There are three main types of eye care practitioners: optometrists, opticians, and ophthalmologists. Each has a different level of training and expertise, and each will provide different levels of care.
Ophthalmologists are doctors who treat eye diseases, optometrists are specialists who provide primary eye care, and opticians are trained professionals who work in a retail setting.
This article reviews the differences between optometrists, opticians, and ophthalmologists. It also discusses the roles of other eye care practitioners, including nurses, medical assistants, and technicians.
Optometrists provide primary vision care. Their services range from eyesight testing and correction to diagnosing, treating, and managing changes in vision.
A person who is training to become an optometrist attends optometry school, not medical school. It can take 4 years of postgraduate studies to obtain a doctorate in optometry.
The practice of optometry involves:
- conducting eye exams
- conducting vision tests
- prescribing and dispensing corrective lenses
- detecting certain eye irregularities
- prescribing medication for certain eye conditions
- providing visual rehabilitation
Optometrists are not surgical specialists and they do not usually perform surgery. However, they can perform minor surgeries, such as laser eye surgery and foreign body removal.
To find out what an optometrist can do in a particular state or country, a person can consult the relevant regional boards of optometry.
Sometimes, an optometrist is more easily accessible than an ophthalmologist. It is worth finding out if an optometrist can perform a test or procedure before calling an ophthalmologist.
Other services an optometrist may perform include:
Prescribing opioids
In the United States, each state board of optometry defines the drugs or services that an optometrist can provide.
Optometrists in some states can prescribe schedule II drugs, which include the following opioids:
- hydrocodone
- hydromorphone
- oxycodone
Foreign body removal
Five states allow optometrists to perform a procedure called foreign body removal.
Foreign body removal, which people may also call foreign object removal, involves removing small objects, particles, or debris that may affect the cornea or conjunctiva.
Laser eye surgery
Optometrists in the following states are also allowed to perform laser eye surgeries:
- Alaska
- Oklahoma
- Louisiana
- Kentucky
An optician is a specially trained allied health professional. In many states, they require a license.
They may work directly with people seeking eye care either in a retail store that sells prescription glasses or contacts or in an optometrist’s office. Opticians are not doctors.
Though they can help detect certain eye concerns, they primarily interact with people and design and fit the following visual aids:
- eyeglass lenses and frames
- contact lenses
- other devices to correct a person’s eyesight
Opticians use prescriptions from an optometrist or ophthalmologist to verify and fit the necessary visual aids.
Though they may have the ability to detect some issues with the eyes, they cannot diagnose eyesight problems, and they cannot treat eye conditions.
To become an ophthalmologist, a person needs to graduate from medical school. Ophthalmologists will have at least 8 years of medical training.
They go to medical school for 4 years, and if they qualify for ophthalmology as a specialty, they then have 4 years of residency training. They may also complete 1–2 additional years of subspecialty fellowship training.
Ophthalmologists are licensed to treat eye diseases and perform surgery.
An ophthalmologist can offer the same refractive services as an optometrist, including prescribing and fitting eyeglasses and contact lenses to correct vision issues.
Ophthalmologists can also:
- diagnose and treat eye conditions
- perform eye surgeries
- conduct scientific research into the causes and cures for eye conditions and vision issues
Sometimes, ophthalmologists can also detect health problems that are not directly related to the eye but become apparent in a routine eye exam.
If this occurs, the ophthalmologist will recommend that the person consult their primary care physician or other specialists.
Ophthalmologists are specialized medical doctors, but some ophthalmologists may choose a subspecialty. This involves continuing their education and training in a specific area of medical or surgical eye care.
Some subspecialties of ophthalmology include:
Corneal specialist
The cornea is the clear, protective outer layer of the eye. It acts as a lens to focus light entering the eyeball. Corneal specialists focus on issues related to the cornea.
People who have trauma to the cornea or complicated contact lens fittings may also consult with a corneal specialist.
A few examples of conditions that a corneal specialist can manage include:
- Corneal eye disease: A cornea specialist can diagnose and treat corneal eye conditions, such as corneal dystrophies, corneal edema, and keratoconus.
- Keratitis: They can treat inflammation of the cornea that results from different causes.
- Severe dry eye: They can provide medical and surgical care to patients with serious ocular surface disorders.
- Corneal infections: They can identify causative bacterial, viral, and parasitic pathogens that cause corneal ulcers and scarring
- Corneal transplants: Cornea specialists may also perform surgeries such as refractive surgery and corneal transplantation.
Retina specialist
The retina is the thin layer of tissue that lines the inner part of the back of the eyeball. Its role is to receive light and send visual signals to the brain.
