The Subspecialties In Optometry Psychology Essay

For those wishing to enter the optometry field, one should be aware of the subspecialties of the profession. The subspecialties serve multiple purposes for the doctor of optometry (OD) such as giving his or her position a unique niche, extending the education beyond schooling, and allowing him or her to server a wider cliental. These are a valuable asset not only for those wishing to be hired as military or corporate optometrists but also for those who want to run a private practice, which will be the primary focus of this document. In addition to learning why subspecialties are important and what they are, it will also discuss how one obtains them.

Optometric Subspecialty Index

Before diving into what each individual subspecialty does, the list below should give a comprehensive understanding of what all falls under such a label. While viewing these, however, keep in mind that there is not necessarily a defined set of functions an ordinary optometrist performs. Rather, the practice consists of a blend of subspecialties founded on the education received in schooling and obtained in one’s own interest.

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Low Vision

Neurorehabilitative Optometry

Refractive Surgery Comanagement

Sports Vision

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Vision Therapy

Contact Lens Fitting

Geriatric Care

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Pediatric Care

Binocular Disorders

Dry Eye

Glaucoma Co-management

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Defining Each Subspecialty and Their Purpose

This section shall explain in detail what each subspecialty entails, but it is important to keep in mind that the services subspecialties provide can sometimes overlap with one another.

Low Vision – This subspecialty is needed when glasses, lenses, and corrective surgery cannot improve a patient’s vision to the point where their quality of life is no longer impaired. The cause of low vision could be due to several differing factors such as disease(s) or visual field defects. Causes can range from hereditary diseases afflicting the patient from birth to alcoholics depriving their body of nutrition to the point where vision is lost due to a damaged optic nerve. Examinations for these patients must not only measure their visual acuity, but it should also be tailored to how they must adapt to their disability in daily life. To accommodate the extreme vision impairment, the Feinbloom low vision chart is used for measuring near and distance acuity rather than standard graphs.

Neurorehabilitative Optometry – This is a newly emerging area of optometry that deals with patients who have had neurological trauma such as strokes, cerebral palsy, autism, traumatic brain injury (TBI), multiple sclerosis, etc. Since the roles of the eyes are invariably tied with the brain in several areas, trauma to the brain can cause visual symptoms invisibly upon inspection of just the eyes. These symptoms vary according to which trauma the patient has suffered, as well as the severity of the condition. For example people who have suffered strokes or TBI can experience panic attacks in crowded spaces like malls, a loss of balance, double vision, photophobia (sensitivity to glare), words appearing to move while reading, and increased eye fatigue/strain. What makes these symptoms fall under neurorehabilitative optometry is that they are all caused by an issue in the brain, rather than in the eye itself.

Refractive Surgery Comanagement – A subspecialty especially ideal when partnering with an ophthalmologist, the optometrist essentially does everything for the patient except for the surgery itself. Specifically, the optometrist informs the patient of what the surgery entails from complication risks to the actual procedure. The OD also evaluates the patient to see if he or she is eligible for refractive surgery, as well as provides pre- and post-operative care for the patient to ensure healthy recovery. If there are post-surgery complications, the OD is expected to know how to treat the patient. The types of surgeries covered are laser in-situ keratomilieusis (LASIK), photorefractive keratectomy (PRK), and phakic intraocular lens (P-IOL) or “implantable contact lens (ICL)”.

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Sports Vision – As the name implies, this subspecialty aims to assist and improve athletes’ performance by training their eyes in a series of visual exercises. Such training can be vital to an athlete’s career no matter what the sport as a weakness in their performance can be due to a visual issue. The exams and therapy vary depending on the sport and role the patient plays and is much more expanded than a routine eye examine. For example, the visual acuity is measured not only as static (reading letters on a board) but also dynamic (ability to see objects in motion) and contrast sensitivity (ability to discern objects under different weather and lighting conditions, as well as overall ability to see detail). There are numerous other criteria a sports visual exam measures like:

eye movement skills – rapidly switching from object to object and tracking objects

accommodation/vergence – switching focus between objects of differing distances, especially when patient is fatigued or stressed

eye teaming/depth perception – ability to use binocular vision in determining distance and speed of objects

