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Optometry

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Optometry (Greek: optos meaning eye or vision and metria meaning measurement) is a doctoral degree health care profession concerned with eyes and related structures as well as vision, visual system and vision information processing in humans.

Like most health professions, optometry education, certification and practice is regulated in most countries. Optometrists and related organizations interact with government, other health care professions and the community to deliver eyecare and visioncare. Optometry is a type of eyecare profession and optometrists often interact with other health care and eye care professionals, such as ophthalmologists and opticians.

An optical refractor (also called a phoropter) in use.

Scope of practice

Optometry as a profession and optometrist are considered to be primary health care providers for the eye and visual system. Optometrists are also known as doctors of optometry. They examine, diagnose and medically treat eye diseases, injuries, and disorders of the eye[s] and visual system including refractive problems such as near or far shighted, as well as identify related systemic medical conditions affecting the eye[s] and ocular adnexa.

An optometrist is defined by the World Council of Optometry (a member of the World Health Organisation) as follows:

Optometry is a healthcare profession that is autonomous, educated, and regulated (licensed/registered), and optometrists are the primary healthcare practitioners of the eye and 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.


While most optometrist practice in communities and serve the general public, some optometrists specialize in work with the elderly, children, or partially sighted persons who need specialized visual devices. Others develop and implement ways to protect workers eyes from on-the-job strain or injury. Others specialize in contact lenses, sports vision, or vision therapy. Few teach optometry, perform research, and consult. SOURCE: Bureau of Labor Statistics/www.bls.gov

Eye and Vision examination

As with most health care, examination often includes history taking of both eye health related as well as optical and visual functioning related aspects of the patient being examined. The typical examination has two components, the evaluation of the health status for the detection of eye disease and evaluating the optical and vision characteristics of the eye and observations during testings.

  • Examination of ocular health may include:
    • inspection of the external structures of the eye such as Cornea, Anterior Chamber, Physiological Lens as well as internal ocular structures such as Retina and Optic Nerve. This is done with various specialty equipment
    • observation of various eye movements and alignment
    • observation of pupillary reaction to light as a neurological test
    • observation of overall health status of adnexal ocular structures such as eyelids and eyelashes, as well as the lacrimal system among others
    • measurement of eye pressure also know as intraocular pressure
    • evaluation of functional aspects of the eye such as visual fields
  • Examination of visual skills:
    • applying a battery of structured visual tasks for patient to complete to evaluate the functional characteristics of the visual system such as tracking and focusing aspects as well as muscle coordination.

Optometric Education

Doctor Optometry degree sample curriculum. Adopted from: http://optonet.inter.edu/aa/aa_course_descrip.html Inter American University school of Optometry.

Human Physiology- 4 credits Function of the body’s major systems. Physiology of the central, peripheral and autonomic nervous systems, endocrine, cardiovascular, respiratory, endocrine, digestive and reproductive systems. Three hours lecture; two hours lab. First semester, first year.

Human Anatomy and Neuro-Anatomy - 7.0 credits The anatomy and histology of the major organ systems of the human body, including the nervous system, are presented in a correlative fashion. The anatomical and histological elements of the different organs that compose the skeletal, muscular, cardiovascular, endocrine, digestive, respiratory, integumentary, reproductive, and nervous systems of the human body are presented. Six hours of lecture and two hours of lab. First semester, first year.

Theoretical Optics- 5.0 credits The fundamental principles of physical and geometrical optics will be presented to provide basic knowledge needed in the prevention, diagnosis, treatment and management of refractive conditions, which can be presented to the optometrist by patients seeking primary eyecare. The geometrical optics of single refracting surfaces, prisms, mirror, thick lenses and thin lenses will be introduced. Special attention to the characteristics of the electromagnetic spectrum (wave optics) to explain such phenomena as diffraction, interference and polarization. Interaction of light and matter will be discussed to explain absorption, emission and fluorescence. Presentation of the theory of operation of lasers. Four hours of lecture, two hour of lab. First Semester, First Year.

Public Health Optometry- 2.0 credits The epidemiology of clinical anomalies, the biostatistics of ocular conditions, the systems, regulations, and socioeconomic factors affecting the delivery and quality of optometric services, and the role of the optometrists in community health maintenance.

The Profession of Optometry- 1.0 credit The development of optometry as a profession with its education, organizational, legislative, legal and ethical developments in the world, United States, and Puerto Rico.

