Ophthalmologists, optometrists and opticians are the three main disciplines of eye health. A lesser known profession is that of an orthoptist. Each provides a different kind of service but all play an important role in providing vision care to people. The levels of training and expertise, and what they can diagnose and treat, vary for each type of provider.
When you go to have an eye exam and get fitted for glasses or contact lenses, you will most likely see an optometrist. Optometrists are health professionals who provide primary vision care ranging from sight testing and correction to the diagnosis, treatment, and management of vision changes. An optometrist is not a medical doctor but is a doctor of optometry, or O.D. Optometrists can work in private practices, vision clinics, optical stores, hospitals, as teachers at optometry schools, in research or government positions, and other venues. Some optometrists specialize in a particular field such as primary care optometry, hospital-based optometry, family practice optometry, pediatric optometry, ocular disease, vision therapy, or contact lenses.
Optometrists are specially trained to diagnose eye abnormalities and treat vision conditions like nearsightedness, farsightedness, astigmatism, and presbyopia; and to provide general eye-health services such as checking the eyes for cataracts, glaucoma, and retinal disease. Optometrists also do testing to determine the patient’s ability to focus and coordinate the eyes, and to judge depth and see colors accurately. They can prescribe eyeglasses, contact lenses, low-vision aids, vision therapy, and some basic eye-related medicines. Optometrists do not perform eye surgery, but in some states they are allowed to perform non-incisional laser surgery. Optometrists are skilled in the co-management of care that affects the eye health and vision of their patients and can make referrals to other health care professionals.
Optometrists have to attend four years of post-graduate training after college at an accredited school of optometry. There are currently only seventeen optometry schools in the U.S. and they all have very competitive admissions standards. Pre-requisites often include having taken basic English, Mathematics, Physics, Biology, and Chemistry. Another requirement is taking the Optometry Admissions Test (OAT). After successfully completing optometry school, optometrists must complete the State Board Examination of the state they wish to work in, to receive a license in that state. Licenses must also be renewed every one to three years depending on the state. All states require continuing education credits to maintain an optometry license.
If you have special eye problems, you may need to see an ophthalmologist. Ophthalmologists are physicians who specialize in vision care and the prevention of eye diseases. They have an M.D. (medical doctor) or D.O. (doctor of osteopathy) degree. They perform eye surgery and prescribe medications in addition to all of the tasks that optometrists do. An ophthalmologist can also diagnose general diseases of the body and treat ocular manifestations of systemic diseases such as diabetes and hypertension. Many ophthalmologists are involved in scientific research on the causes and cures for eye diseases and vision disorders.
An ophthalmologist has completed four or more years of college pre-med education, four or more years at an accredited medical school, one year of internship, and a residency in ophthalmology that includes three or more years of specialized medical and surgical training and experience in eye care. The final step is to pass the licensing examination or, for those specializing in a certain field, to pass a final examination for certification by the American Board of Medical Specialists or the American Osteopathic Association.
Admission into medical school is extremely competitive. Admission requires a good score on the Medical College Admission Test (MCAT) as well as clear goals, a caring personality, a strong work ethic, recommendations, and much more. Those lucky enough to get accepted into medical school will take classes pertaining to basic anatomy, physiology, pharmacology, medical ethics, medicine, pathology and practice management. They also attend clinical rotations, learning different aspects of the field such as family practice, pediatrics, internal medicine, and others.
Some eye doctors complete one or two years of additional, more in-depth training called a fellowship in a subspecialty area such as glaucoma, retina, cornea, pediatrics, neurology, or plastic surgery. This added training and knowledge prepares an ophthalmologist take care of more complex or specific conditions in certain areas of the eye or in certain groups of patients.
Opticians are technicians trained to fit and adjust eyeglass lenses and frames, contact lenses, and other devices to correct eyesight. Opticians are not eye doctors, so they are not permitted to diagnose or treat eye diseases, test vision, or write prescriptions for visual correction. They use prescriptions supplied by ophthalmologists or optometrists to dispense eyeglasses, frames, and contact lenses. An optician usually just has to attend a two year college or do a special apprenticeship.
There are actually two types of opticians: manufacturing opticians and dispensing opticians. Manufacturing opticians are involved in the process of making eyeglasses and contacts. They produce the lenses from start to finish according to specifications or prescriptions. Manufacturing opticians learn their trade through apprenticeship. They start with simple tasks like measuring lenses and eventually move to the end result of completing the lenses through surfacing, smoothing and beveling. Manufacturing opticians also use automated systems so they must learn how to operate machinery.
A dispensing optician must have the patience and care to meet the needs of clients, from helping them to select eyeglass frames to making sure the frames fit properly. Opticians take eye measurements to insure proper fitting of glasses and contact lenses. They tell clients know how to properly care for their eyewear. Dispensing opticians learn their skills through apprenticeships or college classes, and may receive a two year associate degree or a license depending on the state. Some states require certifications, which must be renewed every three years through continuing education.
Ophthalmologists often hire pediatric orthoptists to measure the vision of young patients and perform diagnostic tests to evaluate disorders such as strabismus (cross-eye) and amblyopia (lazy eye.) The orthoptist helps the ophthalmologist develop a treatment plan which may include eye exercises, drugs, or surgery. The orthoptist also teaches patients, who usually are kids, how to do the eye exercises. This position requires an ability to relate to children, including those with disabilities beyond the ocular. An orthoptist is not an M.D., but does take national board exams to become a C.O. (certified orthoptist). Two years of post-bachelor’s training are required, but there are currently less than ten programs in the U.S. accepting students for the two year training program. An orthoptist studies pediatric ophthalmology in depth, along with the treatment of binocular visual disorders.