The Comprehensive Optometry Topics Guide for Optometry Schools

The American Optometric Association's Code of Ethics (first adopted in 1944, readopted in 2007) lists ten duties. The four most useful in interviews:

The others cover access to care for everyone, competence, professional standards, cordial relationships with the healthcare community, society's welfare, and acting with "honesty, integrity, fairness, kindness, and compassion." The AOA also publishes Standards of Professional Conduct and an Optometric Oath.

The Canadian Association of Optometrists' Code of Ethics makes "the visual welfare of all patients" the primary concern, requires equal diligence "regardless of race, creed, or economic status," asks optometrists to consult freely with colleagues and other professions, and limits use of patient information to the patient's benefit.

Binding rules come from provincial regulators. Alberta's college, for example, requires referral "when any procedure is beyond their competence or training" and confidentiality "except where required or authorized by law."

Respecting patients' decisions means explaining options in plain language: myopia control choices for a child, the effects of dilation on driving, or the risks of a procedure. Confidentiality has legal limits, such as driving reports where required.

• Check understanding, not just agreement
• Involve parents for children while respecting the child's voice
• Tell patients when the law requires you to share information

Optometrists work in private practices, retail and corporate settings, hospitals and community clinics, academia and industry. Retail settings bring a specific ethical challenge: keeping care first when the business sells eyewear.

• US: about 25 schools and colleges of optometry, all using OptomCAS. A record 2,897 people applied in 2024–25 (ASCO). Graduates take National Board (NBEO) exams plus state licensure.
• Canada: two schools: Waterloo (90 seats, English) and Université de Montréal (56 seats, French). Graduates take the national OEBC written exam and OSCE.
• The Optometry Admission Test (OAT) covers natural sciences, reading comprehension, physics and quantitative reasoning.

A growing number of US states let optometrists perform some laser procedures, such as selective laser trabeculoplasty (SLT), laser peripheral iridotomy and YAG capsulotomy, after certification. AOA counted 17 states by mid-2026, with Kansas, Tennessee and Vermont added in 2026. Virginia, the 8th, did so in 2022.

The American Academy of Ophthalmology's position (2025) is that laser surgery "should be performed only by licensed doctors of medicine or osteopathy," citing residency-level training and the risk of complications that can permanently damage vision.

A widely cited 2016 study projected about 4.8 billion people (half the world) could be myopic by 2050, with nearly 1 billion highly myopic. A 2025 analysis estimated childhood and adolescent myopia rose from about 24% in 1990 to about 36% in 2023.

• MiSight 1 day contact lenses were FDA-approved in 2019 to slow myopia progression in children aged 8–12
• Other approaches include special spectacle lenses, orthokeratology and low-dose atropine; the evidence is still evolving
• High myopia increases lifetime risk of serious eye disease

In Ontario, OHIP covers a major eye exam yearly for people 19 and under and every 18 months for those 65+. Adults 20–64 are covered only with eligible conditions (such as diabetes, glaucoma or cataract) or on ODSP or Ontario Works.

In 2018 the FDA authorised IDx-DR, widely described as the first autonomous AI diagnostic system, to detect diabetic retinopathy. The CDC says 90% of blindness in US adults caused by diabetes is preventable with early detection, so screening in primary care settings can matter enormously.

• Reaches people who never see an eye doctor
• Clinicians still confirm, manage and follow up
• Questions about accuracy across populations, data and accountability

WHO estimates cataract causes distance vision impairment in 94 million people worldwide, AMD 8 million and glaucoma 7.7 million; most people with vision impairment are over 50. The CDC predicts impairment among Americans 40+ will more than double by 2050.

WHO estimates about 2.2 billion people have near or distance vision impairment, about half of it preventable or not yet addressed. Rural, remote and Indigenous communities face distance and provider shortages; cost of glasses is itself a barrier.

• Université de Montréal is expanding placements in Québec's regions
• Waterloo considers Indigenous applicants with averages from 70.0%
• Outreach, school screening and tele-optometry can help

The US Eyeglass Rule (updated, effective September 24, 2024) requires prescribers to give patients a free copy of their glasses prescription right after a refractive exam, whether or not they ask. Prescribers can't require a purchase, charge a fee, or demand a waiver, and those who sell eyewear must get a signed confirmation and keep it for 3 years. The Contact Lens Rule (amended 2020) has similar requirements.

Lens add-ons and premium products can genuinely help patients, but recommending them must be clinically justified and honestly explained, and never a condition of releasing a prescription.

Some jurisdictions require optometrists to report patients whose vision may not meet driving standards; rules vary by province and state. Even where reporting is required, how you handle it matters.

• Know the law where you practise
• Tell the patient first, with empathy
• Offer help: low-vision services, transport alternatives, a second opinion

The AOA Code asks optometrists to advise patients whenever referral is appropriate; Canadian regulators require referral when care is beyond competence or training. Prompt referral of urgent findings (for example, signs of retinal detachment) protects sight.