Ophthalmologists, Optometrists and Opticians, Do You Know The Difference?

The three “O’s” in eye care are important for anyone to understand, especially since sight is one of our most precious senses. Our eyes are responsible for 80% of the information our brain receives and processes, so choosing an eye care provider is a critical step in safeguarding your vision over your lifetime. We’re here to explain the differences behind the three “O’s” so you know just who to go to for your vision care needs.

Optometrist

Optometrists are the primary-care physicians of the eye responsible for diagnosing, treating and managing disorders that affect the eye or vision.  An optometrist is an eye care professional who has earned a Doctor of Optometry degree from an accredited school of optometry (ASCO, 2017).  Doctors of optometry spend the same amount of time in professional school as medical doctors and dentists but are not required to complete residency training, although this option is available in several specialty practice areas. Optometrists are trained in general health and systemic disease detection making them often the first to identify critical health issues including diabetes, hypertension, certain cancers and neurological disorders.  Their role encompasses prescribing glasses and contact lenses, providing vision therapy and low vision services, treating eye diseases such as glaucoma and infections of the eye, and delivering pre-and post-operative care to patients undergoing ophthalmologic surgery.  In some states, optometrists perform minor surgical procedures.  The scope of medical practice for optometrist is determined by individual state laws.

Ophthalmologist

Ophthalmologiests are your “specialty care” eye doctors. An ophthalmologist is a medical doctor (MD) or doctor of osteopathic medicine (DO) who specializes in eye surgery and general medical eye health.  Ophthalmologists complete four years of medical school before entering a residency program in ophthalmology.  The first year of residency is an internship year followed by a minimum of three years’ hospital-based residency in ophthalmology.  Further specialization is obtained through fellowship training in one of the following disciplines:  retina, cornea, oculoplastics, pediatrics, neurology and glaucoma.  Specialty educated ophthalmologists perform advanced surgical and medical procedures to preserve and restore eyesight.

Optician

Opticians are not eye doctors but are the refractive correction experts of the eye care team.  Opticians like pharmacists fill prescriptions written by an optometrist or ophthalmologist for eyeglasses, contact lenses and specialty lenses.  Opticians complete a training program usually lasting a few months to become licensed, however many are trained in-office without completing a formal training program.  Depending on the state, some opticians can also fit contact lenses after completing a certification program.

Now that you know the differences, which eye doctor should you see?

If you already have an annual eye exam to update glasses or contacts you are most likely seeing an optometrist (simply because there are more optometrists than ophthalmologists in the US). Most optometrists and general ophthalmologists perform routine eye exams unless they specialize in a specific area.  After a routine eye exam, either an optometrist or general ophthalmologist will refer more complex medical or surgical problems to ophthalmology specialists.  For instance, if you are diagnosed with cataracts and your vision cannot be fully corrected with glasses, you will likely be referred to an ophthalmologist who performs cataract surgeries.  Likewise, should an eye care provider find a retinal condition that could threaten your vision, you will be referred to a retinal specialist for treatment.  In some cases, if medical treatment for a condition like glaucoma is no longer manageable with topical medications, you will be referred to a glaucoma specialist for surgical treatment of your glaucoma.

Co-management between ophthalmologists and optometrists is a common practice especially for pre- and post-surgical cataract, Lasik and other eye surgeries.  In this case, your primary eye care provider will refer you for surgical treatment and resume care after the surgery.

In summary, inquiring about the services an eye doctor provides is an important first step in scheduling an eye exam.  Often this information can be found on their website along with a personal bio of their specialty area of practice.  Group practices with both optometrists and ophthalmologists is another option, especially if you have an existing eye condition that may need further attention.  

 

Dr. Caputo: The Future of Telemedicine and Optometry

In our dynamic digital era, we are experiencing the unprecedented development of innovative digital health devices focused on the personalization of healthcare.  The eye care industry is no exception.  Optometrists are accustomed to adapting to very rapid technological advances and are often the first to adopt new diagnostic devices to better serve their patients.  Next time you have an appointment at your optometrist’s office keep an eye out for these new innovative technologies connecting you with your eye doctor.