Critical Scientific Thinking- 1.0 credit Application of critical thinking and the scientific method to research questions in basic and clinical sciences. Discussion of formats for optometric journals and principles of scientific writing.

Ocular Anatomy and Physiology- 6.0 credits Gross microscopic anatomy and physiology of the eye are presented as correlative structure. Topics include adnexa, tears, cornea, crystalline lens, uvea, retina, blood supply, and intra ocular pressure. Five hours of lecture; two hours lab. Second semester, first year.

Pharmacology- 3.0 credits A primary course that introduces the student to the fundamental principles of drug effects on the body organs and systems, including the eye. Details of drug action and interaction, clinics, and possible side effects of drugs, which are of common and current use today. Three hours lecture. Second semester, first year.

Pathology- 3.0 credits Basic histopathological concepts. General pathological processes and diseases of the major organ systems. Three hours lecture and two hours laboratory. Second semester, first year.

Optics of the Eye and Instruments- 4.0 credits The optics of ophthalmic instruments will be presented. The eye will be studied as a physiological optical element of the visual system. Detailed studied of the eye’s optical components from a geometrical, physical and physiological optics approach will be presented. There will be an in depth study of how the eye’s optical components contribute to the quality of the retinal image and become an element in the etiology of ametropia. Three hours of lecture, two hour of lab. Second semester, first year.

Primary Eyecare I- 2.0 credits Introduction to basic optometric procedures and terminology including case history, visual acuity measures, color vision, external examination, stereopsis test, pupils evaluation, cover test and basic concept of retinoscopy. One hour lecture, two hours of lab. Second semester, first year.

Professional Communication- 1.0 credits Development of communication skills with patients, eyecare professionals, other health professionals, teachers, other personnel, and the general public. One hour lecture. Second semester, first year.

Ocular Pharmacology- 3.0 credits Study of visual and ocular manifestations and side effects of pharmaceutical agents, used for varies purposes, direct and side effects of those in ophthalmic drugs used as diagnostic, cycloplegic, mydriatic, miotic, anesthetic, hygienic, disinfectant and therapeutic purposes. Three hours lectures. First semester, second year. Prerequisite:

Anterior Ocular Diseases- 3.0 credits Diseases, abnormalities and anomalies of the anterior segment of the eye, its components, appendages and functionally related mechanisms, with emphasis on their practical clinical detection, measurement, etiology, epidemiology, heredity, sequelae, prognosis and related counseling. Three hours lecture. First semester, second year.

Ocular Motility- 4.0 credits Study of the monocular and binocular eye movements, including the molecular structure, physiology, electro physiology, neural control, and actions of the extra ocular muscles. Functional entity and neurology of the basic eye movement systems perceptual and clinical significance are discussed. The accommodation process, the pupillary reflexes, and adnexal musculature of the eye, are discussed. Three hours lecture and two hours laboratory.

Ophthalmic Optics- 3.0 credits The design, construction, fabrication, and adaptation of spectacles, including the optical, mechanical, physical and bio-reactive properties of ophthalmic materials. Two hours lecture and two hours laboratory. First semester, second year.

Visual Perception I- 4.0 credits Monocular sensory process including dark adaptation, scotopic and photopic phenomena, temporal and spatial perception, and color vision. Gross electrical potentials. Introduction to photometry. Three hours of lecture and two hours laboratory. First semester, secondyear.

Primary Eye care II- 4.0 credits Instrument theory, observation techniques, and psychophysical methods and procedures applicable to clinical tests and measurements enabling optometrists to analyze the performance of the visual system and to determine appropriate corrective measures. Repetitive use of optometric instruments and of techniques of test, measurements and observations on varied human subjects to attain reliability and validity of findings. Basic visual health assessment procedures. Two hours lecture, four hours lab.

Clinical Medicine and Systemic Diseases- 3.0 credits Discussion of the basic principles of assessment of the illnesses with which an optometrist should be familiar. Topics include cardiovascular diseases, respiratory diseases, endocrine diseases, immunologic diseases, renal diseases, neurological diseases, infectious diseases, gastrointestinal diseases, hematopoietic diseases, reproductive diseases, muscle-skeletal disease, and other systemic diseases and common medical emergencies. Cardiopulmonary resuscitation techniques are also covered. Three hours lecture. Second semester, second year.

