Private eye care service catalogue

Private eye care service providers – optical retailers with ophthalmologist offices and optical laboratories, as well as private eye clinics and hospitals – provide eye care services to municipalities, counties, municipal consortia, or wellbeing services counties. 

All the services listed below can be provided within the framework of the current Act on Service Vouchers in Social Welfare and Health Care Services and Act on Public Procurement and Concession Contracts. Not all private eye care service providers offer all the services listed below. They may specialise in providing one or more service packages. 

Examinations 

Eye exam by an optometrist 

An optometrist is a licensed optician authorised to use diagnostic medications. Nearly two-thirds of licensed opticians in Finland are optometrists, meaning there are approximately 900 of them. 

During an appointment with an optometrist, the optometrist performs an eye exam on the client in accordance with the “Good eye and vision examination methodology for optometrists” guidelines (in Finnish), using the necessary examination equipment. An optometrist’s eye exam always includes a medical history review, as well as tests of near and distance vision and alignment abnormalities. If necessary, the optometrist performs a cycloplegic refraction on the client. The health of the eyes is assessed by examining at minimum the front and inner eyes and by measuring intraocular pressure. 

Based on an abnormal finding, the patient is referred for further examination to an ophthalmologist, of which there are approximately 500 in Finland. The findings are documented for the ophthalmologist’s examination, at a minimum to the extent of the “Optometrist’s Assessment of Ocular Findings” data sheet (in Finnish). 

Eye exam by an ophthalmologist 

Eye exam by an ophthalmologist, office visit 

During an eye exam, the ophthalmologist takes the patient’s medical history and performs a comprehensive eye examination using a biomicroscope and other necessary examination tools. During the visit, a refractive examination may also be performed as needed, and appropriate eyeglasses may be prescribed for the patient. If necessary, the patient will be referred for further testing, such as imaging and/or laboratory tests. 

Eye exam by an ophthalmologist, emergency visit 

During an emergency visit to an ophthalmologist, the cause of the patient’s acute eye problem is determined. The doctor takes the patient’s medical history and performs the necessary eye examination using a biomicroscope and other necessary examination instruments. If necessary, the patient is referred for further testing (such as imaging and/or laboratory tests). 

Division of labour between ophthalmologists and optometrists during office visits 

Private healthcare facilities providing eye care services flexibly allocate tasks among licensed professionals in accordance with the provisions of the Act on Health Care Professionals (1994/559) and the guidelines issued by the Finnish Supervisory Agency (formerly Valvira) to licensed ophthalmologists and optometrists regarding the division of labour. 

Private eye care providers are increasingly adopting a division-of-labour model in which, based on an optometrist’s findings, the necessary ophthalmic diagnostic tests are completed for the patient prior to the ophthalmologist’s examination and diagnosis. 

This model has been found to speed up the diagnosis of patients by optimising the use of specialist resources. 

Post-surgery follow-up appointments 

Follow-up after cataract surgery 

The postoperative follow-up for cataract surgery is performed by either an ophthalmologist or an optometrist, provided that the operating ophthalmic surgeon has given their consent. 

During the post-op follow-up after cataract surgery, the condition of the eye is examined using a biomicroscope. During the examination, special attention is paid to visual acuity and the artificial lens implanted in the eye. 

If necessary, based on the optometrist’s assessment, the patient is referred from the follow-up visit for further testing – such as imaging and/or laboratory tests – and then to an ophthalmologist for an examination, along with the test results. 

Other post-surgery follow-ups 

Follow-up examinations after other types of surgery are usually performed by an ophthalmologist or optometrist, provided the operating ophthalmic surgeon has given their consent. The Current Care Guidelines specify the content of the follow-up examination. 

Other post-op follow-up visits may be related to, for example, glaucoma, diabetes, or mole removal surgery. Depending on the condition or ailment and the type of surgery, the follow-up visit includes an eye examination and any necessary laboratory tests. 

If necessary, based on the optometrist’s assessment, the patient is referred from the follow-up visit for further testing – like imaging and/or laboratory tests – and then to an ophthalmologist for an examination, along with the test results. 

