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Ophthalmology

ophthalmologists performing eye surgery

Ophthalmology is a medical field that covers the diagnosis, management and treatment of eye and vision disorders. Ophthalmology includes surgery and has a more medical nature than optometry.

A medical doctor who practices ophthalmology is called an ophthalmologist. They carry the title MD (doctor of medicine) or DO (doctor of osteopathy). An ophthalmologist can perform surgeries and treat more medically complex conditions than a doctor of optometry (optometrist).

The American Academy of Ophthalmology (AAO) is the field’s leading organization in the United States. In 2015, there were about 19,000 practicing ophthalmologists in America, according to the AAO.

What ophthalmology covers

A doctor in the field of ophthalmology is capable of diagnosing — and often treating — almost every known eye or vision disorder. A handful of conditions are more common than others:

  • Cataracts: A clouding of the eye’s natural lens, located behind the pupil. Cataracts are usually a result of aging and can require surgical removal and lens replacement to restore vision.

  • Glaucoma: Optic nerve damage caused by elevated pressure inside the eye. Glaucoma, especially when it’s diagnosed early, can be manageable using one or more treatment methods.

  • Diabetic retinopathy: Retinal damage caused by diabetes. Diabetic retinopathy can cause permanent vision loss if left untreated and/or if diabetes is poorly managed.

  • Macular degeneration: Gradual damage caused to the part of the retina responsible for central vision (the macula). Macular degeneration management usually involves slowing the progression of the disease.

  • Dry eye: A problem with how the eyes are lubricated with natural tears and oils. Ophthalmology includes additional treatment options for more severe cases of dry eye syndrome.

  • Strabismus: A misalignment of the eyes. “Crossed eyes” is one type of strabismus (when one eye points inward), but the misaligned eye can also point upward, downward or outward.

  • Amblyopia: A problem with eye positioning usually known as lazy eye. Amblyopia typically develops during childhood and may be referred to a pediatric ophthalmologist.

  • Uveitis: An inflammation of the eye’s middle layer (the uvea). There are multiple forms of uveitis and many cases are chronic, requiring long-term treatment.

  • Tumors and cancers of the eye: Benign or malignant growths in and around the eye. Like similar problems in other parts of the body, different types of eye cancers and tumors can come with different levels of severity.

  • Refractive error: Common problems such as nearsightedness, farsightedness, astigmatism and presbyopia. They are often associated with optometrists, but ophthalmologists can diagnose and treat them too.

Ophthalmologists can spot the signs of certain whole-body conditions based on what they observe during an exam. When a seemingly unrelated disease shows signs in or around the eyes, it’s called an ocular manifestation.

An ophthalmologist may still be able to alleviate some symptoms, but the disease itself will still need to be treated by a non-ophthalmic doctor. In turn, this can help any vision- or eye-related effects.

Conditions that can have ocular manifestations include:

  • Diabetes

  • High blood pressure

  • Arteriosclerosis

  • High cholesterol

  • Some cancers

  • HIV

  • COVID-19

  • Multiple sclerosis

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Ophthalmology services and procedures

Most patients schedule an ophthalmology appointment when they notice visual or eye-related symptoms, need help managing an eye problem, or have a risk factor or pre-existing condition that makes them more susceptible to eye disease. Other times, a patient is referred when another doctor thinks an ophthalmologist is better equipped to manage their condition.

Both ophthalmologists and optometrists are qualified to provide routine eye exams and vision prescriptions. However, most patients choose to visit an optometrist for these services, since they tend to be more accessible and affordable.

In addition to others, the following procedures are classified under ophthalmology:

  • Cataract removal surgery: A procedure that restores clear vision for someone with cataracts. During surgery, an ophthalmologist will remove the original, clouded lens and replace it with an artificial one.

  • Laser surgery: Corrective vision procedures such as LASIK, LASEK and PRK are common surgeries that offer a permanent alternative to eyeglasses and contact lenses.

  • Glaucoma treatment: Eye drops, oral medication and surgery can all be used to reduce internal eye pressure. An ophthalmologist will use several factors to determine which option(s) is best for the patient.

  • Retinal surgery: Most surgeries that involve the retina are performed by a retinal specialist.

  • Strabismus correction: Surgery is recommended for most cases of strabismus. However, non-surgical options may be possible for more mild cases.

  • Amblyopia treatment: Several treatments are available for lazy eye, but corrective lenses and/or an eye patch are often among the first steps. Surgery may be recommended for amblyopia caused by strabismus.

  • Corrective lens prescription: Corrective lenses and routine eye exams may be associated with optometry, but ophthalmologists can also provide these products and services.

Ophthalmology and optometry sometimes work together to provide long-term care for patients with chronic eye disease, or those who are recovering from an eye-related surgery. This is known as co-management.

Ophthalmology specialists

Like other fields of medicine, ophthalmology can be segmented into specific areas of care. Since ophthalmology can itself be considered a specialty, additional areas of focus are sometimes called subspecialties.

A patient is usually referred to a specialist by a general ophthalmologist, optometrist or other medical professional.

More commonly referred specialists include:

Retina specialist

A retina specialist specializes in disorders that affect the retina, the thin layer of light-sensitive cells in the back of the eye. Many diseases or injuries that affect the retina can lead to vision loss if left untreated.

If an ophthalmologist suspects or diagnoses a condition such as diabetic retinopathy, macular degeneration or retinal detachment, they may refer their patient to one of these doctors.

Neuro-ophthalmologist

Neuro-ophthalmologists focus on patients who have eye or vision problems as the result of a brain or neurological issue. A doctor needs to be certified in ophthalmology and neurology to practice in this specialty.

Doctors often refer their patients to a neuro-ophthalmologist when they think an ocular symptom(s) could be connected to the nervous system in some way.

Pediatric ophthalmologist

A pediatric ophthalmologist specializes in the visual and eye health of children.

The diagnosis and treatment of conditions such as amblyopia, strabismus, ptosis and refractive error can be a little different when they occur in children. Not only is a pediatric ophthalmologist highly trained in examining children’s eyes, they are more skilled at modifying treatment plans to fit the needs of the individual child.

Oculoplastic surgeon

While some oculoplastic surgeons do offer cosmetic procedures, those aren’t the main focus of this type of practice. Oculoplastic specialists also perform plastic and reconstructive surgery on the area surrounding the eyes, including the eyelids, orbital bones and tear ducts.

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Studying and practicing ophthalmology

It takes about 12 years for someone studying ophthalmology to become a practicing ophthalmologist — about four years longer than it takes the average optometrist to be certified in their field. An ophthalmologist’s additional training is mostly due to their ability to perform surgery.

To practice ophthalmology, someone will need to:

  • Complete a four-year undergraduate program (bachelor’s degree)

  • Complete a four-year medical program (doctorate degree)

  • Complete a one-year internship

  • Complete a three-year residency

  • Pass any applicable board exams

Timeframes can vary based on school, specialty or intended use of the degree. For example, someone will spend at least one more year training to become a neuro-ophthalmologist.

Ophthalmology isn’t only practiced in a doctor’s office; it can be practiced and utilized in many different settings:

  • Private practice (one doctor who operates their own office)

  • Group practice (multiple eye doctors who practice in the same office)

  • Hospital

  • Military

  • University

  • Corporate

  • Research

When to see an ophthalmologist

An ophthalmologist has all the necessary training and tools to diagnose, manage and treat almost any eye condition.

If you experience eye pain, changes in vision, or any other eye- or vision-related symptoms, schedule an exam with an eye doctor.

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