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central/peripheral visual recognition – accuracy and speed at which the athlete can react to new visual information across different parts of their visual field

eye-hand-body coordination – tests the speed and accuracy of body movements in response to visual information, as well as balance during simulated sports performances

visual concentration – ability to focus on a task while blocking out peripheral distractions

visualization – ability to use the “mind’s eye” to picture one’s parts performing a task while the eyes and body are concentrating on the immediate obstacle.

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Outside of the training and examination, the OD may also prescribe custom sport contact lenses or protective eye gear tailored for the athlete’s sport.

Vision Therapy – This is usually associated with treating eye conditions such as cross-eye, lazy eye, convergence insufficiency, double vision, and visual learning disabilities. The therapy is non-surgical and if dealing with learning struggles, it aims to resolve visual problems which interfere with learning, reading, and educational instruction. Typically the care is aimed towards children and is done in 30-60 minute sessions once or twice a week. The patient is often responsible to do additional exercises while at home to make therapy more effective. Various methods are used to carry out these exercises such as eye patches, computer software, timing and tracking mechanisms, and differing corrective lenses.

Contact Lens Fitting- Contact lenses have gone from an emerging technology in the early 80’s to a necessary part of optometric practice today. However, with as commonplace as these medical devices are, they still carry risks that ODs must educate their patients on. For example, overnight use of contact lenses can lead to epithelial erosion on the surface of the eye, giving the user an irritated painful sensation. Continued abuse of the eye in this way can lead to permanent damage to the surface of the eye, particularly on the cornea, as well as a loss in vision. There are other maintenance issues optometrists must inform their patients of like how to keep the lenses sterilized, avoid complications with eye injuries, and safely insert the lens itself. The doctor is also required to know how to use different contact lenses such as bifocals, prism, monovision, soft-fitting, bandage, and gas perms. The type of contact lens best for the individual often depends on personal preference and the daily tasks they perform.

Geriatric Care – This subspecialty deals with conditions commonly found in the rapidly growing aged population. The most common condition dealt with in older adults is the development of cataracts, which are caused by a clouding of the lens inside the eye. The optometrist tracks the development of the condition until it has matured far enough to be removed by surgery. Geriatric care also deals with other degenerative eye diseases seen more often in the older population such as glaucoma. The main goal of this care is to allow this aging population to remain independent, self-reliant, and able to contribute to society. This requires optometrists to not view the aging itself as a disease, but rather focus on collaborating with other health professionals to guarantee the patient’s continued well-being.

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Pediatric Care – Providing care to patients as young as six months means the optometrist must provide visual tests since they cannot undergo standard clinical examination. What the optometrist tests for in younger children is also different such as checking for color blindness, reading and learning disabilities, and the ability to track moving objects. This subspecialty often falls under the category of vision therapy and binocular disorders as issues with vision like being unable to concentrate on a single line of text at a time or mixing up letters (dyslexia) is best addressed early in development. Furthermore, pediatric care is aimed at observing the development of a patient’s vision to ensure impairments do not evolve past a treatable stage.

Binocular Disorders – This deals with vision disorders relating to using both of the eyes cooperatively. Visual symptoms such as double vision, loss of depth perception, cross-eyes, and lazy eyes result from a loss in stereopsis (the ability for the eyes to take two images into one 3D image). To break it down, the specific components ODs check the patient’s vision for are tracking (moving eyes across a piece of paper), fusion (using both eyes simultaneously), steropis (depth perception), convergence (ability for eyes to work and move together), and visual motor integration (transforming a vertical image to a horizontal image). The reason why optometrists typically treat younger patients with these conditions is because many of these conditions are caused by a defect in communication between the eye and the brain. As the patient grows older, that defect becomes harder to revert to normal making the condition much harder to treat.