Disease-specific packages 

Glaucoma diagnostic package 

The glaucoma diagnostic package includes a medical history taken by a doctor during the initial visit and a comprehensive eye exam using a biomicroscope and other necessary examination instruments. Gonioscopy and non-contact tonometry are always performed as part of the standard procedure. 

During the second visit, an optometrist or other trained professional typically performs the imaging and laboratory eye tests necessary for diagnosing glaucoma: 24-hour intraocular pressure monitoring, visual field testing, fundus photography, and biomicroscopic OCT imaging (biometric measurements of the optic nerve, retinal nerve fibres, and ganglion cells). 

When a patient comes to an ophthalmologist’s office for an examination following a referral from an optometrist due to suspected glaucoma, the procedure outlined in the ‘Division of Labour Between Ophthalmologists and Optometrists During Office Visits’ guidelines is followed.  

Outpatient follow-up package for glaucoma 

The glaucoma follow-up package essentially includes the same elements as the glaucoma diagnostic package, namely a physician’s examination and ophthalmic laboratory tests. During follow-up, the physician focuses on monitoring the progression of the disease and the effectiveness of treatment. 

An optometrist monitors intraocular pressure every six months, provided the treating physician has given consent. Each year, an optometrist or other trained professional performs the eye laboratory tests prescribed by the treating ophthalmologist. If the results of the intraocular pressure measurements and/or laboratory eye tests exceed the thresholds set by the treating ophthalmologist, the client is referred to the ophthalmologist’s office. 

A patient whose condition is well-managed visits an ophthalmologist once every two years. 

Follow-up package for patients with age-related macular degeneration, wet form 

In cases of wet age-related macular degeneration, the diagnosis is made based on a medical history and a comprehensive eye examination conducted by an ophthalmologist, as well as biomicroscopic OCT imaging and/or fluorescein angiography. 

Follow-up for wet age-related macular degeneration is performed by an ophthalmologist or optometrist, provided the physician has given their consent. Follow-up includes monitoring visual acuity and OCT imaging in accordance with the follow-up schedule recommended by the treating ophthalmologist. If the visual acuity tests and/or ocular laboratory tests reveal findings that exceed the thresholds set by the treating ophthalmologist, the patient is referred to the ophthalmologist’s office. 

Follow-up package for patients with age-related macular degeneration, dry form 

In dry age-related macular degeneration, follow-up care focuses on ruling out the wet form of the disease, minimising risk factors, and teaching patients how to manage their vision proactively through patient education. 

Follow-up for dry age-related macular degeneration is performed by an ophthalmologist or optometrist, provided the physician has given consent. During the follow-up visit, the ophthalmologist conducts a medical history review, a comprehensive eye exam, and a biomicroscopic OCT scan and/or fluorescein angiography. 

If the results of visual acuity tests and/or laboratory examinations show findings that exceed the thresholds set by the treating ophthalmologist, the patient will be referred to the ophthalmologist’s office. 

Venous occlusion monitoring package 

The venous occlusion monitoring package is used to diagnose and treat damage caused by venous occlusions or to prevent, for example, swelling in the macular region. 

During the follow-up visit, an ophthalmologist will take a medical history, perform a comprehensive eye exam, and conduct biomicroscopic OCT imaging and/or fluorescein angiography. 

Treatment aims to address general arteriosclerosis and to treat the fundus of the eye, for example, with laser therapy or a medication that inhibits the growth of new blood vessels, which is injected into the eye.

Diabetes patient monitoring package 

The diabetes patient follow-up package is used to diagnose and, if necessary, treat vascular changes in the fundus and anterior chamber angle caused by diabetes, as well as the resulting swelling of the optic disc. 

The ophthalmologist takes the patient’s medical history and performs a comprehensive eye exam using a biomicroscope and other necessary examination instruments. The patient undergoes a fundus examination during the same visit. If necessary, the patient is referred for further testing, such as imaging and/or laboratory tests, and/or treatment procedures: intraocular laser and/or injection treatments. 

