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Who Do You Need to See? An Optometrist, Optician, or Ophthalmologist

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An explanation of the roles and responsibilities of eye care professionals, and what to expect when you have an appointment.

Sometimes, in the world of health care, there are so many different classifications, roles, specializations, and so many unpronounceable titles, that it can become rather confusing for the average layman to sort through it all.  Take eye care, for example.  There exists three separate fields of care within the general umbrella of Eye Care.  These are Optometry, Opticianry, and Ophthalmology.  Have you ever wondered who does what, exactly?  Is there any crossover between the different fields?  And, most importantly, who do you need to see?

To help you sort this out, I will describe the roles and responsibility of, and what to expect when you visit, each of these three:  Optometrists, Opticians, and Ophthalmologists.   To begin, I present you with a fictitious patient named Mr. White...

Mr. White is 47 years old and has had perfect eyesight all of his life.  In fact, he can't even remember when (or if) he's seen an eye doctor.  But for some time now, he's been noticing words are a little blurry when he's reading the newspaper, or the menu at a dimly-lit restaurant.  And, he's also noticing that he has trouble driving at night because there seems to be halos around all the lights, and it is especially problematic with oncoming vehicles.

So, Mr. White decides to try out a pair of drugstore reading glasses, and this does seem to help with the reading.  He continues on, getting by for a few more months, but the night vision problem is very bothersome.  Mr. White then decides its about time he should see the doctor, or at least get some better glasses.  Who should he call first?

An Optometrist:  An Optometrist holds the title Doctor, and although she/he is a doctor of Optometry, she/he is not a medical doctor. Optometrists attend University for a minimum of seven years, so they are very educated and knowledgeable in their field, and are considered to be the Primary Care Provider for eye health and vision concerns.  You do not need a referral from a medical doctor to see the Optometrist. The Optometrist is the one who will examine your eyes to determine vision problems and prescribe corrective lenses, if needed.  They also screen for eye diseases, such as glaucoma, cataracts, macular degeneration, etc., and if they see a potential problem, they will refer the patient to a specialist.  (See my related article for 5 important reasons to have an eye examination.)

So, back to our patient, Mr. White, who gets an appointment with an Optometrist.  At the Optometrist's office, he is greeted by an assistant, who takes him through a series of preliminary tests before he sees the doctor.  He sits at an instrument, called an autorefractor-keratometer, and stares at a picture of a hot air balloon that seems to go in and out of focus (this is to get a base line reading for his prescription, which is later fine-tuned by the Optometrist). Next test, he looks into a monitor with little flashing lights and presses a button each time he sees a light (this is a visual field screening, which tests the peripheral and central vision of the eyes individually.)  This is followed by the infamous "air puff" (which is an unobtrusive --though sometimes disliked-- method of measuring the intraocular pressure), which startles our patient at first, but then makes him chuckle when it's all over, because it actually just tickled!  Then it's off to the digital imaging, where Mr. White gets to open wide so the assistant can get a great picture of his retina.  No blinking for a second!  Finally, our patient is taken into an examination room where the assistant asks some questions regarding his reason for coming to see the Optometrist, some medical history, family eye history, medications, etc.  The assistant leaves the room and the Optometrist enters, and continues the examination. 

The Optometrist looks in Mr. White's eyes with a bright light, then puts a strange contraption which looks like gigantic glasses (but is called a phoropter), in front of him and asks him to look at the letter chart on the wall.  A few clicking sounds later (as the doctor changes the lenses in the phoropter), some more questions... does this look sharper?...or does this? ...and the Optometrist arrives upon the final prescriptive lenses needed so that Mr. White can finally see!  This process is called refraction (your eyes perform their own refraction, but sometime need the aid of glasses of contact lenses).  During the refraction and examination, when the doctor was looking into his patient's eyes, he saw the beginning of a cataract, which was worse in one eye than the other. This will need further evaluation by a cataract specialist, who is a local Ophthalmologist, for which a referral will be needed.  Before Mr. White leaves the examination room, he is given a written prescription for a new pair of glasses, a sample of some eye drops to help with the dryness he's been experiencing, and he is assured that he will be notified of the day and time of his appointment with the Ophthalmologist.  Following all this, as the two of them walk out into the reception area, Mr. White is introduced to...

An Optician.  The optician is a certified professional who grinds lenses and fits glasses (but cannot prescribe lenses).  She looks at Mr. White's prescription and reads that the doctor has recommended progressive lenses so that he can see better in the distance, and yet also read well at the same time.  She helps him with the selection of an appropriate frame, taking into consideration such things as the power of the prescription, his pupillary distance (the distance from the center of one pupil to the center of the other pupil), width and shape of his head, and his own preference of style.  After a frame is chosen and adjusted for a perfect fit, some measurements are are taken, recorded, and marked on the temporary lenses in the frame, to be sure the corrective lenses are going to work as they should after they are ground and fit into the frame.  In a few days, Mr. White will have his new glasses.

Shortly after his visit to the Optometrist and Optician, Mr. White is apprised of his appointment time with the specialist.  He is instructed that his eyes will be dilated there, so he will not be able to drive after the appointment.  When the appointment time arrives, he is off to see the specialist who will have a closer look at the cataracts that are developing.  The specialist is...

An Ophthalmologist.  An Ophthalmologist (correctly pronounced off-thuhl-mol-uh-jist, but more commonly pronounced op-thuhl-mol-uh-jist) is a medical doctor who has chosen his specialty in eye health and eye diseases.  There are retinal specialists, glaucoma specialists, and cataract specialists; there are specialists who deal specifically with macular degeneration (although that lies within the scope of a retinal specialist); then there are corneal specialists, and then those who do LASIK procedures; in fact there are so many different eye specialists, I won't be able to list them all here for fear of missing some.  Ophthalmologists provide ongoing care and treatment, including surgery and prescribing special eye drops, for patients with some form of eye disease or condition.  You will need a referral from a general practitioner (family doctor) or an Optometrist to see the Ophthalmologist, and because they are often not that plentiful, there is usually a waiting period to get in to see them, as they are booked up for several months in advance.  Of course in the case of an emergency, you would be referred to the On-Call Ophthalmologist.

Back to our patient, Mr. White, who arrives for his specialist's appointment.  Here, he experiences some of the same preliminary testing, and some different procedures, conducted by a certified technician.  Mydriatic eye drops are instilled in both eyes, which will soon cause his pupils to dilate.  Once his pupils are fully dilated, the Ophthalmologist examines the interior and back of his eyes with a slit lamp, looking at all the various structures of the eye, including his natural lenses.  It is indeed determined that Mr. White has the beginning of cataracts, but he will not require surgery just yet.  Before he leaves, he is given a follow up appointment for six months later, where the cataracts will be re-evaluated at that time.

Hopefully, this account of the specific roles and responsibilites* of Optometrists, Opticians, and Ophthalmologists will give you a better understanding of who you may need to see, and why.  If nothing else, you'll now know how to prounounce Ophthalmologist!

*(Note:  These roles and responsibilities are according to Canadian standards, and may not apply to other countries.)

Sources are from the following texts:

 The Ophthalmic Assistant, 8th Edition; Stein, Stein, and Freeman, 2006

The Language of Medicine, 7th Edition; Davi-Ellen Chabner, 2004

Photo credit Stock.xchng

11 comments

Troy Jefferson
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Posted on Apr 23, 2015
Troy Jefferson
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Sharla Smith
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Posted on May 31, 2010
Karina Miranda
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Sharla Smith
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Michelle Dale
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Sharla Smith
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Sharla Smith
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Sharla Smith

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