How an Eye Doctor Differs From an Optometrist
An ophthalmologist is a physician who specializes in the medical and surical care of the eyes and vision. Also known as eye doctors, ophthalmologists are the only practitioners trained to provide comprehensive diagnosis and treatment of eye disorders. They can perform eye exams, dispense medications, prescribe corrective lenses (eyeglasses or contacts), and perform eye surgery.Ophthalmologists in the United States are required to complete four years of college, four years of medical school, and four to five years of additional specialized training.
Ophthalmologists should not be confused with optometrists (who treat certain eye disorders but do not perform surgery) or opticians (who design, fit, and dispense corrective lenses).
Ophthalmology is the specialty concerned with the medical and surgical care of the eye, eye orbit (socket), optic tract (the visual nerve network), and visual cortex (the part of the brain that process nerve impulses from the eyes).Ophthalmologists treat a variety of eye disorders from common vision deficiencies to conditions that can lead to partial or complete blindness. Ophthalmologists will often work with other specialists in cases where vision loss is secondary to another medical condition, such as diabetes or HIV.Among the conditions an ophthalmologist is able to diagnose and treat:
- Amblyopia (also known as “lazy eye”)
- Anisocoria (unequal pupils)
- Astigmatism (blurring of vision caused by an irregular cornea)
- Cataract (clouding of the lens of the eye)
- Chalazion (a swollen bump in the eyelid)
- Conjunctivitis (also known as “pink eye”)
- Cytomegalovirus retinitis (a serious viral infection of the eye, most commonly in people with advanced HIV infection)
- Dermoid cyst (a benign eye tumor)
- Detached retina
- Diabetic retinopathy (retinal damage caused by diabetes)
- Eye cancer (most commonly basal cell carcinoma)
- Eye occlusion (also known as an “eye stroke”)
- Eye trauma (ranging from abrasion to orbital fracture)
- Fuch’s dystrophy (clouding of the cornea)
- Glaucoma (loss of vision often due to elevated eye pressure)
- Herpes zoster ophthalmicus (eye shingles)
- Hyperopia (farsightedness)
- Hyphemia (broken blood vessels in the eye)
- Keratoconjunctivitis sicca (dry eye syndrome)
- Keratoconus (an abnormal bulging of the cornea)
- Macular degeneration (an aging-related loss of vision)
- Macular dystrophy (an inherited loss of central vision)
- Milia (eyelid cyst)
- Myopia (nearsightedness)
- Nystagmus (uncontrollable eye movement)
- Ocular herpes (caused by herpes simplex virus type 1)
- Optic neuritis (vision problems related to inflamed nerves)
- Pingueculae (benign growths on the eyeball)
- Proptosis (bulging eyes)
- Pterygia (also known as “surfer’s eye”)
- Ptosis (drooping eyelids)
- Retinitis pigmentosa (a genetic disorder that causes the breakdown of retinal cells)
- Strabismus (misalignment or deviation of eyes)
- Tear duct obstruction
- Uveitis (inflammation of the middle layer of the eye)
An ophthalmologist typically works in an office outfitted with equipment for eye exams. More complex imaging or exploratory tests may be conducted in a hospital or medical facility. Athough some eye surgeries can be performed in the doctor’s office, others may require an operating room in a hospital.
An eye exam consists of a series of tests that assess the state of your vision and your ability to focus on and discern objects. The basic test includes:
- Visual acuity exam, using an eye chart or other tools to evaluate how your vision compares to that standard definition of normal vision (i.e., 20/20 vision)
- Refraction testing, using a retinoscope or auto-refractor, to measure how light bends when it passes through the lens
- Pupil function exam, which evaluates the pupil’s shape, size, and reaction tolight (often with a swinging-flashlight test used to assess the optic nerve response)
- Ocular motility testing, which measures the strength of your eyes muscles, typically by asking you to follow the doctor’s finger with your eyes
- Visual field testing, which examines your peripheral vision by asking you to count the number of fingers held outside of your central field of vision
- Slit lamp testing, using a table-mounted microscope to view the interior of your eye as a small beam of light is directed through the pupil
An eye examination can be performed by an ophthalmologist, optometrist, or orthoptist (an allied medical technician trained in the diagnosis and management of eye movement disorders).
