The three main types of eye care professionals are ophthalmologists, optometrists, and opticians. Ophthalmologists and optometrists are both involved with the examination of healthy eyes and the diagnosis and treatment of eye diseases.
Opticians are trained in filling prescriptions for eyeglasses and determine the proper eyeglass frames and adjust frames for proper fit. In some states, opticians may be licensed to fit contact lenses. Opticians often work closely within the same practice as an optometrist or ophthalmologist, or an optician may have an independent practice.
An ophthalmologist is a medical doctor who is specialized in eye and vision care. In order to become an ophthalmologist, acquisition of an M.D. or a D.O. (doctor of osteopathy) degree is necessary following the completion of college. After 4 years of medical school and a year of internship in general medicine, every ophthalmologist spends a minimum of 3 years in a university and hospital-based residency specializing in ophthalmology. During residency, the eye M.D. receives special training in all aspects of eye care, including prevention, diagnosis, and medical and surgical treatment of eye conditions and diseases.
Ophthalmologists are trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to performing complex and delicate eye surgery. They may also be involved in research about eye diseases and treatments. Some ophthalmologists will acquire additional fellowship training in a subspecialty area of ophthalmology, such as retina, cornea, glaucoma, pediatrics, oculoplastics, refractive surgery, uveitis, pathology, or neuro-ophthalmology.
Ophthalmologists usually practice in groups of other ophthalmologists or in multispecialty practices with other physician specialists. Solo practices, however, remain popular, particularly in smaller communities.
There are no federal laws or regulations regarding scope of practice or training for ophthalmologists. Those are reserved for the individual states. There are national ophthalmological professional organizations and societies, the most important being the American Academy of Ophthalmology. There are State Societies in every state.
Most ophthalmologists in the United States are "board certified" by the American Board of Ophthalmology after taking a rigorous written and oral test. However, they do not need to be board certified to practice ophthalmology, although they require this to gain hospital privileges at specific institutions. According to state law, any licensed physicians can represent themselves as specialists and practice whatever specialties that they wish.
Having completed medical school, ophthalmologists are often more aware of how different diseases may affect the eye and how different findings noted during an eye examination may indicate serious disease elsewhere in the body. In addition, ophthalmologists have an understanding of how medications prescribed by other physicians can cause unintentional side effects to the eye and how ocular medications can affect the rest of the body or may interfere with other health conditions. They can deliver total eye care, including performing a complete eye examination, prescribing eyeglasses and contact lenses, diagnosing and treating eye diseases, and performing surgery on the eyes and the area around the eye.
An optometrist is a Doctor of Optometry, an O.D. (not to be confused with a Doctor of Medicine, an M.D.). To become an optometrist, one must complete pre-professional undergraduate college education followed by 4 years of professional education in a college of optometry. In optometric school, the student receives education primarily about the eyes and does not receive a comprehensive education regarding the rest of the body and systemic disease processes. The graduate is then eligible to become licensed by a state as an optometrist. Some optometrists also do further postgraduate residency in a subspecialty of optometry such as low vision rehabilitation, primary eye care, geriatric optometry, pediatric optometry, family eye care, contact lenses, sports vision, or vision therapy.
Optometrists are licensed by the individual states to practice optometry, just as physicians are licensed to practice medicine by the individual states. Optometrists can perform an eye examination and can determine the presence of vision-related problems. They can also prescribe eyeglasses and contact lenses. Depending on the state in which they practice, optometrists may be allowed to treat eye diseases and prescribe eye drops for various conditions, but they are not trained or licensed to perform surgery in an operating room.
Throughout all the states in the U.S., optometrists are licensed to provide primary eye care services, including eye examinations and diagnosis of eye diseases. In certain states, optometrists are allowed to medically treat eye diseases such as glaucoma, cataracts, and retinal diseases and, in certain states in the U.S., to treat them medically. In addition, in certain states, optometrists may also perform minor surgical procedures such as the removal of foreign bodies. Over the years, all states have expanded their laws regarding the allowable scope of optometric practice to allow optometrists to perform functions that the specific state deems them able to do, pursuant to their education and training. Currently some states allow optometrists to use and prescribe oral medication. The federal government has allowed optometrists to bill through the Medicare system and receive payment from Health and Human Services (HHS). Similar to ophthalmologists, there are no federal standards for optometrists that address their qualifications or limit of practice. Under the U.S. Constitution, those standards are reserved for the individual states. There are national optometric professional organizations and societies, the most important being the American Optometric Association. There are also State Societies of Optometry in every state.
Ophthalmologists often work closely with optometrists to provide integrated eye care for their mutual patients. Some optometrists work in the same practice as ophthalmologists, providing refractive (glasses and contact lenses) services, surgical screening, analysis of technical measurements prior to surgery, postsurgical care, emergency care, and other medical services. Other optometrists may work in an independent practice or in conjunction with a national eye care chain. In many of these optometric practices, frequent referrals to ophthalmologists for surgical or medical care of serious illnesses may occur. Conversely, some ophthalmologists may refer patients to optometrists for primary eye care, refractions, contact lenses, prescription eyeglass lenses, glasses fittings, and postsurgical care.