Who are Optometrists? :: All About Optometry in Nepal

Welcome!

This article is for people who have avid interest to know about optometrists.

It will be helpful to have good insights on optometry education in Nepal. If you have just passed Higher secondary education or you have just joined optometry course or you have just passed bachelor of optometry, you are at the right place.

For those who have passed 10+2 or A-level and searching for the opportunities for higher education and have particular interest in optometry, take your time! You have to read the whole article.

For optometry students or fresh optometry graduates just skip the initial portion of "how to become optometrist? But wait, read the latter part as there are directions on what to do.

Today we are going to discuss on major six topics:

Ø what optometry is,

Ø how one can become optometrist,

Ø short history of optometry,

Ø scenario of optometry profession from the past to the present,

Ø governing and advocacy bodies of optometrists and

Ø what opportunities do optometrists have.

Who is an Optometrist?

First of all, optometrist is called Drishti Bisesagnya in Nepali, and the global umbrella organization for all optometrists World Council of Optometrists (WCO) has defined optometrist as follows

"Optometrist is a health care professional that is autonomous, educated and licensed. They are the primary healthcare practitioners of the eye and visual system who provide comprehensive eye and vision care, which includes major three things:

1) Checking the power of the eye, which is also called refraction and prescribing appropriate glasses, contact lenses or other optical devices, which is called dispensing,

2) Detection/diagnosis and management of disease in the eye, and

3) The rehabilitation of the conditions of the visual system. "

World Health Organization and over 75 other organizations of 40 different countries embrace this definition for optometrist.

What Optometrists do?

Now let's further elaborate about these three major works of optometrists

1)Refraction and dispensing

An optometrist performing objective refraction (retinoscopy)

First they test vision and check the power of the eye with the help of retinoscope, autorefractor and other modern equipment.

If one is wearing glasses or lenses, they check the power with the help of lensometer and later they verify the power of the eye with lenses on  trial frames or phoropter.

Optometrist finalizes the types of lens, frame size and design according to your power, face shape and the distance between two eyes. They also recommend contact lenses if your eyes are fit and train you how to wear them.

Also, optometrist suggests for refractive surgeries and they are skilled for complicated childhood refraction and the management of keratoconus as well as referring cases of keratoconus for cross-linking or for other necessary surgeries. Optometrists help you to choose design of the lens and frame if you have high power or presbyopia.

2) Disease diagnosis and management

Optometrist doing Slit lamp examination of anterior segment of eye

As per the given condition optometrists use torchlight, ophthalmoscope or slit lamp biomicroscope to detect and manage various internal and external eye diseases. They refer retinal and other complex eye diseases and cases those need surgeries to ophthalmologist. They help ophthalmologist to reach to the correct diagnosis and to properly manage disease condition by conducting diagnostic procedures, like biometry or ocular ultrasonography for cataract, Visual field test or optical coherence tomography (OCT) of the disc for glaucoma, electrophysiological tests for optic nerve and retinal problems and many more.

3) Vision rehabilitation

Binocular vision rehabilitation: Optometrists start lens therapy, prism therapy, pharmacological or vision therapy for the conditions involving binocular imbalance (loss of coordination of two eyes). Similarly, they advise for squint surgery, they perform pre-operative and post-operative evaluation and vision therapy for strabismus. They manage the condition like amblyopia or lazy eye that develops due to high power or squint.

Low vision child being examined by optometrist

Low vision rehabilitation: Optometrist is the right person to cater counseling and rehabilitate low vision patients with the help of low vision devices.

Above three jobs are just the ones delineated by World Council of Optometry (WCO).

What else can optometrists do?

With further focused training optometrists can pursue career in various fields like ocular prosthesis (as an ocularist), eye banking, community eye care projects, vision therapy and orthoptics, neuro-rehabilitation, etc.

Now let's move to the second chapter of this article:

How to become an Optometrist in Nepal?

This is another form of asking about optometry education in Nepal. First of all, if you are interested to become an optometrist you should have a strong background in science and mathematics because this is one of the facets of medical science and  there are complex numerical problems of optics. Secondly, as the language for reading, writing, communication and clinical practice is English, you should also have a good English.

You should study science with Biology major and secure at least 50% marks. Colleges also offer opportunities for ophthalmic assistant to pursue bachelor in optometry.

Each year in the name of bachelor of optometry and vision science or simply bachelor of optometry, TU takes 10 students, NAMS takes 40 students, and PU takes 15 students. After four years college degree and licensure from fulfilling Nepal Health Professional Council (NHPC)'s criteria, one is eligible to become an optometrist. According to Code of ethics of bachelor of optometry issued by NHPC in December 2013, both doctor of optometry and bachelor of optometry have been recognized worldwide as  graduate degree in optometry. Graduated optometrists are entitled with prefix of doctor.