Posterior Ocular Diseases- 3.0 credits Diseases, abnormalities and anomalies of the posterior segment of the eye, its components, appendages and functionally related mechanisms, with emphasis on their practical clinical detection, measurement, etiology, epidemiology, heredity, sequelae, prognosis and related counseling. Three hours lecture. Second semester, second year.

Visual Perception II- 2.0 credits Study of the development and characteristics of normal binocular vision. Concepts of binocular vision as depth perception, perceived space, the horopter, retinal correspondence, fusion, fixation disparity and stereopsis are discussed. Topics on visualmotor integration and visual memory are covered. Two hours lecture. Second semester, second year.

Clinical Optics- 3.0 credits The clinical aspects of preparing, verifying and dispensing of ophthalmic material in a clinical practice. Two hours lecture and two hours laboratory. Second semester, second year.

Basic Contact Lenses- 3.0 credits Materials design, fabrication, modification, and functional analysis of contact lenses of all types, with techniques and criteria for fitting, evaluating, adapting, monitoring, and maintaining them, and for counseling concerning their use in various clinical circumstances. Two hours lecture and two hours laboratory. Second semester, second year.

Primary Eye Care III- 6.0 credits Includes advanced visual health assessment techniques and basic procedures in contact lenses, low vision, and vision therapy. Three hours lecture and six hours laboratory. Second semester, second year.

Ocular Therapeutics- 3.0 credits A study of the diagnosis, treatment, and management of eye diseases. Emphasis is on the selection of appropriate regimen, pharmaceutical dosage, and duration, techniques of administration, contraindications, and interactions with other ocular and systematic medications. Optometry Clinic I- 5.0 credits Students will provide complete primary eye care examinations under the supervision of clinical faculty. Emphasis will be on the accuracy of patient’s history, examination techniques, recording of findings and efficient performance of vision screenings. Assignment will be principally in the school’s primary care clinics. Minimum of 21 hours of supervised clinical care per week, including Grand Rounds and screenings. First semester, third year.

Low Vision- 3.0 credits A study of the etiology, epidemiology, definition, signs and symptoms of low vision and blindness, including methods of examination, determination of prognosis, selection of appropriate therapy, treatment, and counseling and interdisciplinary coordination. Two hours lecture and two hours laboratory. First semester, third year.

Pediatric Optometry and Vision Therapy I- 3.0 credits Techniques for the examination of infant, pre-school and school aged children. Description of the most common ocular and systemic conditions in these ages groups and their visual presentations. The etiology, epidemiology, symptoms, signs and course sequelae of anomalies of ocular motility, accommodation and non-strabismic anomalies of binocular vision. Relation of these anomalies to learning achievement. Analytical, diagnostic testing, training and rehabilitation techniques for these conditions. Two hours lecture; two hours of lab. First semester, third year.

Advanced Contact Lenses- 2.0 credits The fitting of specialty contact lenses using advanced procedures for the correction of astigmatism, irregular corneas, presbyopia, and aphakia. Orthokeratology and the correction of ocular trauma with cosmetic lenses are included. Two hours lecture.

Optometry Research- 1.0 credit Application of descriptive and inferential statistics to optometric research with emphasis on experimental design and critical analysis of published articles. A research proposal must be submitted and approved by a faculty advisor and course instructor.

Case Analysis- 1.0 credit A study of various theoretical patient management problems and actual clinical cases related to all areas of clinical care. Cases will be reviewed for the purpose of evaluating the data including an analysis of the patient’s signs and symptoms, synthesizing the available information, and formulating possible treatment options. One hour lecture. First semester, third year. Prerequisite: Successful completion of all first and second year course work required.

Practice Management- 2.0 credits Economic and sociological aspects of optometry and vision care needs and services, with specific attention to the analysis of community demands, doctor-patient and inter professional relationships, and practice modes and management. Two hours lecture.

Optometry Clinic II- 5.0 credits Students will provide complete primary eye care examinations under the supervision of clinical faculty. Emphasis will be on the evaluation and differential diagnosis of the patient’s conditions, assuming accuracy of the patient’s case history examination techniques, and efficient performance of vision screenings. Minimum of 21 hours of supervised clinical care including Grand Round and screenings. Second semester, third year.

Clinical Lasers- 2.0 credits Basic background knowledge of the nature of laser, it clinical indications, surgical procedures, post-operative care, in laser therapy for the anterior and posterior segments of the eye. Students will have “hands-on” experience in anterior segment laser procedures performed on model eyes. Two hours of lecture. Second semester, third year.

