Choosing an Eye Doctor

By Gary Heiting, OD

Choosing an eye doctor is an important health care decision. After all, you will be trusting your eye doctor to safeguard your precious sense of sight and help you maintain a lifetime of good vision.

The first step in your decision is to understand that there are two types of eye doctors: optometrists and ophthalmologists. It's also helpful to understand the third "O" in eye care: opticians.

What Is an Optometrist?

An optometrist is an eye doctor who has earned the Doctor of Optometry (OD) degree. Optometrists examine eyes for both vision and health problems, and correct refractive errors by prescribing eyeglasses and contact lenses. Some optometrists also provide low vision care and vision therapy.

In all 50 states, optometrists also are licensed to prescribe medications to treat certain eye problems and diseases. This is a relatively recent expansion of the role of optometrists in many states.

Optometrists also may participate in your pre- and postoperative care if you have eye surgery. The scope of medical care provided by an individual optometrist is limited by state law and the discretion of that particular eye doctor.

An optometrist generally must complete a four-year college degree program in the sciences, plus four years of post-graduate training in optometry school. Thus, the educational requirements of an optometrist are equivalent to those of a dentist.

What Is an Ophthalmologist?

An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO) who specializes in eye and vision care. Ophthalmologists are trained to perform eye exams, diagnose and treat disease, prescribe medications and perform eye surgery. They also write prescriptions for eyeglasses and contact lenses.

Ophthalmologists generally complete four years of college, four years of medical school, one year of internship, and a minimum of three years of hospital-based residency in ophthalmology.

So (to extend the analogy with dentistry), whereas the education of an optometrist is similar to that of a general dentist, the education and training of an ophthalmologist are more similar to that of an oral surgeon.

What Is an Optician?

An optician is not an eye doctor, but opticians are an important part of your eye care team. Opticians use prescriptions written by an optometrist or an ophthalmologist to fit and sell eyeglasses, contact lenses and other eyewear.

In some states, opticians must complete an opticianry training program and be licensed. Other states don't require opticians to obtain formal training or licensure. Some states also allow opticians to fit contact lenses, usually after completing a certification program.

Which Eye Doctor Should I See: An Optometrist or an Ophthalmologist?

If your eyes are healthy and don't require special medical treatment, the type of eye doctor you choose for a routine eye exam is a matter of personal preference.

Both optometrists and ophthalmologists examine eyes and prescribe eyeglasses and contact lenses. (Photo: American Academy of Ophthalmology)

Optometrists and ophthalmologists both perform routine eye exams and both types of eye doctors are trained to detect and diagnose eye diseases that require medical treatment.

If you already have a medical eye problem — such as glaucoma, macular degeneration or cataracts — it is important to seek care from an eye doctor who is highly skilled in monitoring and treating your condition. In many cases, this may mean that medical or surgical eye care by an ophthalmologist is in order. In such cases, your optometrist (or general ophthalmologist) may refer you to an ophthalmologist who is a specialist in treating your condition.

Many optometrists are capable of medically treating common eye problems (such as dry eyes and eye infections) and certain chronic eye diseases (such as glaucoma) without the assistance of an ophthalmologist. But only ophthalmologists can provide the entire scope of treatment options, including eye surgery, for complex eye diseases.

Another option for the care of chronic eye health problems is called co-management. In co-management, your primary care eye doctor (usually an optometrist) refers you to a specialist (usually an ophthalmologist) for a definitive diagnosis and treatment plan for your eye problem. The ophthalmologist may choose to manage the problem medically or perform eye surgery or both. After the condition is controlled or surgically treated, the specialist then sends you back to your primary care eye doctor, who continues to monitor and treat your condition or perform your post-operative care based on the specialist's recommendations.

Co-management is a particularly good solution if you are very pleased with the quality of eye care you are receiving from your primary care eye doctor, but you want to have any specific medical eye conditions treated by an experienced specialist.

Vision Insurance and Your Choice of Eye Doctor

If you have vision insurance or a health insurance policy that covers eye care, one factor in choosing an eye doctor is determining if he or she is an authorized provider under your insurance plan, and what your out-of-pocket expense will be for the exam.

Ophthalmologists are medical eye doctors who are licensed to perform eye surgery.

Typically you can get this information by calling the doctor's office and giving them your insurance information. Many insurance companies also post a directory of eye doctors who accept their plans on their websites.

Most optometrists and ophthalmologists who provide general eye care for the entire family accept Medicare for older patients. But be aware that while Medicare covers your visits to an eye doctor for medically necessary eye care, it does not cover routine eye exams.

If you have Medicare coverage and are just getting a routine eye exam to have your eyes checked and your glasses prescription updated, payment for the exam will be your responsibility unless you also have a private vision insurance policy that covers routine exams. But if you are eligible for Medicare and you have a pre-existing eye problem such as cataracts or macular degeneration, part of your comprehensive eye exam may be covered. Ask your eye doctor for details.

Also, when calling an eye doctor's office, ask how they handle insurance claims. Will you have to pay for the exam and then submit the claim to your insurance company yourself, or will the eye doctor's office bill your insurance company for the exam so no payment is required of you?

If you don't have an insurance policy that covers eye care, find out the eye doctor's fee for a routine exam and for any special testing that may be required. While you don't want to base your decision on which eye doctor to see based on cost alone, it still is a factor to consider.

Other Factors When Choosing an Eye Doctor

When inquiring about the services an eye doctor provides, ask how they handle situations when a problem is detected that requires treatment beyond the doctor's scope of care. Do they have an association with medical and surgical specialists? Who are these specialists, and where are they located?

Finally, a major factor you should consider when choosing an eye doctor is the recommendation of that doctor by friends, family members or coworkers. Word-of-mouth referrals often are the best way to find a friendly, competent and caring eye doctor and to avoid unpleasant surprises when you go to have your eyes examined.

[Page updated November 2009]