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Some optometry practices are offering refraction services using a device by SmartVisionLabs.  This compact and portable smartphone based autorefractor delivers an objective refraction in record time allowing optical staff to service your eyeglass needs on the spot.  Practices are using this technology to improve the patient experience and reduce the time it takes for a comprehensive eye exam.

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Another device you will soon see in eye care offices is the EyeQue Insight by EyeQue.  The Insight is a visual acuity screener that is fast and easy to use.  With the increase in nearsightedness starting at younger ages, optometrists now can monitor your child’s vision with the Insight in-between regular eye exams and remotely track vision changes. To obtain more information visit:  https://www.eyeque.com/insight

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Until recently, most ODs relied on expensive, in office retinal cameras to document their ocular health observations.  Now, not only has technology driven down the cost significantly but also made retinal photography portable.  The D-EYE is one example of an inexpensive, smartphone-based device for imaging the retina.  The D-EYE captures photos of the optic nerve and macula without dilating drops and broader views under dilation.  Among the many benefits, the device makes examining children and infants easier.

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If your child has amblyopia, strabismus or convergence insufficiency there is a new virtual reality device that can be used in an optometry office or prescribed for home use.  Vivid Vision has only been available for about 2 years with more and more optometry offices making this treatment available to their patients.  To find out if there is an office near you using Vivid Vision Clinical or Vivid Vision Home check out their website at https://www.seevividly.com/.

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5 Tips Doctors Wish That You, The Patient, Knew

No pun intended but eye care professionals would like you to keep an EYE on your vision health.  We all know that going to the doctor and dentist are all part of taking care of your overall health.  What about the eye doctor?  If you see well, or think you see well does that mean you don’t need to see an eye doctor?  Does a passing result on the visual acuity test at the school, DMV, health fair or doctor’s office count as an eye exam?

What eye doctors wish you, the patient, knew… 

  1. Kids need eye exams earlier and more than ever before.

Although, people tend to have more vision problems as they age, children need eye exams to ensure healthy vision too.  Currently less than 15 % of preschool children get an eye exam and less than 22% receive vision screenings (CDC, 2016).  The most common cause of vision loss in children is amblyopia (2 to 3 children out of 100 children affected) and without prompt treatment this can be permanent.   The key is timely detection with a comprehensive dilated eye exam that starts early on.  The American Optometric Association (AOA) recommends children have their first exam at 6 to 12 months of age, then at least once between 3 to 5 years of age, then before first grade and thereafter annually until age 18.  Before calling for your child’s eye appointment make sure to ask the office if the eye doctor routinely sees pediatric patients or specializes in children’s eye health.

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  1. Most eye diseases do not have symptoms until it’s too late.

As we age, eye diseases are more common and often go unnoticed for a long time before symptoms arise.  During a regular eye exam, age-related eye diseases are detected including cataracts (clouding of the lens), diabetic retinopathy (damaged blood vessels in back of eye), glaucoma (progressive optic neuropathy) and age-related macular degeneration.  Early treatment is critically important in preventing permanent vision loss or blindness.  Waiting for symptoms to occur before seeking eye care decreases your chances of preserving your sight.

  1. Know your insurance and what it covers to avoid surprises.

Upon scheduling an exam, you may be asked about your insurance.  Most optometrists and ophthalmologists accept both vision and medical insurance.  Bear in mind there are similarities and differences between the two.  Some vision plans only cover a basic refraction for glasses with eye exam while others include additional services such as a diabetic retinal exam with photographs.  It’s important to find out what your vision plan covers before your visit.  If you are not sure, ask when you arrive at the office.  Another poorly understood fact is your medical insurance covers medical conditions affecting the eyes including conjunctivitis, dry eye, new symptoms such as flashes or floaters, eye pain, etc. and diabetic retinal exams.  Never hesitate to obtain timely eye care and always bring both your vision and medical insurance card with you to the visit.

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  1. Bring your old glasses with you to your eye exam.

