What is the difference between an Ophthalmologist and an Optometrist?
Many are confused about the difference between eye doctors. Aside from one being a little difficult to pronounce and the other being very difficult to pronounce, the differences pertain to level of training and scope of practice.
The short answer to the difference between ophthalmologists and optometrists:
Ophthalmologists are eye physicians and surgeons licensed without restriction by every state to treat all eye diseases. They complete a minimum 12 years of education and training with four years of college, four years of doctorate education in medical school (M.D.) or osteopathic medical school (D.O.), a one year medical or surgical internship, and three years of surgical residency specializing in the eye.
Optometrists are eye doctors licensed to primarily prescribe glasses and contact lenses, with limited ability to treat a broader range of eye conditions, varying by state. They complete 8 years of education and training that consists of four years of college and four years of optics doctorate education (O.D.) in optometry school. Recently, a small percentage of optometrists have begun to pursue one year residencies.
Scroll to the last sentence if that’s enough background information….but for those who crave more, the long answer correlates with a slice of American medical history.
Over 100 years ago our understanding of disease was narrower, treatment options were limited, medical training was shorter, and scope of the typical physician practice was broader. While physicians have always gravitated toward individual areas of interest, earlier generations did not formally partition organ system expertise into the separate specialties we do today. As the body of knowledge and research grew, support arose for a formalized professional group focused on treating the body above the shoulders. The American Academy of Ophthalmology and Otolaryngology (AAOO) was formed in 1896 to combine the medical interests and talents of physicians and surgeons who specialized in treating the eye, head and neck.1 Paralleling other facets of human endeavor during that time, medical research and knowledge exploded over the next 20 years and the AAOO began to administer specialty “board exams” to test and certify the competence of eye surgeons. Formed in 1917, the American Board of Ophthalmology (ABO) was the first medical specialty board in the United States, and certification by this board is still obtained by over 90% of modern ophthalmologists.2 Board certification is usually requisite for admitting privileges at hospitals and surgery centers in the United States. Ophthalmologists spend an additional year or two after residency completing a series of written and oral examinations for initial board certification.
In the optometry realm, advances in lens manufacturing and human optics fostered increased interest in optometric science, glasses, and contact lenses. The American Academy of Optometry was formed in 1922 and encouraged this interest.3
Over the years, increased understanding of the role general medical conditions such as diabetes, hypertension, and thyroid disease play in eye maladies, coupled with advances in antibiotic, steroid, hormone, and other pharmacologic agents have improved the ability of physicians to treat eye ailments. Expanding materials and engineering knowledge have dramatically improved treatment options eye surgeons can offer – from cataract surgery with lens implants, retinal detachment repair, glaucoma surgical procedures and transplantation of isolated portions of the cornea, to a plethora of laser treatments for a broad range of eye conditions. In 1979 the American Academy of Ophthalmology and Otolaryngology split into two separate societies. The American Academy of Ophthalmology (AAO) and the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) separated to better represent physicians and foster the extensive research and training required to practice their relative specialties. In the optometric arena, contact lens material technology and expansion of use fostered expansion of their practice in the 20th century. With goals of fostering education and providing legitimacy to expanding the optometry scope of practice, short one-year optometric residencies now exist. A Board of Optometry was created in 2009 to provide an avenue for optometry knowledge certification and about 4% of general practice optometrists complete the requirements.4
In recent years, access to health care in under-served and rural areas has become a hot button issue with a push to allow less trained mid-level practitioners such as physician assistants and nurse practitioners to expand their prescribing and treatment capabilities into realms previously reserved for highly trained physicians. With knowledge of the eye gleaned from optics-focused optometric training, optometrists have been lobbying, with success in some states, to expand their scope of practice beyond glasses and contact lenses to include limited medical, and in a handful of states, even surgical eye care.
Ultimately, the difference between eye doctors is their training and licensed scope of practice. Ophthalmologists are medical doctors trained to medically and surgically treat the entire body before spending additional years specializing in ocular medicine and surgery – a minimum of 17,280 hours of clinical experience directly taking care of patients, frequently in life- or vision-threatening scenarios.5 Internship and residency training is so demanding that, in July 2003 (the month after I completed my training), the Accreditation Council for Graduate Medical Education instituted work limits of 80 hrs/week on young doctors participating in accredited programs. In recognition of how difficult it can be to acquire adequate patient care experience in four years with only 80 hrs/week training, some residency programs are allowed to apply to have the weekly limit increased to 88 hours.6 The typical optometrist is an optometric doctor with about 10% of the direct patient clinical training time of an ophthalmologist. In an attempt to narrow the gulf in level of training, a minority of new optometry graduates have been participating in new one-year optometry residency programs.7,8
At this point you might be saying, “That’s interesting, but as a patient, what kind of eye doctor should I see?”
Optometrists are great for glasses and screening vision exams, but you’ll want to see an ophthalmologist for eye issues that might require medicine, laser, or surgery.
Shaun Brierly, MD
Copper Eye Surgery
1 Incollingo J. A Brief History of the American Academy of Ophthalmology. Cataract & Refractive Surgery Today. September 2010. https://crstoday.com/articles/2010-sep/a-brief-history-of-the-american-academy-of-ophthalmology/ Accessed November 12, 2020
2 Board History. American Board of Ophthalmology. https://abop.org/about/board-history/ Accessed November 12, 2020
3 What is the Academy? American Academy of Optometry. https://www.aaopt.org/home/about/what-is-the-academy Accessed November 12, 2020
4 Background information – Article 19 – Maintenance of Certification (MOC). American Board of Certification in Medical Optometry. https://abcmo.org/tag/board-certification/#:~:text=About%204%25%20and%20less%20than,additional%20CE%20in%20general%20practice Accessed November 12, 2020
5 Differences in Education Between Optometrists and Ophthalmologists. Policy Statement. American Academy of Ophthalmology. May 2011. https://www.aao.org/about/policies/differences-education-optometrists-ophthalmologists Accessed November 12, 2020
6 Report of the Work Group on Resident Duty Hours and the Learning Environment, June 11, 2002. Accreditation Council for Graduate Medical Education, https://www.acgme.org/Portals/0/PFAssets/PublicationsPapers/dh_dutyhoursummary2003-04.pdf Accessed November 12, 2020
7 Annual Student Data Report, Academic Year 2019-2020. Association of Schools and Colleges of Optometry. https://optometriceducation.org/wp-content/uploads/2019/11/ASCO-Student-Data-Report-2018-19-updated-11-18-19.pdf Accessed November 12, 2020
8 ORMatch Statistics. National Matching Services Inc. Association of Schools and Colleges of Optometry. https://natmatch.com/ormatch/statistics.html Accessed November 12, 2020