What are the differences between an optometrist and an ophthalmologist?
Optometrists and Ophthalmologists are two distinct groups of health professionals delivering eye and vision healthcare in Australia. Their training and skills are very different; however their care is best delivered when the two professions work together in harmony. Optometrists provide primary eye healthcare, glasses and contact lenses, and screen for serious eye and vision conditions. They refer such problems to the Ophthalmologist who can manage serious eye problems with medicines and/or surgery.
Optometrists provide primary health care; they are the first professional to be seen when people have problems with their vision or eyes. As people can visit Optometrists without a referral and still access Medicare benefits, Optometrists provide accessible and important first-line eye care to the community.
When you visit an Optometrist, they will ask about your vision, any eye problems, past eye health history and perform a series of vision tests – checking reading or distance (with a Snellen chart of diminishing sized letters) and perhaps trying different powered lenses before your eyes to see if spectacles are needed. There are other tests of eyes or vision the Optometrist may need to do.
Optometrists prescribe spectacles, reading glasses and contact lenses, as well as visual aid devices for the visually impaired. They diagnose and manage common eye conditions such as dry eyes, short-sightedness or reading difficulties. In addition they provide comprehensive eye health checks, assessing for serious conditions such as glaucoma or macular degeneration. They are well trained to know when to refer such eye conditions to a medical specialist Ophthalmologist. They also participate in screening for important diseases of the body, such as diabetes, which can affect the eyes. The information they provide to the treating GP or endocrinologist is extremely helpful.
Practising optometrists have undertaken a university degree in optometry and are registered with the Optometry Board of Australia.
Ophthalmologists are physicians and often surgeons, who have trained as a medical doctor specialising in eye health and vision, managing all diseases of the eye. They have studied medicine at university and have then trained as a medical specialist through the Royal Australian and New Zealand College of Ophthalmology.
Ophthalmologists diagnose, monitor and treat all eye conditions, although many have subspecialist skills in a particular field. A/Prof Simon Skalicky is a subspecialist Ophthalmologist in Melbourne who is a glaucoma specialist and performs cataract surgery in Melbourne.
To see an Ophthalmologist you require a valid referral from a General Practitioner (GP), Optometrist or medical specialist. On the day of the Ophthalmologist appointment you will likely need to initially see an Orthoptist first, who will ask basic questions about your past eye health and current eye or vision problems, and who may perform a series of vision tests. (An Orthoptist is a trained allied health professional with a University degree in Orthoptics, who work closely in conjunction with an Ophthalmologist). You may need to have similar vision tests to what was performed by the Optometrist, and some extra ones as well. When you see the Ophthalmologist, he/she will examine your eyes with a moving microscope to diagnose any eye diseases, and will discuss the management and treatment of these. You should feel comfortable talking to the Ophthalmologist and feel free to ask whatever question you think relevant. A good Ophthalmologist will be knowledgeable and skilled, will take the time to get to know their patients, explain the eye condition in clear, understandable terms, and be warm and gentle in their approach.
Figure 1. Ophthalmologist (A/Prof Simon Skalicky) examining the eyes with a movable microscope
Figure 2. Visual field test performed at Ophthalmologist practice
Figure 3 OCT scan of macula and optic nerve. Performed at Ophthalmologist practice to diagnose and monitor common eye conditions
Ophthalmologists are extensively trained and have to pass rigorous examinations to get into medical school, through medical school, into the highly competitive Ophthalmology training program, and then to complete the program. They often undertake additional research and university degrees to complement their clinical knowledge. (A/Prof Skalicky has undertaken 2 Masters degrees and a PhD in addition to the RANZCO Ophthalmology training program). If the Ophthalmologist is a surgical specialist they need to complete many hours of rigorous surgical training. Many subsequently chose to perform an overseas fellowship to refine surgical skills in a particular area. This is important to become a true leader in one’s field. For instance, A/Prof Skalicky spent one year at Cambridge, UK at the prestigious Addenbrooke’s hospital refining his skills in glaucoma and cataract surgery.
Collaboration between optometry and ophthalmology is becoming integral to provide best service delivery for eye and vision healthcare. In modern health delivery a team approach leads to best outcomes. The two professions have different but complementary skills. Patients and the general public are best serviced when the two work together, support each other and communicate well with each other, with other health-providers (such as the GP) and with their patients.