Ask Dr. Pat · Health

Eye “Doctors” and Eye Examinations

Dear Dr. Pat,

I am 55 years old and have never seen an eye MD, only an optician who tests my vision and gives me my contact lens prescription. There is no eye MD in our town so I would have to travel about an hour for an appointment. However, I have a good friend who has lost much of her vision due to a delay in glaucoma diagnosis because she had only seen non-MD eye specialist. My optician has never asked about glaucoma and never tested for it. She is just interested in getting my contact prescription right and filling that prescription. I am beginning to think that it is time that I see a medical doctor for an eye exam even though I don’t think I have anything wrong. When should women begin to see a medical doctor eye specialist?  How often?

Sarah

 

Dear Sarah,

Your question is so timely. March is national Save Your Vision Month.  We are participating in this outreach effort to increase awareness of good eye care and to inform our readers about the nature of an eye exam.  Over the course of this month, we will focus on diseases and conditions of the eye. Vision and health are more intertwined that most people may realize. Many general health problems, like diabetes and high blood pressure, can actually be detected early by having the eyes examined.

Ophthalmologists are physicians specializing in the comprehensive medical and surgical care of the eyes and vision. Ophthalmologists are the only practitioners medically trained to diagnose and treat all eye and visual problems including vision services (glasses and contacts) and provide treatment and prevention of medical disorders of the eye including surgery. The requirements to become an ophthalmologist in the United States are the completion of four years of college, four years of medical school, and four to five years of additional specialized training. I have asked Dr. Wayne Whitmore, a new member of our Medical Advisory Board to discuss your question and to describe what an eye exam involves.  The frequency of visits is based on family history of eye diseases, abnormalities found on exam or symptoms that a patient may have.

Dr. Pat

 

Dr. Whitmore Responds

Eye examinations can be performed by various different professionals with differing skills and education.  Opticians fit, make, and repair eyeglasses and may also fit contact lenses but do not perform eye examinations except to find the right optical correction.  Optometrists (Doctors of Optometry or ODs) may also do everything an optician does, but in addition, they may examine eyes to diagnose disease and, in many states, can now treat some eye diseases by prescribing medications.  Ophthalmologists (Doctors of Medicine or MDs) may do everything an optometrist does, but they can also diagnose and treat all diseases although they generally focus on eye health only.  In addition, ophthalmologists can perform surgery to correct disease and abnormalities in and around the eyes.

The difference in education between ophthalmologists (Eye MDs) and optometrists is extensive: it takes at least five more years of education and experience to become an Eye MD than it does to become an optometrist.  After a college education, an optometrist can enter practice following three years of optometry school; there is no apprenticeship or residency requirement.  After college, an Eye MD spends four years in medical school followed by one year of general medical or surgical internship.  This is followed by an additional three years in an U.S. accredited ophthalmology residency training program where the physician is apprenticed with many experienced Eye MDs while he examines patients and learns to perform surgery.  An additional one to two years of fellowship training may be required to obtain the knowledge necessary to be proficient in certain subspecialties (such as retina or neuro-ophthalmology).  At the completion of their studies, almost all Eye MDs also take a rigorous examination to get certified by the American Board of Ophthalmology which assures that the physician has a standard base of knowledge and experience.  If you go to the trouble of seeing an Eye MD, make sure he or she is “Board Certified”.

Indications for seeking an eye examination for an adult or a child would include having any sort of difficulty with your eyes, such as blurry or decreased vision, persistent redness, pain, seeing “floaters” or “spots” in front of your eyes, getting hit in the eye, getting something in your eye, or having a discharge from your eyes.  Also, you should have a complete eye examination at any age if you have been diagnosed with diabetes, high blood pressure, or if you have any family history for eye disease.  Your doctor will thereafter make a recommendation on the frequency of re-examinations.

Children’s eyes are usually tested and examined by their pediatricians during their regular physical examinations and these physicians will refer children for an eye examination if their vision is reduced or they see some abnormality.  It can, however, be difficult for pediatricians to detect small deviations in ocular alignment in children which can lead to amblyopia (or “lazy eye”).  This can cause permanent uncorrectable loss of vision later in life, if not treated at an early age.  For this reason, every child should have an eye examination by an Eye MD around the age of three even if the pediatrician does not see anything wrong with their eyes.  After that age, in a healthy child with no family history for eye disease, provided vision remains good enough to see detail on the blackboard or screens in school, regular eye examinations are unnecessary.

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