A Guide to Finding the Right Eye Doctor

There are many health professionals trained to take care of your eyes. This article provides a brief description of three major types you may find in your community.

Opticians

An optician is not a doctor, but someone who is trained to design, fit and dispense devices to correct your eyesight, including glasses, contact lenses, low vision aids, and sometimes ophthalmic prosthetics. Opticians practice in a variety of settings, including medical offices, hospitals, eye care centers, and retail stores. Their training varies and may consist of a two-year associate’s degree, a four-year degree, or on-the-job training. In the United States, opticians who are registered with the Society of Advance Opticianry (SAO), a national credentialing body, have a four-year college degree in optical science and advanced certification and/or state licenses in fitting and dispensing eyewear and contact lenses. In general, opticians are not trained to diagnose or treat eye diseases. However, they are well suited to fitting you with eyewear and/or vision aids to correct your vision after your eye problems and/or vision loss have been diagnosed.

Optometrists

Optometrists are licensed physicians who may diagnose and treat various eye conditions, as well as check your eyesight and prescribe vision corrections. With four years postgraduate training in optometry (the equivalent of an undergraduate medical degree), they are called “doctors of optometry” and held to the same legal standards as other physicians, including to pass a national board exam and receive continuing education to stay current in practice. In all states they are able to perform dilated eye exams (ie, the type required to diagnose serious eye diseases including glaucoma and macular degeneration) and to prescribe and/or use topical drugs (such as ointments and/or eye drops), and injectable medications, and in most states they can also prescribe oral medications, such as antivirals, antibiotics, oral steroids and pain medications, for various eye conditions. Optometrists may also be trained in surgical techniques for such things as foreign body removal, corneal injury, eyelid & lacrimal (tear duct) disease, removal of skin folds and other surface lesions around the eye, and sometimes other conditions. States vary as to which procedures they can perform.  In some states, optometrists are licensed to perform laser surgery After their optometry degree, some optometrists complete one- to two-year residencies in subspecialty areas, such as geriatric eye care, ocular disease or neuro-optometry, that equip them to care for eye diseases such as glaucoma and macular degeneration.

Ophthalmologists

Ophthalmologists are physicians who have received the greatest amount of specialized training on the anatomy, physiology, and diseases of the eye. In addition to their four-year medical degree, they have completed a four-year residency program in ophthalmology with both a medical and surgical focus. Thus, they have had 12 years of college-level and postgraduate training, compared to eight years for typical optometrists and four years for opticians. Ophthalmologists may be medical doctors (“MDs”) or doctors of osteopathy (“DOs”); regardless, the training is the same. Similarly, they may be board-certified by the American Board of Ophthalmology or the American Osteopathic Board of Ophthalmology and Otolaryngology and, in addition to this, are state-licensed and required to keep current with continuing medical education.

As combined medical-surgical specialists, ophthalmologists are trained to perform eye operations; however, not all ophthalmologists perform surgery in practice. Nor have all ophthalmologists been trained to do laser surgery (although many have).

Within the medical-surgical specialty of ophthalmology, there are numerous “subspecialists” who have advanced knowledge and training about specific parts of the eye, such as the retina, the cornea, or optic nerve; or about eye diseases, such as glaucoma or cataracts. Both macular degeneration and diabetic retinopathy, as disease of the retina, are treated by retinal specialists. There are also ophthalmologists who become experts in such things as ocular oncology (cancers affecting the eye) or glaucoma genetics.

Often these highly specialized eye doctors also do research, and may be connected to major medical centers or eye treatment facilities. If you are diagnosed with an aggressive, rare, or highly specialized eye condition that requires ongoing treatment, or if you are interested in participating in a clinical trial, then one of these specialists may be a good choice. If you live at a distance, they may be available for consultations and/or second opinions, or may be willing to share in your care with your regular eye doctor.

Why Is the Choice of Eye Doctor So Important?

Most people have their vision checked on a fairly regular basis, and as we age, most of us start wearing corrective lenses and have our prescriptions adjusted. Unfortunately, far too few people have their eyes checked—along with having their vision checked—for the presence of vision-robbing diseases, such as macular degeneration and glaucoma. As a result, these two diseases are leading causes of gradual vision loss and blindness in old age.

As we grow older, the risks of macular degeneration, glaucoma, and other eye diseases greatly increase. Unlike cataracts, which are noticeable to ourselves and others, glaucoma and macular degeneration sometimes have no symptoms until vision loss has already occurred. To screen for them, a doctor must use special instruments to check your eye pressure and look deep inside your eyes to examine the condition of your retina and optic nerve. These procedures are done during a special type of eye exam called a “comprehensive dilated eye exam,” where eye drops are given to numb and dilate your pupils to their widest point to allow a glimpse of the structures inside.

Only ophthalmologists—and optometrists—are permitted to dilate the eyes and use instruments to perform this exam. So even if you are having your vision checked regularly, you still should seek out a doctor who can perform a comprehensive dilated eye exam. The National Eye Institute (a branch of the National Institutes of Health) recommends that you have this once a year after age 60. If you are African American, you should have one yearly after age 40 due to your much higher risk of glaucoma. It’s also important for people with diabetes to have a comprehensive dilated eye exam at least once a year. —Martha Taggart, Health and Science Writer, BrightFocus Foundation