Monday, April 21, 2008

Where to go if we notice any alteration in the vision?

Enlace a entrada en español

Optician’s Shops, Optometrist Offices, Ophthalmologist Offices.

From a point of sanitary view, and in Spain, an Optician-Optometrist can work in any of these places and his occupation in each one is different.

Besides these ones, he can work in ophthalmic lenses factories, contact lenses factories, workshops for fitting eyeglasses, physics laboratories, etc., but I will just write here about the sectors that might concern the reader, since they are the places that you may need access to.

In Spain, the term “Optometrist” did not exit in the past, and people just knew about two types of professionals: in one hand ophthalmologists who were and are the medical doctors and in the other, the opticians, who were those that sold the glasses.
But this has changed. Our functions have increased and though our degree does not allow to pursue Doctorates in Spain, our profession grows day by day and each one of us specializes in whatever we like or perform better. Just like any profession.


Some Opticians-Optometrists work in Optician’s. This group is the most plentiful one. But although, in the past our functions were basically the performance of eye exams and selling in an optician’s, nowadays things are changing (little by little, unfortunately).

According to the Spanish law, an Optician's is not a shop, but a health center. As such, the most important thing is the visual health of the people that come in. But unfortunately I have to admit that this is not always the actual aim. The big optical chains and many little optician's shops, as in any business, lead their aims to earn as much money as possible and obviously that is attained by selling eyeglasses, sunglasses, contact lenses, and so on. The correction “must be obtained quickly”, forgetting the quality of the service and the deontological code that every optician should have engraved in his forehead. In these optician's shops an optician can not “dally” about one person who tells him his “visual problem”. “Do you see or not? Do you see with this one? You need some eyeglasses, follow me to the point of sale”. So sad... They are just sales-oriented opticians.

Fortunately not all optician's work with this way, and the quality of service is much better. Maybe the patient will finish buying some glasses, but at least he will go to home convinced that the manner has been much better and more qualified, and that he has not been just a customer number, but the patient “Mr. Smith”.

Some optician's (very few) have even increased some services in the last decade. They are not just responsible for advising and selling some glasses or adjusting some contact lenses or fitting a pair of ophthalmic lenses in a frame that the patient chose. Their work is more specialized. The glasses are part of their work but it is not the ONLY job.
The visual evaluation is more specific to each problem and so is its treatment. This is the reason why many opticians are beginnnig to charge this service. Really this is our work and it is fair to charge for carrying it out. It is a qualified service, which as any other, has its price (but I will write about this subject in another post, possibly the next one). These optician's shops offer more treatments through contact lenses or eyeglasses and some of them even offer vision therapy.

Although nowadays in Spain, our 3 year “Opticians-Optometrist” degree is the only training available (in Spanish), there are many seniors opticians that do not have the knowledge of an Optometrist. In reality, there should be a differentiation between an commercial Optician (who will advice on the glasses or contact lenses-buying process and its maintenance, or fit /fix your glasses, and so on) and an Optometrist (who will be able to carry out all of these tasks but also, he will be able to offer you a more complete visual evaluation and more treatment options for different non-pathologic visual problems). In USA this difference is much more defined legally , since the studies are different, the each one’s responsibilities are different too, and although an optometrist can work as an optician, an optician can not act as an optometrist , since it is considered that he does not have enough knowledge.


The optometrist can work in two kinds of offices. In one hand, people can find optometrists working in an ophthalmologist office. Generally, these are offices in private refractive clinics. In them, optometrists help ophthalmologists in ALL optometric-related examinations which are necessary to perform to any patient who will undergo refractive surgery (myopia, astigmatism, and so on). Only recently have optometrists started to work so closely with ophthalmologists.


On the other hand, and for me it is the most important thing, optometrists can already set up our own optometry offices legally. We previously required an ophthalmologist to do it and therefore, it was considered as an ophthalmologist office.

Generally, in these offices there is not selling of glasses, and if so, the room for it is so small, that is almost symbolic.

In any offices, the “customer” does not exist, everybody is considered a “patient”.

If you want to receive a visual examination, you need to make an appointment (some optician’s shops do it too).

These visual examinations are complete and sometimes they require one or even two hours depending on the patient’s symptoms and visual problem (I will explain this examination more later on, in another post).

Usually, people, who go to an optometric office, do not arrive complaining because they can not see at distance and so they need some glasses to see better. They are usually people who come with a visual problem that goes beyond seeing or not seeing clearly:
- “I can not read for many hours because I get tired very fast.”
- “When I am working with the computer I have eyestrain, burning and itching eyes.”
- “Sometimes I see blurred or double.”
- “My child has difficulty for reading, he always loses the line and he reads very slowly.”
- “Is there any way to avoid my child’s increasing myopia?”
- “My child has performance problems at school.”
- “My child has lazy eye and he has been wearing a patch all last year and he has not gotten any improvement.”
- “It looks like my one-year-old baby has a squint in one eye, but we are not very sure.”
- “I have undergone a skull-encephalic trauma after a car crash and I have visual consequences.”
- “I have Multiple Sclerosis and since I started my medical treatment I have many visual upsets.”
- “I do not feel safe when I am driving.”
- “I feel sick when I am a car passenger but not when I am the one driving the car.”
- …

With many problems people have, they do not relate them to vision, and many times it is the base problem of everything. And when the visual problem is treated, rest of associated upsets, that they did not know that were related, disappear.

In that visual examination so comprehensive, we can find where the problem is and how to solve it.

For that, we have different treatments or solutions in the office:
- Some glasses for seeing better at distance or at near.
- Some glasses to performing better.
- Some glasses to avoid eye deviation.
- Some glasses to prevent the head from tilting…

As you can see, there are many options for using glasses and the first one is just one more.
It happens the same thing with the contact lenses, but I will explain later how we use each one of our work “instruments”.

Besides using glasses and contact lenses for helping in the treatment of a visual problem, many times patients need to know some little guideline in order to use their visual system in an optimal way, and therefore, to remove their upsets and prevent them for appearing again. For that, we resort to the Vision Therapy. It is a treatment that might need more or less time to automate all what the patient learns in the office and put it into practice daily.

Some offices also are specialized sport vision or low vision; in any of them, optometrists use specific visual tests and procedures of vision therapy.

THEREFORE, after reading all this, I guess it is a little bit more clear where you have to go depending on your visual problem, and the service and/or the manner that you would like to receive.

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