History of World Optometry

Let's now go to Chapter 3, where we will shortly discuss about the history of optometry.

When we go searching for the history of optometry in the ancient times we reach to jewelers and then to optician as the origin of this profession. While ancient Romanian and Chinese literatures and artworks reveals the use of crude glasses, the fact that people do have vision problems was first cited by a person named Seneca in his book Questiones Naturales in 100AD. This is supposed to be the first book of optometry as it mentioned about refraction.

The first manufactured vision aid, however, is made in 1000AD that magnified the object. It was later used by elite for reading purposes and was called reading stone. The glasses was invented after about two hundred years in China. Those glasses were made up of rock crystals and smoky quartz.

But the modern glasses were developed in the fourteenth century in Venice, the capital city of Italy which is now the hub for branded spectacles.

Etymology of Optometry

Now let's talk about word origin of optometry. The word optometry comes from the combination of two Greek words: Opsis which means vision and metron which means measure. The word optometer was used first in a book called Treatise on the eye: The manner and phenomena of vision published in 1759 AD. The word optometry, however, was used to introduce a noble profession only during the start of twentieth century. Then the working field of optometry was gradually concentrated on clinical practice and patient care. World Council of Optometry was established in 1927 AD which is regarded as the milestone in the development of optometry.

Optometry in Nepal: from the Past to the Present

The first optometry school of Nepal was established in 1998 AD under the banner of Tribhuvan University at Institute of Medicine constituent campus Maharajgung Medical Campus with the support of Auckland University, New Zealand. The basic science and community courses are offered by the campus while clinical training and academic course of optometry are based at BP Koirala Lions Center for Ophthalmic Studies, which lies in the premises of TU Teaching Hospital, Maharajgunj.

2001 AD witnessed five graduates while there are now 10 graduates each year from IOM. Many youngsters kept on going to India searching for the opportunities to study optometry. The second and the third optometry schools were started after two decades of the establishment of the first, in 2018 AD.

List of Colleges offering Bachelor of Optometry (and vision science) in Nepal

Course	Affiliation	Institute	Started in	No of seats
B Optom	TU	Institute of Medicine Maharajgunj Campus	1998	10
BOptom	Pokhara University	Himalaya Eye Institute	2018	20
BOVS	NAMS	5 eye hospitals (given below)	2018	40
BOptom	Purvanchal University	Nobel Medical College	2023	10
Total				80

Institute of Medicine (IOM) offers total 10 seats with 6 scholarship and 4 paying quotas. National Academy for Medical Science (NAMS) takes 40 students on paying and the name of the program is Bachelor of optometry and vision science (BOVS). Basic science course is conducted at Lumbini Eye Institute, Bhairahawa, for six months and then students are sent for clinical posting according to the merit choices in the following eye hospitals of Nepal:

·       Tilganga Institute of Ophthalmology (TIO), Gaushala, KTM - 8 students

·       Nepal Eye Hospital (NEH), Tripureshwore, KTM - 8 students

·       Lumbini Eye Institute, Bhairahawa - 8 students

·       Bharatpur Eye Hospital, Chitwan - 8 students

·       Biratnagar Eye Hospital, Biratnagar  - 8 students

 

Similarly, Pokhara University offers 20 seats in which one seat is for merit scholarship (17 Seats now; UPDATED November 2021) The courses and clinical training are both conducted at Himalaya Eye Institute, Gharipatan, Pokhara. Ophthalmic Assistants can also apply in NAMS and PU.

Each year many students go to India for Bachelor of optometry. Before going, please explore more, contact the seniors from the concerned college, and fulfill all the criteria set by Ministry of Education (MOE), Nepal Health Professional Council (NHPC) and Nepalese Association of Optometrists (NAO). The colleges that you are going to study must have been enlisted in NHPC registry and the same college should have its own hospital for better clinical exposure. Since in the past years, many colleges didn't have any hospital for training, students would have to come Nepal's eye hospitals for internship.

How many Optometrists are there in Nepal?

Till now the number of NHPC registered optometrists is around 1150 (UPDATED November 2021), which is greater than number suggested by World Health Organization. According to WHO there should be 50, 000 population for one optometrist. Hence, the number of optometrists have been saturated in Nepali market after it reached 563 (WHO cut-off number). This has resulted huge number of novice optometrists unemployed or hired in relatively meager amount of salary if they follow the usual trend of choosing to have jobs as a clinician.

What are the governing bodies of optometry?

Nepalese Association of optometrists (NAO) is continuously working for the rights and benefits of Nepalese optometrists since long. As there is no council of optometry till date, all the monitoring and licensing works are undertaken by NHPC.

