Ophthalmologist vs. Optometrist

• When you need to visit an eye-care professional, it is important to make sure that you see the person who is most qualified to take care of any concerns or problems that you may have regarding your eyes.
• The main types of eye-care professionals are
  • ophthalmologists,
  • optometrists, and
  • opticians.
  • Ocularists and ophthalmic technicians work closely with these specialists.
• Your primary-care provider (PCP), internist, pediatrician, general practice physician (GP), urgent-care doctor, or emergency-room doctor can assist you with a referral to the appropriate eye-care professional.

Ophthalmologists are physicians, either a doctor of medicine (MD) or a doctor of osteopathy (DO), who have graduated from college with a bachelor's degree and then completed four years of medical school, at least one year of internship, and three or more years of residency training specializing in medical and surgical care of eye diseases. Ophthalmologists may have also completed one or more years of subspecialty fellowship training in a specific area of ophthalmology, such as retina, cornea, glaucoma, pediatrics, oculoplastics, refractive surgery, uveitis (inflammation of the eye), pathology, or neuro-ophthalmology.

Ophthalmologists are medical doctors who are licensed by the state to practice medicine and to perform surgery. They can deliver total eye care, including performing a complete eye examination, prescribing eyeglasses and contact lenses, diagnosing and treating eye diseases, and performing surgery on the eyes and the area around the eye. Ophthalmologists usually practice in groups of other ophthalmologists or in multi-specialty practices with other physician specialists. Solo practices, however, remain popular, particularly in smaller communities.

Having completed medical school, ophthalmologists are often more aware of how different diseases may affect the eye and how different findings noted during an eye examination may indicate serious disease elsewhere in the body. In addition, ophthalmologists have a keen understanding of how medications prescribed by other physicians can cause unintentional side effects to the eye and how ocular medications can affect the rest of the body or may interfere with other health conditions.

Diseases treated by ophthalmologists include but are not limited to: 

• cataract,
• glaucoma,
• eye infections,
• conjunctivitis,
• corneal ulcers,
• glaucoma,
• drooping lids (ptosis),
• strabismus (crossed eyes),
• lazy eyes,
• eye allergies,
• thyroid eye disease,
• diabetic eye disease,
• wet and dry macular degeneration,
• retinal detachments,
• eye hemorrhages, and
• all forms of eye injuries.

The most common surgical procedures performed by ophthalmologists include cataract extraction with intraocular lens (IOL) implantation, laser capsulotomy for routine post-cataract membranes, and injections into the vitreous cavity to treat potentially blinding wet macular degeneration. Other procedures performed by ophthalmologists include glaucoma surgeries, filters, laser treatment for glaucoma, refractive eye surgery including LASIK and PRK, lid lifts (ptosis repair or blepharoplasty), retinal detachment repair, diabetic retinal laser therapy, laser treatments for macular degeneration, vitrectomy, naso-lacrimal drainage surgery for excess tearing (epiphora), and strabismus (eye muscle) surgery.

Optometrists are eye-care providers who have attended college and completed four years of training at an optometry school but have not attended a medical school. In optometry school, they receive education primarily about the eyes and do not receive a comprehensive education regarding the rest of the body and systemic disease processes. Optometrists receive a doctor of optometry (OD) degree.

Optometrists are licensed by the state to practice optometry. They can perform an eye examination and can determine the presence of vision-related problems. They can also prescribe eyeglasses and contact lenses. Depending on the state in which you live, optometrists may be allowed to treat less complicated eye diseases and prescribe eyedrops for various conditions, but they are not trained or licensed to perform surgery.

Optometrists often work closely with ophthalmologists to provide integrated eye care for their mutual patients. Some optometrists work in the same practice as ophthalmologists, providing refractive (glasses and contact lenses) services, surgical screening, analysis of technical measurements prior to surgery, post-surgical care, emergency care, and other medical services. Other optometrists may work in an independent practice or in conjunction with a national eye-care chain. In many of these optometric practices, frequent referrals to ophthalmologists for surgical or medical care of serious illnesses may occur. Conversely, some ophthalmologists may refer patients to optometrists for primary eye care, refractions, contact lenses, glasses, lens prescriptions, and glasses fittings.

Opticians are trained in filling prescriptions for eyeglasses and contact lenses. They may have received significant formal classroom instruction, but many receive on-the-job training. Depending on a particular state's regulations, opticians may or may not be licensed.

Opticians help in determining the best eyeglass frames to suit your needs. In addition, they ensure that eyeglass frames are adequately adjusted, and if necessary, they can also repair broken eyeglass frames. In some states, opticians may be licensed to fit contact lenses. Opticians often work closely within the same practice as an optometrist or ophthalmologist, or an optician may have an independent practice.

An ocularist is an eye-care provider who specializes in the fabrication and fitting of ocular prostheses for people who have lost an eye or eyes due to trauma or illness. The fabrication process for a custom-made eye typically includes taking an impression of the eye socket, shaping a plastic shell, painting the iris, and then fitting the ocular prostheses. These prosthetic devices are remarkably similar to the patient's own eye, usually matched to the remaining normal eye's colors and dimensions. With modern technology, the prosthetic eye can be created in three dimensions from acrylic plastic.

In addition to creating the prosthetic eye, ocularists show the patient how to care for and handle the prosthesis. Ocularists may develop their skills from various background disciplines, for example medical, optometry, dental, nursing, biology, medical arts, and illustration. If insurance coverage is available, most ocularist offices will assist in every possible way to obtain full insurance benefits for purchase of the prosthesis. However, it should be noted that the patient, or in the case of children, a parent or guardian is always responsible for payment. In the case of HMOs, it is always necessary to obtain a referral before work can begin on a new ocular prosthesis. The ocular prosthesis needs to be polished regularly in order to restore the acrylic finish and insure the health of the surrounding tissues. It is generally recommended that infants under 3 years of age wearing a prosthesis be seen every three months; patients under 9 years of age should be seen twice yearly, and all other patients should be seen at least once a year.

As members of the allied health professions, ophthalmic technicians are ophthalmic medical personnel (OMP) trained as a part of a professional team of eye-care providers. OMP perform assigned procedures under the direction or supervision of an ophthalmologist licensed to practice medicine and surgery. OMP may receive formal educational training or be trained at the workplace. There are various levels of national certification for OMP, including certified ophthalmic assistant (COA), certified ophthalmic technician (COT), and certified ophthalmic medical technologist (COMT). Such certification is supervised by the Joint Commission of Allied Health Personnel in Ophthalmology (JCAHPO).

Some of the most common tasks performed by OMP at all levels of certification include taking patient histories, maintaining instruments, administering tests and evaluations, taking eye measurements, providing patient services, and performing a variety of clinical tasks including surgical assisting.

Ophthalmic allied health professionals possess skills and knowledge attained by didactic and clinical ophthalmic educational training. Their function is to assist the ophthalmologist by collecting data, administering treatment ordered by the ophthalmologist, and supervising patients. OMP do not practice independently or see patients separately from a medical practice.

American Academy of Ophthalmology

American Society of Ocularists

Joint Commission on Allied Health Personnel in Ophthalmology

Opticians Association of America