to offer the deal-of-the-day and pay little heed to what might be best for the client. See notes on Refractive Technician below. Opticians have no medical training or training in human visual function.

Ophthalmic Technician: Ophthalmic Technicians have a one-year training program to operate equipment for diagnostic testing, to assist in surgery, and determine basic glasses prescriptions. You will work mostly with ophthalmic technicians when you go to see an ophthalmologist and spend only a few minutes with the doctor.

Optometric Assistant: Assists optometrists with gathering information about patient cases. Optometric Assistants are the doctor’s right hand, and they perform a number of diagnostic tests on patients before the doctor sees them. Optometric Assistants might also assist with glasses and with minor surgical procedures in the examination room. In Canada, the Optometric Assistant program is 9 months in duration.

Refractive Technician: Checks for refractive error, that is, determines the glasses prescription. Training is variable and can be as short as a few hours. Refractive technicians typically work under the guidance of a doctor. Beware any ‘eye exam’ that consists of a simple machine-centered refraction, or where the refraction is the entire examination. Some opticians are refracting opticians, but beware: Best advice is to not fill a glasses prescription issued by someone who isn’t also trained in human visual physiology. Corollary: You can’t fix what you don’t understand. 

Vision Therapist: Vision Therapists work with developmental optometrists to deliver therapy to patients experiencing visual dysfunction. Vision Therapists can be either trained on site in Vision Therapy clinics, or undergo more formal training through approved organisations such as COVD (College of Optometry in Vision Development, www.covd.org), or NORA (Neuro-optometric Rehabilitation Association, noravisionrehab.org). 

In an upcoming post, we’ll put all the pieces together and try to make better sense of how defective elements of vision (Visual Impediments to Learning and Development) can and will interfere with our best hopes for our children. Knowing who to turn to will be of critical importance.

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