At last,

What next after being an optometrist?

Ok, if you passed university exams and then you will have to submit your credentials and nominal fees to NHPC for licensing examination. After getting the practicing license you have a plethora of choices, apart from usual clinical practice and patient care. Obviously, what works you can do after getting practicing license from NHPC depends upon your interest.

1.    Work in hospital, project or company

2.    Private practice: as a job or at a self-owned outlet

3.    Business: retail or wholesale optical business. Online business can be rewarding these days

4.    Abroad Employment: optometrists can go to work or teach in various countries including India, Bangladesh, Sri Lanka, Maldives, Vietnam, Combodia, Myanmar, Papua New Guinea (PNG), Saudi Arab, UAE, Qatar and several African countries.

5.    Agencies/NGO : they can work as a staff of various donor or international agencies like Fred Hollows, Brien Holden Vision Institute, Essilor Vision Institute, Christopher Blinden Mission (CBM), SEVA foundation, International Association for Prevention of Blindness (IAPB). They can also get hired by NGOs like Nepal Netra Jyoti Sangh, Nepal Eye Program, BP Eye Foundation, etc. They can also register their own NGO to work as an executive board members, for e.g., Better Vision Foundation is one of the NGOs that is based on optometrists.

6.    Policy Making and advocacy: Optometrists who love to advocate and work for the profession in a policy level can start from Nepalese Association of Optometrists (NAO), and politically lobby to be nominated for governmental chairs like portfolio in NHPC, national insurance board, etc.

7.     Further Study

·       In Nepal: If you want to change the field then you can study many subjects but Masters in Health care management and Master of public health is more popular. If you want to continue optometry then Pokhara University is offering M.Optom course with a total 13 intake of the students each year. They have to appear in the common medical entrance examination system conducted by Medical Examination Commission, Sanothimi, Bhaktapur around October of every year. After M. Optom you can work as a lecturer in Optometry and OA colleges.

NB: Tilganga Institute of Ophthalmology (TIO) has discontinued the MOptom program after uptaking two batches (2019 and 2020 Batch)

·       Abroad Study

ü If you wish to broaden your clinical expertise and business aspect in practice then you can follow your pursuit by going to the Philippines to study doctor of optometry (OD). School of Health and Allied Health Sciences under Southwestern university, Phinma and college of optometry affiliated to Cebu Doctors' University, Cebu are two colleges from where many Nepalese optometrists have taken OD degree.

ü If you don't get a chance to study M. optom in Nepal, you can pursue your dream going to India and Malyasia.

ü Masters and PhD can be obtained from various universities at UK, Portugal, Norway, and Hong Kong.

ü Mostly pursued US universities for PhD by Nepalese optometrists are University of Houston college of optometry, State University of New York (SUNY) college of optometry, University of Alabama school of optometry, University of Indiana school of optometry. The tough university is University of Berkeley where no Nepali optometrist has yet been successful to enter.

ü Australia and New Zealand: Queensland University of Technology has become the hotspot for Nepalese optometrists to study M.Phil and PhD. Other universities that Nepali has tracked records of admissions in scholarships are University of New South Wales (UNSW) and Flinders University. Melbourne University also provides M. optom clinical course. University of Auckland is another attractive point for Nepalese optometrists from where three optometrists have passed PhD with significant achievement until now. The scopes after PhD are post Doc and professing at universities, and working in the research companies and industries. Nepalese PhDs are working in world's renowned institutions and have published commendable articles in journals as prestigious as New England Journal of Medicine, the journal with the highest impact factor in medicine. 

ü Few optometrists have gone to Australia for studies in various institutions in closely related fields like orthoptics.

ü Few optometrists from IOM have gone to accomplish PhD programs in Neuroscience in South Korea and Germany.

ü Besides, we can further explore the areas and universities via the internet

Above mentioned realms of scopes are not the only available options. Optometry profession flexibility so much so that one can create one's own scope. Since number of clinical optometrists have already been saturated, one should be aware to create new scope of work. Some of them are:

Ø Optometry colleges from Optometrists

Ø Optometry specialty and referral clinics

Ø Optometry preparatory and career counseling institutes

Ø Optometry book writing

Ø Optometry research institutes for regular researches and indexed journal publication

Ø Opening sophisticated dispensing lab

Ø Opening dispensing training institute with standardized curriculum and well developed laboratory facilities

Ø Starting a platform for conducting regular Continue Optometry Education, seminars, conferences, workshop, talks and symposium

Ø Optometry mobile and charitable clinics

 Wait, if you want to watch the video that includes all the information click below. It's in Nepali, don't forget to watch with English captions on in YouTube.

 This article is last updated on 2nd October 2023.