Follow-up care is provided by an optometrist in accordance with the criteria established by the treating ophthalmologist. If the optometrist’s examinations reveal findings that exceed the thresholds set by the treating ophthalmologist, the optometrist will consult with the ophthalmologist remotely. If necessary, the patient will be referred to the ophthalmologist’s office. 

Treatment package for patients with dry eye 

The dry eye treatment package provides symptomatic treatment for patients suffering from this condition and identifies those who need an eye exam and treatment from an ophthalmologist. 

An optometrist performs a dry eye examination using the appropriate equipment. The examination includes, at a minimum, determining visual acuity, examining the anterior segment of the eye under a microscope, measuring the quantity and quality of the tear film, and examining the eyelids. 

Based on the results of their examinations, optometrists provide patients with treatment instructions and determine the necessary follow-up examinations to ensure the effectiveness of the treatment. 

If clinically significant findings are observed, the optometrist refers the patient to an ophthalmologist for an examination, if necessary. 

Procedure packages

These procedures are performed only at optical retailers equipped with an eye clinic. 

Cataract surgery 

In cataract surgery, the clouded lens – that is, the eye’s natural lens – is removed and replaced with a monofocal lens, which corrects either distance or near vision; a toric lens, which corrects astigmatism in addition to the above; or a multifocal lens, which corrects all of the above. The procedure is performed as outpatient surgery under local anaesthesia, takes about 20 minutes, and the patient is discharged from the hospital approximately 1–2 hours after surgery. 

Strabismus surgery 

In strabismus surgery, the muscles that move the eye are adjusted either under local anaesthesia (usually in adults) or under general anaesthesia (in children). It is an outpatient procedure preceded by comprehensive orthoptic examinations conducted by an ophthalmologist and an optometrist or orthoptist. 

Eyelid surgery 

In eyelid surgery, either the upper or lower eyelid is reshaped under local anaesthesia as an outpatient procedure. One reason for the procedure may be, for example, drooping of the upper eyelid that obstructs the field of vision. 

SLT laser procedure for glaucoma 

In selective laser trabeculoplasty (SLT), a procedure used to treat glaucoma, the anterior chamber angle is treated with a laser with the goal of lowering intraocular pressure. The treatment aims to eliminate or reduce the need for medication. If necessary, the procedure can be repeated several times as the treatment’s effectiveness diminishes. The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

YAG laser procedure for posterior capsular opacification (secondary cataract) 

After cataract surgery, cells may remain in the eye’s capsular bag. As these cells multiply, they may cause posterior capsule opacification. The cloudy portion of the capsular bag is removed using laser treatment. The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

Laser peripheral iridotomy 

In peripheral iridotomy, a small hole is made in the outer edge of the iris using a YAG laser. This creates an additional opening between the anterior and posterior chambers. The procedure is used to treat certain types of glaucoma. It is an outpatient procedure performed under local anaesthesia, and the patient is discharged after the procedure. 

Fundus laser procedure, peripheral retinal hole; outpatient clinic and follow-up visits 

A peripheral retinal hole can be repaired with a laser by “burning” the retina to its underlying layer (photocoagulation). The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

Fundus laser procedure, local laser treatment of the fundus in diabetic patients 

In a local laser procedure for a patient with diabetes, localised bleeding caused by changes in the eye’s blood vessels is treated with laser treatment of the fundus (photocoagulation). The procedure is performed on an outpatient basis under local anaesthesia, and the patient is discharged after the procedure. 

Fundus laser procedure; extensive laser treatment of the fundus in diabetic patients 

In an extensive laser procedure for patients with diabetes, new blood vessel growth in the eye is treated with laser therapy of the fundus (panretinal photocoagulation). The procedure is performed on an outpatient basis under local anaesthesia, and the patient is discharged afterward. 