Pediatric Optometry and Vision Therapy II- 2.0 credits The etiology, epidemiology, symptoms, signs and course sequelae of amblyopia, strabismus and its adaptations, fixation disparity, aniseikonia, nystagmus, visual perception, visualmotor and auditory-visual integration and visually related cognitive dysfunctions. Relation of these anomalies to learning achievement. Diagnostic and rehabilitative techniques for treatment of these conditions. Two hours lecture; two hours lab. Second semester, third year.

Neuro-Optometry- 2.0 credits Diagnosis and management of neuro-eye diseases. Differential diagnosis and management of neurological diseases that have ocular manifestation Specialized testing and pupil anomalies on neurological disorder are covered. Two hours lecture, second semester, third year. Geriatric Optometry and Special Populations- 2.0 credits Epidemiological, psychosocial and ocular changes that occur in the aging patients. Examination techniques including those used in nursing home and other non-traditional settings. Similar consideration to special populations such as physically and mentally impaired patients.

Optometry Clinic III- 20 credits Students will provide comprehensive primary eye care in the School’s clinical program. Patients will be diagnosed, treated or referred. Students may also select advanced primary care clinical rotations in contact lenses, low vision, vision therapy and prosthetic eye clinics. Minimum of 20 weeks (each consisting of 5 days) of clinic. Term one of the fourth years consists of six months and starts immediately after completion of the third year.

Optometry Clinic IV- 20 credits Students will provide comprehensive primary eye care in the School’s clinical program. Patients will be diagnosed, treated or referred. Students may also select advanced primary care clinical rotations in contact lenses, low vision, vision therapy and prosthetic eye clinics. Minimum of 20 weeks (each consisting of 5 days) of clinic. Term two of the fourth year consists of six months and starts immediately after completion of term one.

Examples of equipment

There are many types of equipment used during an eye examination. For example, various vision charts and machines are used to measure vision and visual fields. Trial (spectacle and contact) lenses or a phoropter and retinoscope may be used during refraction. Prism bars, small objects and occluders may be used to assess eye movements and eye alignment. Various test booklets/sheets/instructions and pencils may be used for visual information processing examination.

Penlight/transilluminator can be used when assessing pupil light response, a neurological screening test. Specialty magnifiers such as ophthalmoscope, and slit-lamp bio-microscope help with detailed inspection of external and internal anatomical ocular structures. Diagnostic eye drops may also be used to assess the various anatomical structures of the eyes.

For at least the past decade, many optometrists have used computerized equipment specifically designed to help diagnose and /or monitor certain ocular diseases. For example, many optometrists' offices have various visual field analyzers and tonometers. Also some optometrists use digital imaging equipment, such as digital cameras to document appearance of the anterior and posterior eye. Corneal topographer are used to gather information on anterior aspects of the anatomy of the eye. More sophisticated equipment such as Optical coherence tomography, GDX [1], or HRT II can be used for various pathology testing.

Diagnoses

Diagnoses made by optometry depends on integrating eye examination information.

Some ocular pathology can be associated with systemic, neural or other disease complications. Some ocular disorders may be treated by an optometrist. In many cases, referral to an ophthalmologist may be required for surgical treatment.

  • visual dysfunctions assessed by optometrists may include:
  • common examples of diseases of systemic origin with eye complications that can be recognized and managed by evaluation of the ocular structures include:

Patient Management

Optometry clinical patients management can include:

  • Counsel on status regarding comprehensive or detailed evaluations of the human eye.
  • Diagnosis and treatment or management of eye disease, ocular findings or visual disturbance.
  • Prescribing medications such as antibiotics, antiinflammatory and other for the treatment of eye conditions and diseases.
  • Prescribing optical aids such as glasses, contact lenses, magnifiers.
  • Prescribing low vision rehabilitation.
  • Prescribing vision therapy.
  • They advice and follow-up care regarding use of optical aids (especially contact lenses)
  • They provide referral to other health professionals including internist and other primary care physicians and particularly sub specialists like ophthalmologists for surgical consultation.
  • They interacting with opticians and the optical industry which manufacture the optical aids such as glasses in accordance to optical prescriptions.