To better serve your eye care needs here are a few tips of things to bring to your next eye care appointment.  Remember to bring your most recent glasses with you, even if they never worked well for you.  Bring older pairs of glasses that you liked or felt worked better than the last pair.  Sometimes this is helpful in assuring your next pair works well for you.  Another important item to bring are your contact lens boxes with a current pair either worn or with you on the day of visit.  Equally important is bring a current list of medications (including over-the-counter), especially if this is your first visit to an eye doctor or a new one.

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  1. Learn more about your eyes and how to care for them!

Lastly, visit our website, http://www.eyeque.com for helpful articles highlighting important facts about your vision and reminders.  Also, learn more about how you can track your vision between visits with your eye doctor, helping you and your eye doctor to stay in the know.

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The EyeQue Insight: At Home 20/20 Vision Screener

Half the World Will Be Nearsighted by 2050

Myopia (nearsighted, reduced distance vision) is increasing worldwide at an alarming rate. In the US alone, myopia has doubled in the last 30 years, affecting one in four people over the age of 40. By the year 2020, it is estimated that 2.5 billion people or one-third of the world’s population will have myopia. Further global projections predict myopia to reach almost one-half of the world’s population by 2050. Currently, some East Asian countries have myopia prevalence of 70-80% of the population.

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Why is this cause for concern?

Myopia is the most frequent cause of distance impairment in the world. Left uncorrected, it leads to a reduction in the quality of life of an individual and associated economic consequences. Additionally, myopia increases the risk of serious ocular disorders including myopic macular degeneration, retinal detachment, glaucoma and cataracts. Another concern is myopia is starting at younger ages, which typically leads to more rapid progression and likelihood of developing high myopia; a degenerative condition with increased risk of vision loss.

How does lifestyle and family history impact myopia prevalence?

Myopia development is influenced by both environmental and genetic factors. Several studies show an association between education, socioeconomic status and occupation with myopia prevalence. A higher prevalence of myopia in urban areas has also been documented in multiple studies. In general, these all indirectly represent the effects of reading or near work activity on the visual system. While behavior and environment play an important role in myopia development, hereditable factors are also significantly associated. Children of myopic parents are more likely to develop myopia in childhood or adolescence from anatomically heritable longer eyes. Even stronger associations exist for children if parents have higher levels of myopia. It is estimated that 50-90% of myopic refractive errors originate from family history.

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What lifestyle changes can protect against myopia development?

While little can be done to change genetic factors in myopia development, changes in certain environmental factors show a protective effect. Specifically, participation in sports and time spent outdoors is associated with a decreased risk of myopia. Planning outdoor activities on the weekends, taking walking breaks at work or joining an outdoor team sport are all lifestyle changes with visual benefit. Because of the earlier onset of myopia, it is also important to frequently monitor the eye for any refractive error change to reduce risks associated with myopia and seek treatment options. Along with annual eye exams with an eye care professional, in-home monitoring is also encouraged in-between visits for those at increased familial risk of myopia development.

About The Author: Dr. Careen Caputo

Dr. Careen Caputo graduated with her Doctor of Optometry degree from the Southern California College of Optometry (SCCO) in Fullerton, California,

Screenshot 2017-08-29 15.19.38after completing a BS in Visual Science. Dr. Caputo received specialized training in low vision at the Center for the Partially Sighted in Santa Monica as well as rotations in ocular diseases. Dr. Caputo will complete her Master’s in Public Health in Global Health Leadership at the Keck School of Medicine of the University of Southern California in 2017, where she conducted research in an underserved community to inform and develop educational materials to increase awareness of diabetic retinopathy in a Latino population with diabetes. Dr. Caputo was awarded the Delta Omega Honorary Society in Public Health. She volunteers her time at community clinics giving eye exams to the underserved, working to increase access to quality affordable eye care. Her aspiration is to reduce the burden of vision loss through increasing awareness and access to timely, acceptable and quality eye care to vulnerable populations both locally and globally.

How Stable Is Your Eyeglass Prescription?