In addition to a basic eye exam, an ophthalmologist may order specialized tests and imaging studies, some of which require a trained technician. Examples include:
- Applanation tonometry, a technique using a tonometer to measure the amount of pressure needed to flatten the cornea
- Corneal topography, in which a topographic map of the cornea is created using a non-invasive computerized imaging device
- Eye ultrasonography, a non-invasive imaging technique that uses high-frequency sound waves to form a live image of your inner eye
- Fluorescein angiography, using a fluorescent dye and a specialized camera to evaluate blood circulation in the eye
- Optical coherence tomography, an imaging technique that uses light waves to create two- and three-dimensional images of the internal eye
There is an almost encyclopedic range of drugs (including eye drops, injections, and oral medications) used in ophthalmology. Some are over-the-counter remedies and supplements used to treat dry eye or prevent progressive disorders like macular degeneration. Others require a prescription and/or administration by a medical professional.These include expensive antivascular endothelial growth factor (anti-VEGF) drugs used to treat macular degeneration and certain types of eye cancer.In addition to medications, an ophthalmologist can prescribe corrective lenses, including bifocal, multifocal, and progressive eyeglasses and contacts.Unlike optometrists, ophthalmologists can perform more sophisticated medical procedures and surgeries. Some of the more common include:
- Bionic eye implants, currently available as the Argus II Retinal Prosthesis System used for people with severe retinitis pigmentosa
- Botox injections, sometimes used in place of surgery to correct misaligned eyes by temporarily paralyzing orbital muscles
- Cataract surgery, in which a cloudy lens is replaced with an artificial one
- Corneal transplant, in which diseased or scarred corneal tissue is replaced with healthy tissue from an organ donor
- Enucleation and eye prosthesis, the removal of a diseased or damaged eye followed the insertion of an artificial, nonfunctioning eye
- Glaucoma surgery, using lasers or standard surgical tools to increase fluid outflow from the iris or remove a portion of the iris
- Oculoplastic surgery, a subspecialty of ophthalmology that deals with the reconstruction of the eyelid, orbit, tear ducts, and face
- Orbital decompression, used to relieve the characteristic eye bulging associated with Grave’s disease
- Refractive surgery, including LASIK surgery, to correct errors of refraction, reducing or eliminating the need for corrective lenses
- Strabismus surgery, used to adjust eye muscles to straighten misaligned eyes
- Vitrectomy, a procedure removes the gel-like substance in the eye, called the vitreous humor, to correct vision problems8 Reasons Lasik Surgery May Not Be Right for You
While many ophthalmologists will choose to operate a general ophthalmology practice, as many as 40 percent will specialize in a specific field of ophthalmology, according to the American Medical Association. These include:
- Cataract and refractive surgery
- Corneal and external diseases
- Neuro-ophthalmology (related to the brain and optic nerves)
- Ocular pathology (the diagnosis of eye disease)
- Oculoplastics (cosmetic and reconstructive surgery)
- Ophthalmologic oncology (related to cancer)
- Pediatric ophthalmology
- Uveitis and ocular immunology (inflammatory eye diseases)
- Vitreoretinal diseases (involving the retina or vitreous humor)
Training and Certification
An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. To enter medical school, you must first get a bachelor’s degree, complete the prerequisite premedicine studies (including advanced math, science, and biology), and take the Medical Competency Aptitude Test (MCAT).Medical school involves two years of classroom studies and two years of clinical rotations in different medical facilities. Upon graduation, you would need to obtain a medical license in the state in which you intend to practice.This usually involves passing the United States Medical Licensing Examination (USMLE) if you are an MD or the Comprehensive Osteopathic Medicine Licensing Examination (COMLEX) if you are a DO. Some states also require you to pass a state exam.
After getting your license, you would need to complete a one-year internship focused on direct patient care. This would be followed by a one-year residency program in general surgery and a three-year residency in ophthalmology.
Upon completion of the residency, you can obtain board certification by passing a written and oral exam administered by the American Board of Ophthalmology (ABO). The certification is valid for 10 years during which time you must take regular continuing medical education (CME) courses to be eligible for recertification.Some ophthalmologists will embark on additional one- to two-year fellowships to specialize in a specific field of practice. A pediatric fellowship, for example, involves an additional year of training, while a corneal fellowship will usually require two.
Seeing an ophthalmologist can be stressful for people who find eye procedures uncomfortable or unnerving. To allay your nerves, it often helps to know what to expect if referred for treatment.Your first visit to the ophthalmologist would involve a comprehensive evaluation that will take around one and a half hours to complete. It may take longer if you need specialized testing or have a complex eye condition.Be sure to bring your ID, insurance card, and a list of any medications you are taking. If you have had previous eye surgeries, bring along any medical records you have or ask the treating doctor to forward them electronically in advance of your appointment.Feel free to ask any questions you need to better understand your condition and the procedures involved. Examples include:
- Can you go over the eye exam and tell me what the tests mean?
- What is the cause of my vision loss?
- Is my condition stable, or can I lose more sight?
- Are there symptoms should I watch out for?
- What treatments are available, and what do they involve?
- What is the success rate?
- What are the risk and possible side effects?
- Is there anything I should avoid during treatment?
- Are there alternative treashouldI shoiuld consider?
- What might happen if I decide not to be treated?
Always be sure to check whether the recommended procedures are covered, at least in part, by your health insurance. This includes checking whether the labs and medical facilities are in-network providers.
If not, ask your doctor or insurance company for a list of in-network providers if affordability is a concern. You can check their credentials by using the ABO physician verification webpage.