A retina specialist can diagnose and treat retinal eye conditions, including:
- Retinal detachment: The retina may tear or permit fluid to disturb the normal anatomy of the eye, causing issues with a person’s vision. A person experiencing retinal detachment may see flashes of light, experience blurry vision, or see floaters in their vision.
- Age-related macular degeneration: A retina specialist examines the retina to check for changes in its appearance, along with the development of abnormal blood vessels underneath the retina.
- Diabetic retinopathy: A retina specialist treats abnormal blood vessel proliferation involving the retina caused by chronically elevated blood sugar levels.
- Conditions of the vitreous: The vitreous is the gel-like substance in the eyeball. Retina doctors may perform vitrectomy for certain vitreoretinal diseases.
Glaucoma specialist
Glaucoma specialists treat the eye condition glaucoma. Glaucoma is an ocular condition that can lead to irreversible vision loss.
It occurs when fluid builds up within the eye. The excess fluid puts pressure on sensitive retinal nerve fibers, causing damage to the optic nerve.
Without treatment, this can cause a person to progressively lose their peripheral vision. Glaucoma often happens without a person noticing any symptoms.
Neurology specialist
Ophthalmologists who specialize in neurology are called neuro-ophthalmologists. This subspecialty deals with vision issues related to how the eye communicates with the brain, nerves, and muscles.
Some conditions that neuro-ophthalmologists can diagnose and treat include:
Vision loss and issues
A neurology specialist may treat vision loss or double vision relating to diseases that affect the brain, such as multiple sclerosis or stroke.
Though they may treat other forms of vision loss, neuro-ophthalmologists specialize in conditions arising due to issues involving the central nervous system.
Examples include multiple sclerosis, Parkinson’s disease, trauma brain injury, brain tumors, and vascular abnormalities.
Unequal pupil size
Unequal pupil size, known as anisocoria, occurs due to a number of different conditions that affect the brain or nerves. A neurology specialist may help treat the condition and return the pupils to their normal state.
Abnormal eye movements
An ophthalmologist with a neurology specialty may help treat eye movement relating to issues that affect the brain or nerves, which people call nystagmus. This condition primarily occurs due to neurological issues that were either present at birth or develop in childhood.
Orbital and oculoplastic surgery
Oculoplastic surgeons are ophthalmologists who diagnose and treat problems affecting the bony socket that contains the eyeball (orbit), the eyelids, and the soft tissues surrounding the eyes.
Common problems managed by these subspecialists include:
- thyroid eye disease
- benign or malignant orbital masses
- orbital or facial trauma
- tear drainage abnormalities
- eyelid droop, or ptosis
- eyelid and facial skin cancer
- cosmetic or aesthetic eyelid surgery
Pediatric specialist or strabismus specialist
A pediatric ophthalmologist treats infants and children with childhood eye conditions and other eye issues.
Some eye issues a pediatric specialist may treat include:
- Strabismus: Strabismus, which people sometimes refer to as crossed eyes, is a condition in which the eyes point in different directions at the same time. A pediatric specialist can help treat this condition in children and adults.
- Uncorrected refractive errors: Refractive errors cause issues with a child’s vision. Without treatment, this can lead to blurry vision that affects their school performance. A pediatric specialist can help identify and treat the condition, often with prescription lenses or other corrective measures.
- Vision differences between the two eyes: In some cases, a child or adult may have different vision levels in each eye. An ophthalmologist can help identify and correct the difference in vision between the two eyes.
Ophthalmologists often require additional help from nurses, medical assistants, and technicians. These roles provide crucial help in-office.
Nurses
Ophthalmic registered nurses have undergone extra training in eye care. They can administer eyedrops and other medications and assist with office or hospital surgeries.
Some nurses with specialized training in ophthalmology are clinic or hospital administrators.
Medical assistants
Ophthalmic medical assistants can perform a variety of tests to help an eye care practitioner during an examination or procedure.
Technicians
Ophthalmic technicians or technologists are highly trained assistants who can help an eye care practitioner with more complex tests and operations.
An ophthalmic photographer, for example, uses cameras and photographic techniques to document a person’s eye condition.
A perimetrist uses sophisticated technology to administer visual field tests.
Opticians, optometrists, and ophthalmologists are the three most common eye care professionals. Nurses, medical assistants, and technicians can also specialize in eye care and provide essential services when a person visits an office for eye care.
Ophthalmologists diagnose and treat all eye conditions. Some ophthalmologists continue their training to specialize in a particular eye condition or part of the eye.
Beyond refractive eye care, optometrists can offer different services depending on where their practice is located. Some optometrists can perform certain laser eye procedures, whereas others can only perform foreign body removal.
Opticians can design and fit visual aids prescribed by an ophthalmologist or optometrist.
A person must consult an appropriate eye care professional to get the care they need for their specific eye or vision problem.