My Opinion

The "O" in Eye Doctor

Every wonder how many kinds of eye doctors there are?  It can be somewhat confusing as there are 2 professions, starting with the letter “O,” who are referred to as “eye doctor.”  An eye doctor is usually an optometrist or an ophthalmologist.

(There are also ocularists and opticians.  Ocularists work and fit prostheses.  Opticians prepare and dispense eyeglasses.)

What is the difference between eye doctors? The biggest difference between “eye doctors” is the type of training.  Eye doctors went to either medical school or optometry school.

Ophthalmologists went to medical school. Medical school lasts 4 years and follows undergraduate work.  After receiving the “M.D.,” doctors usually move on to an “internship” which is usually classified as the first year out of medical school.  Most internships are one year and are spent within the confines of the hospital.  We learn a lot of general medicine during this year.  After one year of internship, in the old days, many physicians then went into the community and started practicing medicine.  These were general practioners.

Nowadays, after internship, a young doctor will then engage a residency.  This is further specialty training and can be as short as 3 years or as long as 7 years of additional training.  Ophthalmology residency is usually 3 years and follows the 1 year internship.  It is during Ophthalmology residency that a doctor specializes in treatment of eye diseases and surgery.  After the completion of a residency in Ophthalmology, a doctor is now a general ophthalmologist.  Many start practicing medicine at this point and work in a private practice.  Most general ophthalmologists treat a variety of diseases, prescribe glasses and contacts, and operate;  including cataract surgery and laser vision correction.

But wait, there’s more! There are at least 9 recognized sub-specialties within Ophthalmology; cornea, glaucoma, pediatrics, pathology, oculo-plastics, neuro-ophthalmology, oncology, uveitis and…………retinal diseases!  A fellowship, completed after ophthalmology residency, is focused exposure to one of the ophthalmic sub-specialties.  It is another 1-3 years of training.  My retina fellowship was completed in Memphis, TN.  I took care of only patients with retinal diseases under the tutelage of Drs. Steve Charles and Maurice Landers.  This is how I became a retina specialist.

A retina specialist treats patients with diabetic retinopathy, macular degeneration, retinal detachments, retinal tears, etc.  We usually do not prescribe glasses, perform laser vision correction or cataract surgery.

Optometrists went to optometry school. Optometry school also lasts 4 years and starts after obtaining an undergraduate degree.  The “O.D.” usually completes optometry school and then starts practicing optometry.  Optometrists usually prescribe glasses and contact lenses.  In most states, optometrists can treat certain diseases and write prescriptions.

Optometrists can also develop a specialized practice treating patients with binocular vision/vision therapy, low vision and medical treatment of eye disease.  Optometry residencies can be an extra 1-2 years of training.

The definition of “Eye Doctor” becomes Blurry.  Both “eye doctors,” ophthalmologists and optometrists, traditionally have had political differences.  It is not uncommon to have “turf-wars” in medicine (e.g. mid-wives vs. obstetricians).  For generations, they did not practice together.

Times are changing.  Many private practices are now composed of both optometrists and ophthalmologists.  You’ll find both types of “eye doctors” within the same office!  I first started working in this type of setting after I finished fellowship.  Many estimate that ophthalmologist-optometrist models of practice are the wave of the future.  It may be one of the more efficient ways to deliver comprehensive eye care to the public!


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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Good Sugar Control Does Not Prevent Diabetic Retinopathy

Despite all of the technology that we have today, most people, including doctors, do not realize that sugar control does not prevent diabetic retinopathy.  While sugar may affect the severity of diabetic retinopathy, the number of years that one is diabetic is the single most predictive variable.  Over the years, I have found it very difficult to get this message to the primary care physicians; family docs, internists and pediatricians.  On average, a patient develops signs of retinopathy after 7 years of the diagnosis of diabetes.

More importantly, it is imperative that every diabetic be seen by an eye doctor at least one a year.  The doctor, ophthalmologist or optometrist, should take the time to dilate your eyes; looking for signs of diabetic retinopathy.  Once diabetic retinopathy has been noted, referral to a retinal specialist is appropriate.

Diabetic patients can NOT tell if they are developing retinopathy.  To state another way, vision does not correlate with presence or absence of the disease.  Don’t wait until you can not see before going to the eye doctor!  Go while you have excellent vision.  We are better at preventing vision loss from diabetes than we are at reclaiming lost vision.

One last item.  I tell every diabetic to expect to get the retinopathy.  Diabetic retinopathy is not a reflection of poor sugar control.  It happens to almost 90% of diabetics; regardless of sugar control.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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