Optometry vs Ophthalmology

As a young optometrist, one of the questions I’m most commonly asked is,

what’s the difference between an optometrist and an ophthalmologist, and who should I see for (insert problem here)?

The simplest answer to this question is as follows:
Ophthalmologists do surgeries. Optometrists do everything else.
In all reality though, that’s a bit of an oversimplification. A slightly longer explanation would be:

Optometrists (at least in the United States) are eye care practitioners (ODs) who have graduated from an accredited optometry school and are licensed to diagnose and treat non-surgical disorders of the eye and optic pathway.  They may further specialize (via residency) to additional experience in working with a specific patient subset. (Note: not all states recognize OD specialization.)

Ophthalmologists are medical doctors (MDs) who have completed additional training (via residency) to specialize in the diagnosis and treatment (including surgical treatment options) of ocular disease.  These individuals may specialize further (via fellowship) to gain additional expertise in a specific patient subset.
Okay, great. But, what does that mean practically?  Why are there two different types of eye doctors? Which is better (one or two…)? Do they work together?  Who should I see?
For me, this is most easily answered with examples. So, let’s run some scenarios,

I need glasses or contacts.

  • This is generally an optometrist’s job.  Both doctors are capable of writing prescriptions, but optometry as a rule has a greater emphasis on refractive error management.  That said, not all optometrists love spending all day asking, ‘which is better, one or two’ – some of us have further specialized as well, so, before coming to the office, consider asking what all will be included in your exam.

My eyes are red/watery/itchy/burning/feel like they have something in them.

  • Optometry is generally the best starting place for these complaints.  We are trained to treat ocular surface disease and remove superficial foreign bodies (things that you get in your eye). As the gatekeepers to ophthalmology, we can assess the problem, determine the severity, and refer if needed. 

My primary care doc says I need a diabetic eye exam.

  • OD’s are again my first choice for diabetic eye exams.  As the early stages of diabetic retinopathy are currently managed by observation only, optometrists are more than able to monitor for disease progression.  If significant changes occur that require further treatment, we will then refer to ophthalmology for intervention and management.

I have double vision (seeing two things when there should only be one).

  • Double vision is something neither general optometry nor general ophthalmology (from my experience) likes to work with.  So, find a provider on either side of the optometry/ophthalmology wall who specializes in binocular vision or neuro/neuro-rehab.  In ophthalmology, these are often pediatric or neuro-ophthalmologists.  For the optometry side, it can be harder to find specialists (some states don’t allow OD’s to claim specialization), so be sure to call and verify that the doc you’re going to be seeing feels comfortable assessing causes of double vision.

I have (insert ocular disease here).

  • With a known ocular condition, treatment and management can fall on both sides of the optometry/ophthalmology wall – it really depends on what the disease is and how far it has advanced. Most common ocular diseases (glaucoma, dry macular degeneration, early cataracts, mild/moderate hypertensive and diabetic retinopathy) can be managed by optometry.  Once they progress/if they progress to a point of needing surgical intervention, then management is transferred to ophthalmology.

I’m sure there are other scenarios that I could pick out, but I think these 5 highlight the main differences between optometry and ophthalmology, and provide a general outline on where to begin your patient care experience.
To make it even easier, here are my 
            Top 5 OD v MD Tips:
  1. ODs are the primary hub for routine ocular care.
  2. Optometry (optimally) serves as the gatekeeper to ophthalmology.
  3. Both ODs and MDs can diagnose and treat ocular disease. MDs are simply further specialized, and can perform ocular surgeries.
  4. Talk to your eye doctor about your concern to make sure it’s something they’re comfortable with treating.
  5. When the system works right, ODs and MDs work together to provide comprehensive and efficient ocular care through the diagnosis, treatment, and management of ocular disease.

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