What an optometrist actually does

World Optometry Day falls on 23 March. It is a reasonable occasion to set out what the profession is, because the confusion is persistent and it has consequences: people who need an eye examination go without one because they think it means a hospital, and people who need surgery are sold spectacles by someone unqualified to tell the difference.

The three roles

An optometrist — Doctor of Optometry, OD — completes a six-year university degree and registers with the Optometrists and Dispensing Opticians Registration Board of Nigeria. Optometrists are primary eye care providers. They examine eyes, diagnose and manage eye conditions, prescribe and fit spectacles and contact lenses, manage a range of ocular disease, and refer on where surgery or specialist medical care is required.

An ophthalmologist is a medical doctor who has specialised in the eye and is registered with the Medical and Dental Council of Nigeria. Eye surgery — cataract, retinal, glaucoma and corneal surgery — belongs to ophthalmology.

A dispensing optician is trained and registered to fit and supply spectacles to a prescription written by someone else. They do not examine eyes.

The relationship between the first two is a referral relationship, not a hierarchy. Most eye problems never need to reach a surgeon; most of the ones that do are found by somebody who is not one.

What a day actually contains

Comprehensive examinations, which is the core of it: refraction, binocular vision assessment, intraocular pressure, examination of the front of the eye and of the retina and optic nerve.

Glaucoma detection and co-management. Diabetic retinopathy screening. Dry eye and ocular surface disease. Red eye, foreign bodies, corneal abrasions. Contact lens fitting and aftercare. Paediatric vision, including amblyopia and squint. Myopia control in children. Low vision assessment and rehabilitation. Occupational and sports vision. Post-operative care shared with the surgeon.

And referral: knowing what to send on, to whom, and how quickly. This is a larger part of the skill than it sounds.

Why primary matters

Nigeria has a small number of ophthalmologists relative to its population, concentrated in tertiary centres in the cities. A system in which every eye complaint must reach a surgeon is a system in which most eye complaints reach nobody.

Optometry distributed across communities is what makes early detection possible at scale. Glaucoma found at a routine examination is a manageable condition; glaucoma found when the patient notices is not. The examination that makes the difference is not a surgical one.

What the Lagos chapter does

The Nigerian Optometric Association was founded in 1968. The Lagos State Chapter comprises members living and practising in Lagos, organised into four zones — Ikeja, Alimosho, Festac and Island — and it runs continuing education, zonal meetings, public screening, and the professional and welfare business of the chapter.

The public-facing part of that work is visible in two places: the free screening the chapter runs around World Sight Day and World Glaucoma Week, and the register of licensed practitioners published on this site.

A practical note

If you are unsure whether your problem is one for an optometrist, the answer is almost certainly yes — that is what primary care means. You will either be treated or told precisely where to go next. Either is better than guessing.