One of the most common questions asked during an eye exam is “has my prescription changed?” but less frequently requested is, “how stable is my prescription?”. The eye has natural mechanisms in place that aid in keeping the prescription (refraction) from fluctuating.  A spectacle prescription is based on eye features including corneal curvature, anterior chamber depth, lens thickness, and the axial length of the globe (whole eye).  During early developmental years, the prescription is least stable, due to rapid growth causing changes in these eye features.  Starting in early adulthood, refractive changes usually slow but this depends on the type of refractive error (myopia, hyperopia, etc.) and age of onset.  In later adult life, refraction changes primarily result from changes in the lens of the eye.  However, some health conditions can induce refractive error instability by altering one or more eye features, for instance:

Pregnancy

During pregnancy, various changes occur throughout the body including the eye.  Ocular changes affecting the prescription of expectant mothers are most often related to alterations of the corneal curvature due to the corneal thickness from swelling or a change in the tear film.  These changes usually appear in the second and third trimester, are transient but occasionally, may be permanent.  Refractive surgery requires a stable refractive status. Therefore, the current recommendations during pregnancy are to delay surgery and wait until the refraction is once again stable.  This precaution also applies to getting new glasses unless the refractive change significantly impairs vision.

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Diabetes

Hyperglycemia (elevated blood glucose) is a significant cause of temporary refractive changes in diabetic patients.  Newly diagnosed individuals beginning treatment can experience fluctuation in vision from refractive instability.  Once blood glucose levels normalize, the prescription typically stabilizes.  Although the precise mechanism for the refractive change is not clear, lens abnormalities appear to be the likely cause. The general recommendation is to wait for at least 4-weeks before prescribing new glasses to allow for stabilization of the prescription.

Dry Eye Syndrome

Dry eye syndrome (DES) is characterized by a deficiency in the amount and quality of tears, an unstable tear film and resulting ocular surface changes.  Consequently, vision can fluctuate during the day depending on the severity.  Refractive instability leads to challenges in daily tasks including reading, computer work, and driving.  Left unmonitored and untreated, DES can progress causing permanent changes in vision.  Instability in the prescription decreases with appropriate dry eye therapy and close monitoring.

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Glaucoma

Between 2-4 million people in the U.S. have glaucoma, which can cause blindness by damaging the optic nerve.  Trabeculectomy, a surgical procedure to lower intraocular pressure, is typically reserved for patients with severe glaucoma who no longer respond to treatment with standard medication or laser therapy.  Vision changes/instability accompany this procedure in over half of the cases but are usually temporary.  Recent studies have shown that after the surgery the axial length of the eye changes due to choroidal thickening, which can lead to temporary and possibly permanent changes in an individual’s vision.

Keratoconus

Keratoconus is a noninflammatory corneal bulging or ectasia with onset typically in puberty and progresses until about forty years of age.  Alterations of the front surface of the cornea lead to irregular astigmatism.  The stability of the prescription during this time may vary depending on the severity of the disorder, however, once keratoconus progression stops the refractive status stabilizes.Screenshot 2017-09-21 11.20.43

About The Author: Dr. Careen Caputo

Dr. Careen Caputo graduated with her Doctor of Optometry degree from the Southern California College of Optometry (SCCO) in Fullerton, California,

Screenshot 2017-08-29 15.19.38after completing a BS in Visual Science. Dr. Caputo received specialized training in low vision at the Center for the Partially Sighted in Santa Monica as well as rotations in ocular diseases. Dr. Caputo will complete her Master’s in Public Health in Global Health Leadership at the Keck School of Medicine of the University of Southern California in 2017, where she conducted research in an underserved community to inform and develop educational materials to increase awareness of diabetic retinopathy in a Latino population with diabetes. Dr. Caputo was awarded the Delta Omega Honorary Society in Public Health. She volunteers her time at community clinics giving eye exams to the underserved, working to increase access to quality affordable eye care. Her aspiration is to reduce the burden of vision loss through increasing awareness and access to timely, acceptable and quality eye care to vulnerable populations both locally and globally.