Demystifying the Three "O"s of Eyecare
There are two types of eye doctors, a fact that is often confusing to both patients and other health care professionals alike. This confusion occurs because there are very few other medical disciplines where two distinct providers specialize in the same part of the body. Both optometrists and ophthalmologists are expertly trained and have unique strengths which, when used in a spirit of professional cooperation, combine to give all patients better care than the separate parts could on their own. The following is a description of each type of doctor:
Optometrist - Optometrists are the eye care equivalent of your "family doctor." They are trained and licensed to diagnose and treat diseases and disorders of the eyes and visual system, including the use of prescription eye drops and oral medications, as well as to detect the ocular manifestations of systemic disease (for example, diabetes) and refer patients to other health care specialists for eye surgery and/or secondary medical evaluation if needed. Optometrists perform the majority of vision and eye health examinations in the United States.
Optometrists earn the degree of doctor of optometry (O.D. degree). Becoming an optometrist requires four years of pre-medical undergraduate education (identical to medical doctors) and then an additional four years of optometry school. Optometry school education is very rigorous and consists of courses in geometric, physical and physiological optics, ocular anatomy and physiology, general anatomy and physiology, general and ocular pathology, general and ocular pharmacology, ocular manifestations of systemic disease, binocular vision, vision therapy, pediatric vision, geriatric vision, refraction, cosmetic and medical contact lens applications, and specialized electrodiagnostic testing.
The final two of four years is spent examining patients in eye clinics and hospitals, including externships with eye surgeons and sub-specialists, and conducting original ophthalmic research. Three sets of national board examinations and individual state board examinations are required for licensure, with mandatory continuing education requirements every one to two years. In fact, the continuing education requirements for optometrists are among the most demanding of any medical profession. Some doctors of optometry complete an additional one-year residency in sub-specialties such as ocular disease and low vision (treatment and rehabilitation of visually impaired patients), and a few complete multi-year specialty fellowships in areas like retinal disease and glaucoma.
Ophthalmologist - Ophthalmologists earn the degree of medical doctor (M.D. degree). Like optometrists, they are trained in the medical treatment of eye disease, as well as the ocular manifestations of systemic diseases (like diabetes). Unlike optometrists, ophthalmologists primarily provide surgical care for the eyes, and most have completed a surgical residency and practice in affiliation with a hospital or 'ambulatory surgery center.
Becoming an ophthalmologist requires four years of pre-medical undergraduate education, four years of medical school, and an additional three to six years of residency/post residency training, depending upon the degree of sub-specialization. The medical school curriculum covers the aspects of human disease and principles of medical treatment and management, yet provides little training in eye disease and the human visual system. Ophthalmologists receive nearly all of their training in eye disease and surgery during their residency after medical school.
Because the surgical skills required for eye surgery are demanding, most of their training is spent developing those skills. Ophthalmologists must pass national licensure examinations and a series of board examinations in order to practice. Continuing medical education requirements must be met for re-licensure. After their general ophthalmology residency, some doctors choose to receive additional fellowship training in sub-specialties such as glaucoma, oculoplastics (eyelid and eye socket surgery), corneal disease, and retinal disease.
Both optometrists and most ophthalmologists have spent about the same amount of time learning about the eyes. What is different is the educational emphasis. Optometrists focus on comprehensive eye and vision care, treatment and management of eye disease, physiological and visual optics, binocular vision, contact lenses, low vision, and vision therapy. Ophthalmologists focus on the treatment and management of eye disease and surgery.
The broad breadth of comprehensive training makes the optometrist the eye care provider of choice for the vast majority of vision and medical eye health care, while the ophthalmologist is most effective providing referral based medical and surgical care.
Opticians - Opticians are not doctors, but professionals that dispense glasses and sometimes contact lenses. Some even make the glasses themselves in an optical lab. They are knowledgeable about materials used and appropriate tints, etc. that fit your needs. Some opticians are required to earn a 1-2 year associate degree to become certified in their field. This varies from state to state and can be optional. In some states, they are allowed to refract patients to find out their prescription, but this is a dangerous precedent because they are not trained in the diagnosis or management of eye disease or the systemic diseases that can affect the eyes. They also do not have any training in visual function. You will find that opticians often work for doctors in their eyeglass dispensaries or contact lens laboratories.