History

Optometric history is tied to the development of

The term optometrists was coined by Landolt in 1886, referring to the "fitting of glasses". Prior to this, there was a distinction between "dispensing" and "refracting" opticians in the 19th century. The latter were later called optometrists. [2]

Apparently the first schools of optometry were established in 1850-1900 (presumably in USA) and contact lenses were first used in 1940s [3]

Licensing

Most countries have regulations concerning optometry education and practice. Optometrists like many other health care professionals are required to participate in ongoing continuing education courses to stay current on the latest standards of care.

Optometry is officially recognized:

See also: List of optometry schools

United Kingdom

In the United Kingdom, optometrists have to complete a 3 or 4 year undergraduate honours degree followed by a minimum of a one-year "pre-registration period" where they complete supervised practice under the supervision of an experienced qualified practitioner. During this year the pre-registration candidate is given a number of quarterly assessments and on successfully passing all of these assessments, a final one-day set of examinations. Following successful completion of these assessments and having completed one year's supervised practice, the candidate qualifies for membership of The College of Optometrists and is eligible to register as an optometrist with the General Optical Council (GOC).

Registration with the GOC is mandatory to practice in the UK. Members of the College of Optometrists may use the suffix MCOptom. Optometrists in the United Kingdom, as in most countries except the United States and Canada, receive a Bachelor of Optometry or Masters degree. They are not called "doctor" in the United Kingdom.

United States

As primary eye care providers, doctors of optometry are an integral part of the health care team, earning their degree just as dentists or podiatrists do. Prior to admittance into optometry school, optometrists typically complete four years of undergraduate study, culminating in a bachelor’s degree. Required undergraduate coursework for pre-optometry students covers a variety of health, science and mathematics courses. Optometry school consists of four years of study focusing on the eye, vision, and some systemic diseases. In addition to profession-specific courses, optometrists are required to take health courses that focus on a patient’s overall medical condition as it relates to the eyes.

Upon completion of optometry school, candidates graduate from their accredited college of optometry and hold the optometry (OD) degree. Optometrists must pass a rigorous national examination administered by the National Board of Examiners in Optometry (NBEO)http://www.optometry.org/passfail.cfm. The three-part exam includes basic science, clinical science and patient care. (The structure and format of the NBEO exams are subject to change beginning in 2008.) Some optometrists go on to complete residencies with training in a specific sub-specialty. These specialties include pediatric care, children’s vision, geriatric care, specialty contact lens (for keratoconus patients or other corneal dystrophy) and many others. All optometrists are required to participate in ongoing continuing education courses to stay current on the latest standards of care.

Argentina

In Argentina optometrists are required to register with the local Ministry of Public Information, but licensing is not required. Anyone holding a Bachelor's degree may register as an optometrist after completing a written exam. Fees for the exam are set by the provincial government and vary from province to province.

Colombia

In Colombia optometry education has been accredited by the Ministry of Health. The last official revision to the laws regarding health care standards for the country was issued on the year 1992 through the Law 30.[4] Currently there are eight official Universities that are entitled by ICFES to grant the Optometrist certification. The first optometrist arrived to the country from North America and Europe circa 1914. These professionals were specialized in optics and refraction. In 1933 under Decree 449 and 1291 the Colombian Government officially set the rules for the formation of professionals in the area of optometry. In 1966 La Salle University opens its first Faculty in Optometry after a recommendation of a group of professionals. At the present time optometrists are encouraged to keep up with new technologies through congresses and scholarships granted by the government or private companies (such as Bausch & Lomb).

Europe

Currently, optometry education and licencing varies through out Europe. For example, in Germany, the tasks of an optometrist are split between ophthalmologists and professionally trained and certified opticians. In France, there is no regulatory framework and optometrists are sometimes trained by completing an apprenticeship at an ophthalmologists' private office. [5]

Since the formation of the European Union, "there exists a strong movement, headed by the Association of European Schools and Colleges of Optometry (AESCO), to unify the profession by creating a European-wide examination for optometry" and presumably also standardised practice and education guidelines within EU countries.[6] ew

Ireland

The profession of Optometry has been represented for over a century by the Association of Optometrists, Ireland [AOI]. In Ireland an optometrist must first complete a four year degree in Optometry at D.I.T. Kevin Street. Following successful completion of the a degree, an optometrist must then complete Professional Qualifying Examinations in order to be entered into the register of the Opticians Board [Bord na Radharcmhaistoiri]. It is illegal to practice as an optometrist in the Republic of Ireland, unless registered with the Board.

