The Three O’s: What is the difference between an ophthalmologist, an optometrist and an optician?

Eye care professionals all work in concert with each other to help you maintain your eye health for a lifetime, but what is the difference between the three job titles? There is often confusion in the general public about what all of these people do, exactly. How does the scope of practice of an ophthalmologist and optometrist compare, and what do dispensing opticians do, anyway?

Ophthalmologists are medical doctors (MDs) with a specialty in diagnosing and treating eye health and disease. They are the specialists who do laser and intraocular lens surgeries, for example, and also help their patients monitor and treat eye conditions such as glaucoma and macular degeneration. If you have an accident involving a trauma to the eye or immediate surrounding area and go to the hospital, the doctor who will see you there will be the ophthalmologist “on call.” Also, if in the course of your routine eye examination by your regular optometrist your optometrist sees something during the exam that warrants further investigation by a specialist, this is the person they will refer you to. Ophthalmologists often have subspecialties in which they have extremely in-depth knowledge about a specific part or condition of the eye, such as the retina or cataracts. Eyes are complex!

Optometrists are doctors of optometry and their areas of expertise involve performing comprehensive eye examinations and prescribing corrective eyewear and certain medications. They are your first line of defence in maintaining eye health and preventing and managing eye disease. They have attended a minimum of three years of undergraduate education in the sciences (but often hold bachelor degrees) followed by a four or five-year university program in optometry to obtain a doctor of optometry (OD) title. An increasing number of optometrists are choosing to do an additional year of residency training upon completion of their optometry degree. Graduates are also required to satisfy provincial board requirements in the province or territory in which they intend to practice. Some optometrists also have more specialized areas of interest, such as vision therapy or low-vision rehabilitation, and they have undertaken additional study and training on these subjects. All optometrists are required to regularly attend continuing education sessions in order to stay on top of the latest research and developments in eye care.

Their scope of practice can vary slightly from one jurisdiction to another, but in B.C., these are the eye doctors you see on a routine basis to make sure your vision is optimal and your eyes are healthy. They are extensively trained in recognizing and diagnosing ocular manifestations of systemic conditions such as diabetes and high blood pressure and complications of the aging process like cataracts and macular degeneration, and will refer you to the appropriate specialist if they see any signs of these diseases or any other. They also work in conjunction with other health professionals to provide you with high-quality integrated eye-related care. And if you require glasses, they will also write you a prescription based on the results of the exam and in consultation with you about what your visual requirements are for your work and lifestyle.

A dispensing optician will take that prescription written by the doctor and fit you with glasses. After analyzing the prescription and reviewing any notes or comments from the doctor regarding your specific visual requirements, he or she will most likely go over with you how you intend to use the glasses to make sure that the frames and lens designs match up with your style and that you are getting what you need and want. Do you wear them all day for seeing at all distances, or just while you are reading or working at a desk, for example, and take them off and on a lot? Do you prefer to have separate pairs for specific tasks or maybe an extra set for emergencies, because you are the sort of person who likes to have a contingency plan? How about safety protection at your job or for your hobby, or are you especially concerned about sun or blue-light protection because of a family history of macular degeneration? Do you want to make a dramatic fashion statement, or are you more interested in functionality and comfort? Out of the several hundred frames you might see in the dispensary, a skilled optician can help you narrow down the options to a carefully-selected few that fit you properly, give you the look and feel you want, and are an appropriate size and shape for your face and for the type of lenses you need to put into them.

Once you have made your choices on the frames, the dispenser will take some very precise measurements of where your eyes are situated in each frame, and the lenses are designed around those measurements. This is where the dispenser’s expertise and knowledge about optics really pays off–you can have a perfectly good prescription from the doctor and can spend a fortune on the latest technology in lenses, but if the frame doesn’t fit well and the measurements aren’t done properly, the glasses simply will not work optimally, no matter how cutting-edge those lenses are! Once the glasses are made and checked to meet stringent standards, the optician will fine-tune the frame adjustment and make sure you are seeing well through the lenses, as well as keep those glasses cleaned, maintained and aligned whenever you come into the office to have them serviced. To learn how to do all of this, opticians undertake a course of study of either one year of full-time opticianry school (followed by another full year if they want to also fit contact lenses), or they can do a two-year apprenticeship under the supervision of a licensed optician while completing the theory portion of the course through a distance-learning program offered by a technical college such as NAIT. Students must then pass both a theory and practical exam to receive their license and must complete a required number of continuing education courses each year to maintain their standing with the B.C. College of Opticians, the provincial governing body for optical dispensers.

Although their scopes of practice are different, all of these skilled optical experts ultimately work as an eyecare team to help you look after your eye health and see to the best of your ability, whether you require glasses every waking moment, simply need a bi-yearly routine check-up but don’t wear prescription glasses at all, have a serious eye condition that requires frequent monitoring or urgent care, or just want a great looking pair of shades that will safely protect your eyeballs from the sun’s glare. We want you to live your life with happy eyes!