Differences Eyecare Professionals
Optometrists are eye doctors trained to diagnose and treat eye conditions, emergencies,
infections and diseases such as "pink eye" and foreign body removal. Most optometrists
are trained and certified to administer drugs to treat these problems when necessary.
Many optometrists perform pre- and post- operative care for eye surgeries including
cataracts, retinal detachments, laser refractive surgeries and diabetic retinopathy.
An optometrist spends four years beyond an undergraduate
program in a professional graduate program studying subjects such as the anatomy
and physiology of the eyes, how the eyes function and how that function can
be trained to bring us the most from our visual world. Not only do optometrists study the eyes, but they also study the brain and rest of the
body because so many systemic (body) diseases and problems manifest as problems
in the eye. Diseases such as diabetes, multiple sclerosis, cancer, hypertension,
high cholesterol, stroke, heart disease, herpes simplex and thyroid problems
can cause physical changes in the eye. Some of these diseases, if left untreated,
can actually cause a person to lose their sight permanently. Optometrists can
help diagnose and co-manage with other healthcare professionals, including ophthalmologists,
on the systemic conditions that have eye related problems.
Training includes several years in how to prescribe glasses and contacts for
clarity of sight, treatment and management of eye disease and neurological disorders, training eye movements (how our eyes
work together), vergence (how we point our eyes), accommodation (sustaining
and changing our focus), visual perceptual skills (information processing, spatial
skills, visualization, memory), and eye-hand coordination (gross and fine motor
Within optometry, there are several different modes of practice. There is general
practice, usually called primary care, or specialty practices. Some of these
specialties include contact lenses, refractive surgery co-management, dry eye,
disease, glaucoma, geriatrics, low vision, neuro-rehabilitative optometry, sports
vision, developmental/ behavioral optometry, pediatrics, vision training, and
learning disabilities. Optometrists can also choose to go into vision research
It is important to obtain a second opinion by an optometrist who
specializes in the area of concern, or if you have seen a specialist, an optometrist
that shares the same specialty with the doctor already seen.
For more information on what vision is, click here.
There are fellowship programs available to optometrists to become an officially
recognized specialist in their field by their colleagues. These programs require
that the candidate prove their knowledge by rigorous training, experience in
the field, publishing, testing and interviewing by the fellowship committees
before fellowship is granted. One such fellowship program is offered by the
College of Optometrists in Vision Development (COVD). A COVD fellow is a person
that specializes in vision training and binocular vision. Another fellowship
program is offered by the American Academy of Optometry (AAO). The AAO has several
different specialties that they recognize and each fellowship requirements vary.
Some of the subspecialties are Binocular Vision, Perception and Pediatric Optometry,
Cornea and Contact Lenses, Disease and Low Vision.
For information on COVD click here.
For information on AAO, click here.
Ophthalmologists are also doctors that spend four years in a graduate program
beyond an undergraduate degree, but their program is in medicine or osteopathy.
They study systemic disease, including diagnosis, treatment and management.
Once they earn their general medical degree (M.D.) or osteopathic degree (D.O.),
they also go on to do a four-year residency specializing in the treatment and
management of eye diseases including surgery in order to earn the title of ophthalmologist
Residency includes learning how to manage and treat eye conditions, infections
and diseases and also co-manage the systemic problems that can affect the eyes.
They also get roughly 6 weeks of training in refraction, depending on the residency,
so they can prescribe glasses and contacts if they choose. It is rare for residency
programs to teach visual function, which includes the relationship between eye
teaming (vergence) and focusing (accommodation), visual motor integration and
vision perception. They do, however, receive in-depth training on strabismus
(eye turn) surgery.
Most of their training is in eye surgery, including removal of cataracts,
retinal tears, retinal detachment, hemorrhages, tumors, strabismus surgery,
plastic recontructive surgery of the eye and surrounding structures, and laser
procedures to correct astigmatism, near and farsightedness. They are also trained in the treatment and management of eye diseases such as diabetic retinopathy and hypertensive retinopathy.
Strabismus surgery is concerned mostly with making the eyes look straight from
an aesthetic point of view. Most surgeons are not concerned with gaining binocular
vision to achieve good depth perception. There are ophthalmologists that do
recognize that vision therapy can actually improve their strabismus patients'
prognoses (their success rate) if performed before and/or after surgery. These
ophthalmologists often wait until their patients begin to achieve "peripheral
fusion" (both eyes just beginning to work together) with vision therapy
before surgery is performed and request active vision therapy after surgery
to increase fusion (the sensory glue that keeps the eyes coordinated together).
Just like optometrists, they can choose to specialize in any one area such
as oculoplastics, neuro-ophthalmology, cornea, retina, glaucoma, pediatrics
and strabismus. They can also choose to go into vision research or teaching.
Most of the time, optometrists and ophthalmologists work in conjunction with
each other. Some work in the same offices to co-manage patients. However, they
can disagree on their philosophies of care and treatment strategies based on
their training, especially when it comes to visual function. Many ophthalmologists are not trainined in vision therapy and do not know that it can improve many visual problems and
reject the scientific research that proves the validity of vision training.
If you see an ophthalmologist and want a second opinion from an optometrist
about visual function, or vice versa, it is almost a guarantee that they will give you different
insights and professional opinions due to their different training backgrounds.
This is because opinions from different eyecare providers is not a second opinion, but really a different opinion altogether.
Opticians are not doctors, but professionals that dispense glasses and sometimes
contact lenses. Some even make the lenses in your glasses in optical laboratories. They are
knowledgeable about materials used and appropriate tints, etc. that fit your
needs. Some opticians are required to do 1-2 year associate degree to become
certified in their field. This varies from state to state and can be optional.
In some states, they are allowed to refract patients to find out their prescription. However, they are not heavily trained in eye conditions, disease or systemic disease
that can affect the eyes. They also do not get trained in visual function.
You will often find opticians work for doctors in their eyeglass dispensaries
or contact lens laboratories. You may also see them in commercial eyeglass stores. Opticians are able to own their own optical boutiques, but the prescriptions still must come from an eye doctor.
Ophthalmic technicians usually assist eye surgeons in surgery and in pre and
post operative care. There are associate programs that they can complete in
order to become a certified technician. In some states, they are trained in basic refractive techniques and contact lens fitting and management. They also are not eye doctors.
Vision therapists are not doctors, but are specifically trained to design and/or implement vision
therapy programs once an optometrist has completed a comprehensive eye exam
and determines that an individual needs therapy. In most vision therapy offices,
vision therapists are the professionals you see each week who work with the patients needing vision therapy. The optometrist directs the vision therapist
on implementing the treatment program. Most vision therapists are on-the-job trained, similar to an apprenticeship. Vision therapists can begin a certification process after completing 2000 clinical hours as long as they work under a doctor who has completed the fellowship process. Certified Vision Therapists go through a rigorous testing process to ensure they meet the high standards of a specialist.