By the Division of Professional Licensure

Board of Registration of Optometrists

Licensed doctors of optometry are independent primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures. The scope of optometric care ranges from vision testing and correction to diagnosing, managing and treating complex eye and vision problems such as conjunctivitis.

The Board of Registration in Optometry licenses all new optometrists, and renews licenses for established optometrists. The Board both proposes and reviews legislation, as well as new rules and regulations, affecting the profession. It maintains high standards in the field and protects consumers by investigating and disposing of complaints against optometrists. It also works to maintain the educational standards of the profession by reviewing and either approving or rejecting continuing education and postgraduate courses for Massachusetts's licensees.

Each board of registration administers and enforces its regulations regarding licensing requirements. The boards receive, investigate and adjudicate complaints against the respective licensed practitioners.


Optometrists

Optometrists examine people's eyes to diagnose vision problems and eye disease. They treat vision problems and certain eye diseases such as conjunctivitis or corneal infections. Optometrists use instruments and observation to examine eye health and to test patients' visual acuity, depth and color perception, and their ability to focus and coordinate the eyes. They analyze test results and develop a treatment plan. Optometrists prescribe eyeglasses, contact lenses, vision therapy, and low vision aids. Optometrists often provide postoperative care to cataract patients. When optometrists diagnose conditions that require care beyond the optometry scope of practice such as diabetes or high blood pressure, they refer patients to other health practitioners.

Optometrists should not be confused with ophthalmologists or dispensing opticians. Ophthalmologists are physicians who diagnose and treat eye diseases and injuries. They perform surgery and prescribe drugs. Like optometrists, they also examine eyes and prescribe eyeglasses and contact lenses. Dispensing opticians fit and adjust eyeglasses and in some states may fit contact lenses according to prescriptions written by ophthalmologists or optometrists.

Optometrists provide most of the primary vision care people need.


What to Expect

A thorough vision examination given by your doctor of optometry may take 30 minutes to an hour. There are no shortcuts. During this time your optometrist gets to know you, your family history, lifestyle and vision needs. To know you're getting a comprehensive examination, here are some procedures to look for:

  • A complete health history should be taken before the examination.
  • Inspection of the exterior and interior of your eyes for signs of possible eye or systemic diseases.
  • Visual acuity test. Tests your ability to see sharply and clearly at all distances.
  • Refraction. A measurement of your eye's ability to focus light rays exactly on the retina.
  • A check eye coordination and eye muscle control.
  • A test of your eyes' ability to change focus.
  • Glaucoma test.

You may also be given special tests for color perception, depth perception, field of vision and other vision skills.


Common Vision Problems

Nearsightedness, or myopia, as it is medically termed, is a vision condition in which near objects are seen clearly, but distant objects do not come into proper focus. Nearsightedness occurs if your eyeball is too long or the cornea has too much curvature, so the light entering your eye is not focused correctly.

Nearsightedness is a very common vision condition that affects nearly 30 percent of the U.S. population. Some evidence supports the theory that nearsightedness is hereditary. There is also growing evidence that nearsightedness may be caused by the stress of too much close vision work. It normally first occurs in school age children. Since the eye continues to grow during childhood, nearsightedness generally develops before age 20.

A sign of nearsightedness is difficulty seeing distant objects like a movie or TV screen or chalkboard. A comprehensive optometric examination will include testing for nearsightedness. Your optometrist can prescribe eyeglasses or contact lenses to optically correct nearsightedness by altering the way the light images enter your eyes. You may only need to wear them for certain activities, like watching TV or a movie or driving a car, or they may need to be worn for all activities.

Refractive surgery or laser procedures are also possible treatments for nearsightedness as is orthokeratology. Orthokeratology is a non-invasive procedure that involves the wearing of a series of specially designed rigid contact lenses to progressively reshape the curvature of the cornea over time.

Spots (often called floaters) are small, semi-transparent or cloudy specks or particles within the vitreous, the clear, jelly-like fluid that fills the inside of your eyes. They appear as specks of various shapes and sizes, threadlike strands or cobwebs. Since they are within your eyes, they move as your eyes move and seem to dart away when you try to look at them directly.