Treatment package for patients with age-related macular degeneration, wet form 

To prevent the progression of wet age-related macular degeneration, a medication that inhibits blood vessel growth is injected into the eye every 4–6 weeks; this causes the new blood vessels to atrophy and stops them from leaking fluid under the retina at the back of the eye. The duration of injection therapy varies from patient to patient. The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

Intravitreal injection therapy for diabetic retinopathy 

Swelling of the optic disc caused by bleeding resulting from vascular changes in the eyes of a diabetic patient is treated with a medication that prevents vascular leakage, which is injected directly into the eye. The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

Venous occlusion injection therapy 

Oxygen deprivation in the fundus caused by bleeding resulting from vascular changes in patients with venous occlusion is treated with an anti-angiogenic drug injected into the eye. The procedure is performed as outpatient surgery under local anaesthesia, and the patient is discharged afterward. 

Other examinations

Separate eye laboratory tests and other examinations and procedures are usually performed by an optometrist or another trained healthcare professional, and only rarely by an ophthalmologist. 

Fundus photography 

A fundus photograph is a photograph of the back of the eye taken with a fundus camera. The photograph can be used to detect or monitor changes in the back of the eye. 

Optical coherence tomography (OCT) of the retina 

The macula – the central part of the retina – can be imaged using optical coherence tomography (OCT). OCT provides a cross-sectional view of all the layers of the retina and the structures between them. This imaging technique is used as a diagnostic tool, for example, in the monitoring and treatment of macular degeneration, macular edema, and glaucoma. 

Papilla OCT/GDx 

The optic nerve and the optic disc – that is, the area at the back of the eye where nerve fibres travel to the brain – can be imaged using optical coherence tomography (OCT). This test can identify structural abnormalities in the optic nerve and determine the number of nerve fibres passing through it, which decreases, for example, in cases of glaucoma. The test is used, among other things, to diagnose and monitor glaucoma. 

Nerve fibre imaging 

Optic nerve imaging is performed using a fundus camera and a special filter that provides a clear view of the optic nerve fibres. This examination is used, for example, to diagnose and monitor glaucoma. 

Central visual field test (automated static perimetry) 

A visual field test is used to identify any areas of visual field loss. This test is used to diagnose and monitor glaucoma. 

Visual field exam (automated kinetic perimetry) 

A visual field exam is used to assess the extent of the visual field and identify any areas of loss. It is used to diagnose and monitor conditions affecting the neurological components of the visual pathway, such as brain tumours and cerebral haemorrhages. 

24-hour intraocular pressure curve (Ta) 

The purpose of the 24-hour intraocular pressure profile is to identify fluctuations in intraocular pressure at different times of the day. This test is used to diagnose and monitor glaucoma. 

Corneal topography 

Corneal topography is used to map the shape and thickness of the cornea. This test is used, for example, prior to cataract and refractive surgery, as well as for the diagnosis and monitoring of keratoconus. 

Fluorescein angiography (FAG) 

Fluorescein angiography (FAG) is used to produce contrast-enhanced images of blood vessels, allowing their structure to be seen in detail. FAG is used to diagnose and monitor eye complications caused by vascular diseases. 

Photographs of the front of the eye 

Photographs of the structures of the front of the eye can be taken when diagnosing or documenting diseases of the anterior eye segment. 

Meibography 

A test used to image the meibomian glands, which are located in the eyelids and secrete oil onto the surface of the eye. The test is used to diagnose and monitor dry eye. 

Schirmer test 

The Schirmer test is used to measure the amount of tear secretion. The test is used to diagnose and monitor dry eye. 

Tear duct irrigation 

A tear duct irrigation is performed using a small needle and a saline solution injection to open and flush the tear ducts. The procedure is usually performed by an ophthalmologist. 

Orthoptic examination and pleoptics treatment 

An optometrist performs orthoptic examinations, develops treatment plans, and monitors progress. Orthoptic exams and pleoptics treatments are used to determine the cause of and treatment for vision-related double vision. The cause may be pathological or functional strabismus. If a pathological condition is suspected, the patient is referred to an ophthalmologist for an examination and, if necessary, further testing, such as an MRI and/or laboratory tests. 

Treatment for strabismus may involve corrective lenses and/or orthoptic eye exercises. Treatment is always tailored to the individual but often requires follow-up visits after the initial appointment. 

Sources: Duodecim, Current Care Guidelines 

Authors: A multidisciplinary working group within NÄE ry, which includes optometrists, physicians, vision physiologists, and healthcare process experts, among others.