The A.O.I. runs a comprehensive continuing education and professional development program on behalf of Irish optometrists. Unfortunately for the profession in Ireland, the legislation governing Optometry was drafted in 1956 and is hopelessly out of date. The unnecessary restrictions in this fifty year old piece of legislation restricts optometrists from using their full range of skills, training and equipment for the benefit of the Irish public. The amendment to the Act in 2003 addressed one of the most egregious restrictions - the use of cycloplegic drugs to examine children. Review of this legislation is urgent to allow the public to benefit from the skills of optometrists to reduce the enormous waiting lists in the public health service particularly for children.

Distinction from ophthalmology

Ophthalmologists after obtaining a 4 year bachelors degree, attend medical school for 4 years of medical training to obtain an MD degree. Ophthalmologists train for an additional three to four years of residency training. Residency training in ophthalmology encompasses all aspects of diagnosis and management of diseases that affect the eye, orbit, and neurological system of the brain. This includes surgical treatment. Many ophthalmologists pursue additional fellowship training in various subspecialties.

(Most of the following information pertains to Optometry in the United States): Optometrists also acquire a 4 year bachelor degree followed by 4 years of Optometry school to earn an OD degree. While in school, optometry students undergo a full year of internship training and have the option of a 1 year residency following graduation. Optometrists having completed a residency can further specialize in a particular area such as Pediatric Optometry, Geriatric Optometry, Behavioral Optometry or Neuro-optometry. Optometry school is more specialized in scope, with courses that include vision sciences, health sciences, pharmacology, and clinical education. Examples include courses in visual psychophysics, optics, as well as training in aspects of functional vision such as vision therapy, binocular vision, and low vision. Optometrists are also trained extensively in anatomy, histology, neurology, vision perception. They have a broad understanding of disease etiology, management, and treatment. In general, optometrists can do the same things ophthalmologists do with the exceptions of internal surgery and particular diseases (e.g. wet macular degeneration, proliferative diabetic retinopathy) that require extensive surgical treatments. Depending on state law, however, many optometrists are trained to perform minor surgery as well as laser surgery. Some states prohibit or limit the prescribing of oral medications by optometrists.

The two fields often have a mutually beneficial relationship:

Ophthalmologists may refer patients to optometrists for contact lenses or for optical aids or low vision rehabilitation whilst continuing to treat the underlying disease/condition that may have reduced vision. Similarly, complicated and emergency eye conditions are referred from Optometry to Ophthalmology.

Both optometrists and ophthalmologists perform screening for common ocular problems affecting children (i.e., amblyopia and strabismus) and the adult population (cataract, glaucoma, and diabetic retinopathy).

Optometrists generally manage treatment of strabismus and amblyopia with vision therapy while Ophthalmologists manage these disorders with refractive, orthoptic, medical and surgical therapy.

See also Ophthalmology#Distinction from Optometry

Sub-specialties

There are currently nine sub-specialty residencies offered by various schools of optometry in the United States [1] [2]:

  1. Cornea and contact lenses
  2. Family practice optometry
  3. Geriatric optometry
  4. Glaucoma
  5. Low vision rehabilitation
  6. orthoptic pratice
  7. Ocular disease
  8. Pediatric optometry
  9. Primary care
  10. Vision therapy and rehabilitation

Many of these sub-specialties are also recognised in other countries.

Please note, refractive surgery and ocular surgery fellowships involve learning how to co-manage patients before and after eye surgery. Similarly, ocular disease residencies involve co-management practice with other health professionals. Also the College of Optometrists in Vision Development provides certification for eye doctors in vision therapy, behavioral and developmental vision care, and "visual rehabilitation". Training in binocular vision and orthoptics sub-specialties are often integrated into either pediatric or vision therapy programs.

See also

Organizations

Other

References

  1. ^ Handbook of Ocular Disease Management - Understanding Nerve Fiber Layer Analysis
  2. ^ History of Optometry, Lecture Handout at Indiana University School of Optometry by David A. Goss.
  3. ^ History
  4. ^ Consejo Nacional de Acreditación
  5. ^ Welcome to Eurotimes
  6. ^ The unification of European optometry: how the profession will change after 1992 by Hamakiotes DS, Thal LS in J Am Optom Assoc. 1992 Jun;63(6):388-9.
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