Optometrist? Ophthalmologist?
Who To See To See More Clearly

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

One of my most memorable patients was a gentleman with an artificial eye. He had recently turned forty and had come in for a routine physical examination. On his health history questionnaire he stated that he had had a traumatic eye injury. I asked him to tell me about it.

“At my old job, there was an explosion. I got some chemicals and stuff in my eye and it got all messed up. They had to replace it. Wanna see?”

Before I could respond, he popped out his right eyeball. I totally freaked!!!!! “Put that back!” I shrieked. He simply chuckled and popped the prosthesis back into place. Regaining my composure, we continued with the examination, but I’ll never forget that pink hole in his head. I’m also sorry that my shock prevented me from taking a closer look in that empty socket. Another golden opportunity gone by....

As I approach my fortieth birthday, I recognize that I too should have my eyes checked. I haven’t had an eye examination in about fifteen years, and thankfully, I haven’t had any vision problems. I know a baseline assessment is necessary because after age forty certain vision problems become more prevalent. How thorough a vision screening do I need? Who should I see, an optometrist or an ophthalmologist?

I made a few inquiries and sent out e-mail to a business group to which I belong. One of the members replied that an optometrist, Parisa Lamei, OD was willing to speak with me and would answer my questions, so I gave her a call.

In response to my initial question, Lamei replied, “You should have an initial, comprehensive exam, including pupil dilation to examine the retina. Then you should have regular eye and vision exams every one to one and a half years.”

Lamei said optometrists evaluate visual acuity, depth and color perception, and the eyes’ ability to focus-individually and together. They diagnose and treat a variety of vision problems, eye allergies and infections. They also examine the retina (the back of the eye) for diseases or defects. Optometrists are skilled vision specialists trained in rigorous optometry programs, and are licensed by the states in which they practice.

Lamei said that ophthalmologists are physicians who have completed medical school and residency programs specializing in eye diseases and injuries. They monitor and treat the symptoms and problems that arise as a result of chronic diseases, illnesses and injuries, and perform surgery when necessary. While many ophthalmologists perform vision exams and prescribe corrective lenses, most focus on treating the more serious eye diseases and injuries requiring advanced skills. (I wonder if my old patient follows up with an ophthalmologist to have his eye prosthesis checked?)

“What types of eye problems become more prevalent as we age?” I asked.

“Presbyopia or farsightedness, is probably the most common problem we encounter in the aging population,” said Lamei. “Aging eyes can also show signs of diabetes, hypertension, vascular changes associated with years of smoking and retinal changes from years of sun exposure. The risk of developing glaucoma (increased fluid pressure within the eye that can lead to blindness), cataracts (lens thickening and opacity leading to blindness) and macular degeneration (damage to the macula, the central part of the retina responsible for central vision sharpness) increases with age.”

Lamei added that optometrists and ophthalmologists work together to treat many eye problems. “I may detect a problem and refer a patient to an ophthalmologist. After the diagnosis is confirmed and treatment is initiated, the ophthalmologist will often send the patient back to me for further vision care and follow up. In many large eye care centers, optometrists and ophthalmologists practice in the same office, making it easier for patients to receive the treatments they need.”

Optometrists specialize in fitting individuals for glasses and contact lenses, and vision therapy. They work to fine tune a patient’s corrective lens prescription, making adjustments until the patient leaves with the best possible corrected vision. They offer many non-invasive options for vision therapy such as bifocal contact lenses and lenses that will correct astigmatism in children.

“With all of the laser surgeries and other advanced technologies could optometry become obsolete?”

“Not at all because not all laser surgeries or new treatments can correct vision problems one hundred percent in all patients,” Lamei said. “Some people will have laser surgery and still require reading glasses or glasses to drive. Some people are not candidates for certain treatments, and still others simply prefer to wear glasses and not have invasive procedures performed on their eyes. Optometry allows people the choice.”

So what will it take for us to be more diligent about our health? For some, it will be an injury or more traumatically, a loss of function. With regard to vision, I have been as blasé as the next person. Speaking with Dr. Lamei and remembering my former patient have given me a clearer view of the gift that I have. Rest assured it won’t be another fifteen years before I have my eyes examined. What about you?

Darline Turner-Lee is busily scheduling her eye appointment. Any suggestions are welcome