Spots are often caused by small flecks of protein or other matter trapped during the formation of your eyes before birth. They can also result from deterioration of the vitreous fluid, due to aging; or from certain eye diseases or injuries.

Most spots are not harmful and rarely limit vision. But, spots can be indications of more serious problems, and you should see your optometrist for a comprehensive examination when you notice sudden changes or see increases in them.

By looking in your eyes with special instruments, your optometrist can examine the health of your eyes and determine if what you are seeing is harmless or the symptoms of a more serious problem that requires treatment.

Lazy eye, or amblyopia, is the loss or lack of development of central vision in one eye that is unrelated to any eye health problem and is not correctable with lenses. It can result from a failure to use both eyes together. Lazy eye is often associated with crossed-eyes or a large difference in the degree of nearsightedness or farsightedness between the two eyes. It usually develops before age six and it does not affect side vision.

Symptoms may include noticeably favoring one eye or a tendency to bump into objects on one side. Symptoms are not always obvious.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. Vision therapy teaches the two eyes how to work together, which helps prevent lazy eye from reoccurring.

Early diagnosis increases the chance for a complete recovery. This is one reason why the American Optometric Association recommends that children have a comprehensive optometric examination by the age of six months and again at age three. Lazy eye will not go away on its own. If not diagnosed until the pre-teen, teen or adult years, treatment takes longer and is often less effective.

Astigmatism is a vision condition that occurs when the front surface of your eye, the cornea, is slightly irregular in shape. This irregular shape prevents light from focusing properly on the back of your eye, the retina. As a result, your vision may be blurred at all distances.

People with severe astigmatism will usually have blurred or distorted vision, while those with mild astigmatism may experience headaches, eyestrain, fatigue or blurred vision at certain distances.

Most people have some degree of astigmatism. A comprehensive optometric examination will include testing to diagnose astigmatism and determine the degree.

Almost all levels of astigmatism can be optically corrected with properly prescribed and fitted eyeglasses and/or contact lenses.

Corneal modification is also a treatment option for some patients.

Crossed-eyes (strabismus) occur when one or both of your eyes turns in, out, up or down. Poor eye muscle control usually causes crossed-eyes. This misalignment often first appears before age 21 months but may develop as late as age six. This is one reason why the American Optometric Association recommends a comprehensive optometric examination before six months and again at age three.

There is a common misconception that a child will outgrow crossed-eyes. This is not true. In fact, the condition may get worse without treatment.

Treatment for crossed-eyes may include single vision or bifocal eyeglasses, prisms, vision therapy, and in some cases, surgery. Vision therapy helps align your eyes and solves the underlying cause of crossed-eyes by teaching your two eyes to work together. Surgery alone may straighten your eyes, but unless your eye muscle control is improved, your eyes may not remain straight.

If detected and treated early, crossed-eyes can often be corrected with excellent results.

Presbyopia is a vision condition in which the crystalline lens of your eye loses its flexibility, which makes it difficult for you to focus on close objects.

Presbyopia may seem to occur suddenly, but the actual loss of flexibility takes place over a number of years. Presbyopia usually becomes noticeable in the early to mid-forties. Presbyopia is a natural part of the aging process of the eye. It is not a disease and it cannot be prevented.

Some signs of presbyopia include the tendency to hold reading materials at arm's length, blurred vision at normal reading distance and eye fatigue along with headaches when doing close work. A comprehensive optometric examination will include testing for presbyopia.

To help you compensate for presbyopia, your optometrist can prescribe reading glasses, bifocals, trifocals or contact lenses. Since presbyopia can complicate other common vision conditions like nearsightedness, farsightedness and astigmatism, your optometrist will determine the specific lenses to allow you to see clearly and comfortably. You may only need to wear your glasses for close work like reading, but you may find that wearing them all the time is more convenient and beneficial for your vision needs.

Since the effects of presbyopia continue to change the ability of the crystalline lens to focus properly, periodic changes in your eyewear may be necessary to maintain clear and comfortable vision.

