Q: I read your columns often. You are well-versed as well as appropriate with your advise to readers. However, every time they bring up eye problems, your suggestion is to refer the patient to an ophthalmologist.
While I realize that medicine dictates that ophthalmologists are medical eye practitioners, you might be unaware that in most states optometrists are also properly educated and licensed to treat many eye diseases, including glaucoma, pink eye, corneal abrasions and ulcers, and many, many more conditions. Optometrists don’t just “check for glasses” anymore but are an integral part of the eye health team that works with ophthalmology to properly assist patients with their eye health needs.
A: Eye care issues are complex so it is sometimes difficult to determine whether to recommend seeing an ophthalmologist or an optometrist. By way of explanation an ophthalmologist is a physician with a medical degree. He or she must have graduated high school, college, four years of medical or osteopathic school before their residency, internship for a year and residency for three in order to be qualified to handle a wide range of eye trauma. An ophthalmologist can perform corrective surgery for cataracts, glaucoma, traumatic injuries, and strabismus (crossed eyes), and is essentially trained in all aspects of eye care. Some physicians acquire additional sub specialty training in areas that include oculoplastics, refractive surgery, pathology, neuro-ophthalmology, and more. Their scope of practice and training is covered by the state in which the doctor practices, not by any federal laws. Most ophthalmologists are board certified by the American Board of Ophthalmology, however they need not be in order to practice in this field.
An optometrist on the other hand is a medical professional without being an MD. Following high school graduation, college and four years for receiving a degree in optometry, he or she focuses on prescribing and fitting glasses and contact lenses, diagnosing glaucoma, cataracts, macular degeneration, astigmatisms, conjunctivitis and a number of other conditions. In some (but not all) states medication prescriptions can be written by an OD who can participate in both pre-and-post op care for those who will require eye surgery. In some states an OD can do laser surgery and some minor eye surgery. Individuals in this category may partake in post-graduate residency for pediatric or geriatric optometry, vision therapy, or sports vision. Depending on the state in which they practice, they may be allowed to treat eye diseases but are not trained or licensed to perform minor surgery in an operating room environment. Having said this, they may be allowed in some states to remove a foreign body from the eye. Over the past few years most states have expanded their laws regarding what can and cannot be done in an optometric practice. For example, some states now allow an optometrist to prescribe oral medication and to file insurance claims through the Medicare system.
You didn’t mention it but there is also an optician who is not a MD or OD but who has a one or two year degree, certificate or diploma. This individual will accept a prescription from an eye doctor, order the glasses, order contacts (in some states), help you select frames, and take measurements.
So, the proper eye care “professional” depends on a person’s needs. If an individual needs glasses, he or she may be directed to an optometrist or ophthalmologist for an initial exam and the glasses may be ordered by the optician. Some conditions such as conjunctivitis can be handled by an optometrist or even a general practitioner in a family practice. While an OD can diagnose a cataract and an optician may also know one is present, he or she will have to refer the patient to an ophthalmologist. There is a great deal of give and take between the fields of ophthalmology and optometry, with one specialist referring to another for specific functions.
While we’ve written about this in the past, we appreciate you bringing the subject to the forefront once again and we thank you for doing so. We will attempt to be more open-minded in the future and give each field equal billing. I can only add that individuals in need of eye care should check with the laws of their specific state to determine what can and cannot be legally done.
