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Who are Optometrists, Ophthalmologists and Opticians?

Afua Owusua Oteng-Amoako (Final year, Doctor of Optometry- KNUST)

Vision is one of the most important senses of the human body. Without it, there may be a total loss of independence. It has been proven that most individuals upon becoming blind have lowered life expectancies. Furthermore, the eyes are one of the most delicate parts of the human body. Due to its complex nature; unlike other parts of the body, transplant surgery of the eye is presently impossible. Your eyes must therefore be well catered for by qualified eye professionals. Optometry according to Dorland‟s illustrated medical dictionary is “the professional practice of primary eye and vision care for the diagnosis, treatment and prevention of associated disorders and for the improvement of vision by the prescription of spectacles and by use of other functional, optical and pharmaceutical means regulated by the laws of a particular country”. Doctors of Optometry are defined by the American Optometric Association as “independent primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions”. An optician is a specialist trained in the manufacture of spectacles. They sell spectacles and other optical instruments. They receive prescriptions from patients who have been seen by optometrists and make their spectacles. They help patients in the selection of frames and fit and adapt eyewear to the wearer. The word optician is synonymous to ophthalmic dispenser. An ophthalmologist is a medical doctor specializing in the diagnosis and treatment of diseases of the eye. He is a physician (M.D) practicing in ophthalmology. Ophthalmology is the branch of medicine that deals with the anatomy, functions, pathology, and treatment of the eye. Ophthalmologists perform surgery on the eye. The Doctor of Optometry (O.D.) is currently a 6-year program similar to that found in the USA. It is undertaken in two universities in Ghana; The Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi and The University of Cape Coast. At KNUST, the program commenced in the 2004/2005 academic year of the tertiary institutions academic calendar. Previously, it had been a fouryear BSc. Optometry and Visual Science degree which was also in turn preceded by a 2-year postgraduate program of Optometry and Visual Science. In the first two years of the present O.D., general courses in mostly the basic sciences are taken. This is followed by four years of required optometry elective courses. One semester of the final year is spent on a clinical externship under the supervision of a qualified optometrist, ophthalmologist and optician. Upon graduation with the Doctor of Optometry degree, one is required to undertake an internship for a year, after which he/she takes a professional preregistration exam to be officially recognized as a member of the Ghana Optometric Association (GOA). There are currently about 100 Doctors of Optometry in the country. Currently, opticians in Ghana are being trained at the Optical Technician Training Institute (OTTI) at Oyoko in the Ashanti Region. It is a 3 year-diploma program which replaced the former 2-year certificate program. In the new 3-year diploma program, one semester each of duration of about 4 months, is spent out on attachment every academic year. Presently, arrangements are being made for an affiliation to be built with the KNUST Department of Optometry. OTTI was established by a registered German philanthropic organization known as the International Union of Westphalian Children's Villages (IUWV) in 2000. There are currently about 100 opticians in the country.

Ophthalmology on the other hand is a medical specialization. After completing the 7-year (now 6-year) medical degree and housemanship of two years, individual doctors decide to specialize in ophthalmology for about 5 years. There are currently only about 40 ophthalmologists in the country concentrated mostly in the big cities of Accra, Kumasi and Tema. The optometrist assesses your visual status and performs refraction which is the test to determine the degree to which the eye differs from normal, which will determine whether or not the patient needs glasses or contact lenses and if so how strong they should be. He/She then refers the patient to an optician who fills the prescription. If one‟s visual deficit or discomfort is not as a result of a refractive error (requiring glasses or contact lens), optometrists are to detect whether it is due to a disease or binocular vision anomaly. In the case of minor disease conditions, the optometrist is required to diagnose and treat the condition e.g. conjunctivitis („red eye‟ or „apollo‟), allergies, etc. Binocular vision anomalies and refraction are the sole responsibility of the optometrist. In the case of a major eye disease, an optometrist immediately refers to an ophthalmologist for appropriate medical attention. Optometrists are also trained to fit contact lenses and manage „low vision‟ – a term used to describe a peculiar condition in which only the provision of specialized low vision devices can enable patients with very limited vision to obtain as close to a normal life as possible. Optometrists through their examinations of the eye can detect certain systemic diseases such as hypertension, diabetes and even H.I.V AIDS. Optometrists in such a situation refer the patient to the appropriate specialist for further examination, diagnosis and treatment. An optometrist, ophthalmologist and an optician therefore are not synonymous as is many times assumed. There are distinct differences between the three in terms of the type of training, years of study and the nature of work. Perhaps, the only similarity is the fact that they all work on the same part of the human body. Most private optical shops (optician‟s) in Ghana contain the services of all three professionals; the optician, optometrist and ophthalmologist. In this setting, the ophthalmologist many a times is employed on a part-time basis, while the others are full-time. However, ophthalmologists work full-time in hospitals. Optometrists are also employed in the hospital setting where they work together as a team with the ophthalmologist. Currently, some few hospitals have also employed opticians. There are many self-proclaimed quack „eye doctors‟ or practitioners in the Ghanaian society with no kind of formal training in optometry, ophthalmology or opticianry. Some of these individuals are people who may have once worked with professionals. One very good way of detecting them is by the very cheap services they provide. When you go to an eye care professional, you have the right to query the kind of training the professional has had before submitting yourself to their care. These quacks are dangerous and by submitting to their care, you may only be compounding your eye problems all the more, which may result in blindness. You must therefore be extremely careful and vigilant of such quack eye care “professionals” in our midst. We each have only one chance at maintaining our vision. Therefore as individuals in society, we must recognize this importance and make the utmost use of such professionals to enable us maintain the best of our vision to sustain our independence and livelihood.