Farsightedness, or hyperopia, as it is medically termed, is a vision condition in which distant objects are usually seen clearly, but close ones do not come into proper focus. Farsightedness occurs if your eyeball is too short or the cornea has too little curvature, so light entering your eye is not focused correctly.

Common signs of farsightedness include difficulty in concentrating and maintaining a clear focus on near objects, eyestrain, fatigue and/or headaches after close work, aching or burning eyes, irritability or nervousness after sustained concentration.

Common vision screenings, often done in schools, are generally ineffective in detecting farsightedness. A comprehensive optometric examination will include testing for farsightedness.

In mild cases of farsightedness, your eyes may be able to compensate without corrective lenses. In other cases, your optometrist can prescribe eyeglasses or contact lenses to optically correct farsightedness by altering the way the light enters your eyes.

Color vision deficiency means that your ability to distinguish some colors and shades is less than normal. It occurs when the color-sensitive cone cells in your eyes do not properly pick up or send the proper color signals to your brain. About eight percent of men and one percent of women are color deficient.

Red-green deficiency is by far the most common form and it results in the inability to distinguish certain shades of red and green. Those with a less common type have difficulty distinguishing blue and yellow. In very rare cases, color deficiency exists to an extent that no colors can be detected, only shades of black, white and gray.

Since many learning materials are color-coded, it is important to diagnose color vision deficiency early in life. This is why the American Optometric Association recommends a comprehensive optometric examination before a child begins school.

Color vision deficiency is usually inherited and cannot be cured, but those affected can often be taught to adapt to the inability to distinguish colors. In some cases, a special red tinted contact lens is used in one eye to aid persons with certain color deficiencies.


Optometry Treatment

Not every vision examination ends in a pair of glasses. If your examination indicates a need, however, your optometrist will prescribe glasses or contact lenses, based on your vision needs and personal choice. If you need vision therapy, he or she can design a program for you or refer you to an optometrist who specializes in this area. It will involve prescribed visual tasks under controlled conditions to correct specific vision problems and to improve your vision skills. Lenses can be used in conjunction with vision therapy. And, in some cases, he or she may prescribe medications or refer you to another practitioner for treatment.


Selecting glasses

If you need prescription lenses, there are a wide variety of lens types and frames to choose from, so you can look your best as well as see your best. However, not all lens sizes, tints and materials are appropriate for all prescriptions. Eyeglasses are designed, first and foremost, to meet your individual vision needs. Discuss your activities and fashion preferences with your optometrist so that your glasses will meet your vision needs and enhance your appearance.


About contact lenses

If you need or prefer contact lenses, you can choose from daily wear soft and rigid gas-permeable, extended-wear frequent replacement, eye color enhancement lenses and standard hard lenses. But not all lenses are appropriate for all vision conditions and, to a large degree, successful; wear depends on the professional skill and knowledge of your optometrist and how well you follow his or her instructions. When you are considering contact lenses, seek an optometrist who is a skilled contact lens prescriber, offers a variety of lenses and provides complete optometry care, including follow-up examinations.


Consumer Tips

Now that you have learned a little about eyecare, we hope that you will remember how important vision is. When your children go to school ... when you pick up a newspaper or book ... when you play you favorite sport ... when you get behind the wheels of your car ... and when you work at your job. And, we hope that you will remember that comprehensive, professional optometry care is a good way to make sure that you are seeing well, being more productive and enjoying life more.


Filing a Complaint

While the majority of licensees conduct themselves as true professionals, the Division of Professional Licensure will take action against those who fail to maintain acceptable standards of competence and integrity.

In many cases, complaints are made by dissatisfied consumers - but, dissatisfaction alone is not proof of incompetence or sufficient grounds for disciplinary action. Cases are evaluated on the basis of evidence. The more evidence presented, the stronger the complaint.

If you have a serious complaint against a licensed optometrist, call or write the Division's Office of Investigations and ask for a complaint form. Or download a copy of the complaint form pdf format of Application for Complaint Form
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Division of Professional Licensure
Office of Investigations
1000 Washington Street, Suite 710
Boston, Mass. 02118
(617) 727-7406