There are 8 defined “sub-specialties” in ophthalmology. I’m defining these by the 8 different areas that exist to train doctors after finishing residency in ophthalmology (basic training if you will). These “fellowships” offer additional training in branches of ophthalmology and allow us to become sub-specialists.
I am an ophthalmologist and “sub-specialize” in retinal diseases. Thus, my practice is limited to retinal diseases such as retinal detachment and diabetic retinopathy.
Here’s a typical timeline for becoming an Ophthalmologist;
In the United States, all of us must complete 4 years of medical school after graduating from a 4 year undergraduate program. There are a few programs left in the U.S. where students complete both undergraduate and medical school in a combined 6 year program, but these programs are dwindling.
Before starting ophthalmology residency, we are required to complete an internship. This may be in any primary field (e.g. Internal Medicine, Surgery) and is hospital based, that is, we work in the hospital for one year. My internship was in internal medicine.
Most ophthalmic residencies are 3 years. We learn the practice of ophthalmology usually in large hospital centers where patients abound. When residency is completed, most of us enter private practice and practice “General Ophthalmology.”
A general ophthalmologist can treat all sorts of eye problems: cataracts, most types of glaucoma, prescribe glasses, prescribe medications, perform laser refractive surgery, treat dry-eye, etc.
Fellowship training is completely optional. Fellowship training allows us to further “sub-specialize” in an area of ophthalmology.
BTW – the terms I’m using (intern, resident, fellow) are standard through American medical schools. Other disciplines in the related health fields use the terms differently.
Based upon the system described above, there are 8 sub-specialties of ophthalmology, that is, there are 8 different types of fellowships available after general residency is completed.
The sub-specialties available in the United States:
Fellowship training allows us to focus only on those diseases which interest us. For example, I knew I had no interest in performing routine eye exams and cataract surgery, yet diseases and surgery of the retina fascinated me.
As a retina specialist, I see patients only with diseases of the retina and vitreous (such as those diseases found here on this website). I do not see “general” patients and while I am qualified to perform cataract surgery, write eyeglass prescriptions, etc., I only perform retina surgery.
What Does This Mean?
We probably have more specialists in the United States than anywhere. As a result, the level and sophistication of medicine available to the general public is just as complex and sophisticated – one reason we provide some of the best healthcare in the world.
As a sub-specialist, I spend my day seeing patients with types of diseases I find interesting. As a retina specialist, however, my staff and I can’t take care of the everyday types of problems, such as; eye glass prescriptions, dry eyes, allergies, etc.
As a result, most of my patients have already been seen by a general ophthalmologist or optometrist FIRST, before being referred to me.
It’s a system which requires more doctors visits, but ultimately, the best care.
In more rural areas of the country, you’ll find the “general ophthalmologist” is better versed to handle a broader range of eye problems because;
1. There are fewer sub-specialists to refer patients.
2. The distances patients must travel can be formidable.