Grand Canyon National Park, South Rim, Arizona

Russ Quiring, O.D.

"I'm Confused.  Which Eyecare Professional Should I go to for My Eye Examination?"

It seems that nothing is more confusing in the eyecare industry than understanding the difference between the three O’s: Ophthalmologists, Optometrists and Opticians. And the confusion surrounds the difference between an Optometrist and Ophthalmologist; both are eyecare doctors but which doctor should people go to for their eyecare needs. The answer to this question lies in what services you desire.

Some Considerations
Cost for Service: Generally Ophthalmologists charge more for routine eye examinations and office visits for medical treatments (such as for an eye infection) than Optometrists.

Insurance: Check with your insurance company to find out which provider you can go to for services. However, just because a provider’s service is “covered” under your plan, sometimes you can save money by going to a less expensive provider, filing your insurance claim, and getting reimbursed after your visit from your insurance company.

Level of Comfort: Patients must feel comfortable with the level of care received from their doctor, prescribed treatments, and explanations from their doctor. If you don’t feel comfortable with your care, please get a second opinion from another eyecare professional.

Who Does Your Refraction (Vision Test for Eyeglasses): When visiting an Optometrist’s office, the Optometrist almost always performs the refraction for eyeglasses. At an Ophthalmologist’s office, almost always a technician performs the refraction. The Ophthalmologist performs the eye health evaluation part of the eye examination.

Eye Surgery: Only Ophthalmologists perform surgery. Your Optometrist will refer to you a capable surgeon (Ophthalmologist) if you require surgery. Many Optometrists perform minor surgical procedures like foreign body removal from the eye, but major surgery is performed only by Ophthalmologists.
 
The table below summarizes the major differences between the “O’s” in the eyecare industry.

Optometrists are trained to refer patients on to an Ophthalmologist or “Specialist” when their services are required. This might be for a surgical referral or a second opinion on treating a medical problem.
 
Also, this link to Vision and Learning – A Resource for Parents and Educators is an excellent source of information to help explain the differences between eyecare professionals.
 
Below are definitions by the American Optometric Association (for an Optometrist) and American Academy of Ophthalmology (for an Ophthalmologist).

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye.

Doctors of Optometry prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures.

Optometrists counsel their patients regarding surgical and non-surgical options that meet their visual needs related to their occupations, avocations, and lifestyle.

An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice.

Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. -Approved by the AOA Board of Trustees, June 21, 2005
 

About Ophthalmology (Eye M.D.s)

What is Ophthalmology?
Ophthalmology is a branch of medicine specializing in the anatomy, function and diseases of the eye.

What is an Eye M.D. (Ophthalmologist)?
An Eye M.D. is an ophthalmologist, a medical doctor who specializes in eye and vision care. Eye M.D.s are specially trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. Many Eye M.D.s are also involved in scientific research into the causes and cures for eye diseases and vision problems.  Eye M.D.s are an essential part of the eye care team.

Education & Training
In addition to four years of medical school and one year of internship, every Eye M.D. spends a minimum of three years of residency (hospital-based training) in ophthalmology. During residency, Eye M.D.s receive special training in all aspects of eye care, including prevention, diagnosis and medical and surgical treatment of eye conditions and diseases.

Often, an Eye M.D. spends an additional one to two years training in a subspecialty, that is, a specific area of eye care (for example, glaucoma or pediatric ophthalmology.)

Board Certification
Many (but not all) Eye M.D.s are board certified. A board certified Eye M.D. has passed a rigorous two-part examination given by the American Board of Ophthalmology designed to assess his/her knowledge, experience and skills.

Subspecialties in Ophthalmology
The following are subspecialties in ophthalmology:

Cornea and External Disease: This subspecialty involves the diagnosis and management of diseases of the cornea, sclera, conjunctiva and eyelids, including corneal dystrophies, microbial infections, conjunctival and corneal tumors, inflammatory processes and anterior ocular manifestations of systemic diseases. Training in this area frequently includes corneal transplant surgery and corneal surgery to correct refractive errors.

Glaucoma: This subspecialty includes the treatment of glaucoma and other disorders that may cause optic nerve damage by increasing intraocular pressure. This area involves the medical and surgical treatment of both pediatric and adult patients.

Neuro-Ophthalmology: Involving the relationship between neurologic and ophthalmic diseases, neuro-ophthalmology also deals with local pathology affecting the optic nerve and visual pathways. Over 50 percent of all intracranial lesions involve the visual or oculomotor pathways. Neuro-ophthalmology is generally practiced as a nonsurgical subspecialty but can be combined with surgery of the eye and orbit.

Ophthalmic Pathology: The ophthalmic pathologist has training in both ophthalmology and pathology, typically in that order. Because of the unique combination of skills involved in this subspecialty, it is usually the ophthalmic pathologist, rather than the general pathologist, who examines tissue specimens from the eye and adnexa.

Ophthalmic Plastic Surgery: The practice of ophthalmic plastic surgery includes orbital surgery, lid and upper facial reconstructive procedures following trauma and tumors and cosmetic lid surgery. Oculoplastic surgeons combine ophthalmic surgery with plastic surgery and are trained in the use of radiotherapy, chemotherapy and chemosurgery to treat ocular and orbital disease.

Pediatric Ophthalmology: The bulk of pediatric ophthalmic practice involves the medical and surgical management of strabismus, amblyopia, genetic and developmental abnormalities and a wide range of inflammatory, traumatic and neoplastic conditions occurring in the first two decades of life. This subspecialty also deals with the ocular manifestations of certain systemic disorders.

Vitreoretinal Diseases: This subspecialty involves both the medical and surgical treatment of retinal and vitreoretinal disease. The types of diseases treated include manifestations of local, systemic and genetic diseases as they affect the retina and vitreous. Diagnosis involves the use and interpretation of ultrasound, fluorescein angiography and electrophysiology. Treatment methods include laser therapy, cryotherapy, retinal detachment surgery and vitrectomy (removal of the vitreous).

The Bottom Line:  There are clear differences between the different eyecare professionals. I recommend that you see an Optometrist for routine eye examinations but see an Ophthalmologist for eye surgery needs and eye disease problems. Why? Because generally speaking, an Optometrist's examination fee is probably less and an Optometrist is the eyecare professional far more trained to perform a good refraction for eyeglasses and contact lens prescribing. See an Optometrist for the fitting of your contact lenses as this is an primary part of the Optometrist's training. At an Ophthalmologist's office, usually a technician is performing the vision test for eyeglasses and also fitting all contact lenses. Hopefully this column will help you decide which professional is right to provide your eyecare. However, if you have a diagnosed eye disease (that your Optometrist can't treat or doesn't feel comfortable treating) or you need/desire eye surgery, schedule your appointment with an Ophthalmologist.   ~RQ

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