Dry Eye – Dry eyes are a condition every individual experiences from time to time, especially when one is exposed to strong winds or low humidity. Typically it happens because the eye is not producing enough oils in the tears so they become very watery. The cause for it, however, can be due to many different issues. Perhaps one the of most common causes is from rosacea, a very widespread skin condition that brings blood vessels closer to the surface. This leaves the eye watery and irritated since the blood vessels are more prominent in the conjunctiva (the white of the eye). The cause of this condition is currently unknown and is incurable. Seasonal allergies can also result in a dry eye feeling when air-borne allergens land directly on the eye, causing it react with an overproduction of tears and mucus. This can be combated by using medications such as Zirtec or Visine. Additionally, dry eye can be caused by blocked glands along the eyelids that are responsible for producing essential oils in lubricating the eye. To treat this, ODs often recommend using a warm compress on the eyes for several minutes to help unclog the glands. The tricky situation optometrists must be aware of, however, is that lubricant eye drops used to help the dry eye condition can make the situation worse. Preservatives in the drops can facilitate dystrophy on the surface of the eye, leaving the eye worse off than before.

Glaucoma Co-management – With an aging population on the rise, glaucoma becomes an ever more prevalent issue. As a disease capable of causing blindness and incurable, it is extremely important that the condition is managed. This means check-ups every three to four months to monitor the disease’s progression. As a result, health care professionals such as ophthalmologists cannot keep up with managing this spreading condition. This leaves optometrists to run the frequent check-ups, always looking out for signs such as eye pressure rising above 21 IOP, blind spots appearing in the visual field, and damage to the optic nerve. With glaucoma being the third highest cause of blindness worldwide, it is a subspecialty that must be practiced diligently and thoroughly.

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How to Become Certified in a Subspecialty

In a nutshell, there is no straightforward way to be certified in a subspecialty, no formulaic approach, no set way to reach certification. There are, however, two general ways to go about it: 1. Complete a residency program under an optometrist or professor who has had years of experience in the subspecialty, or

2. Research the desired subspecialty on your own. Seek out workshops and lectures covering the topic and become as knowledgeable of the subject as possible before implementing it into practice.

In both cases, the optometrist must keep up to date on the subspecialties to ensure they can prescribe the best treatment possible to patients. For the past few years, there has actually been an ongoing controversy in the practice as to whether or not an optometrist should have to become certified through a nationally recognized system. On one side, some argue that one must complete a course and pass a standard exam to prove that he or she is capable of serving in that subspecialty. The other side, in contrast, asserts that such a course and exam could not show whether or not an optometrist is competent enough to fulfill the role, and instead the system would only mean more time and money an optometrist would have to invest to continue his or her practice.

Why having Subspecialties is Important

From a private practice standpoint, having a subspecialty means that practice can offer a service unavailable in competitors’ offices. This allows the practice to expand their cliental and as a result, increase revenue. Despite this, implementing more subspecialties also means another time investment in learning it, as well as the tools needed to perform it. This means an optometrist must be able to weigh the pros and the cons of a subspecialty before using it in practice. Besides being a market and profit tool, having certain subspecialties allows the optometrist to serve a need to a patient that would otherwise go unmet. It is a way for the doctor to serve the community in a vital way, showing that the OD is not just concerned with nickels and dimes.

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Summary

After discussing the various aspects of subspecialties, it becomes apparent why anyone interested in the field of optometry must become acquainted with them. They are vital for making one successful in the practice not only because it makes the optometrist more knowledgeable of the field, but it also makes him or her more marketable. One cannot simply hope to pick up all of the subspecialties as they often demand expensive specialized equipment, as well as a significant amount time to research the topic. By learning what a majority of these subspecialties do, it also helps illustrate what the job really entails and where one may want to specialize. Obtaining a subspecialty, however, is not very straightforward; rather, it becomes a process of independently researching a topic until it is mastered whether it be through a residency or on your own with workshops and lectures. Perhaps most importantly, these subspecialties allow optometrists to serve the population in a way that is both rewarding and satisfying.

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