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April 27, 2003


Question from College Station, Texas, USA:

I recently changed insurance coverage and need to choose a new eye care professional. Do you recommend an optometrist or an ophthalmologist? What is the difference exactly? Which will be better for me in the long run?


You may need someone who has experience with laser therapy for diabetic retinopathy. Usually this is an ophthalmologist. There are some excellent optometrists who can also check the retina. You should discuss this with your diabetes team and see what they recommend for you. If you want to decide on your own, the key questions to ask are:

Do you do laser therapy for diabetes retinopathy?
If so, how often do you do such therapy?

If the answer is positive and you have an experienced ophthalmologist, then you can usually feel safe that this is the proper specialist. Ophthalmologists are medical doctors and eye surgeons. Optometrists prescribe glasses and can do checks for glaucoma, contact lenses and often do examinations quite nicely., but optometrists cannot operate or use the laser. Opticians just check prescriptions and fit glasses/lenses.

Additional comments from Dr. Charles Garcia:

With many insurance plans you may not have a choice. Some plans use only ophthalmologists while others may use both where the optometrist is your first point of contact to screen for eye disease, and if detected, he/she will refer you to an ophthalmologist for secondary care. These plans typically limit optometrist from practicing fully under their license while other plans allow optometrist to provide full scope primary care and referral to ophthalmology when secondary and tertiary care is needed.

I am assuming that you have diabetes although you did not say in your e-mail. If you have diabetes, the standard of care is to have a dilated eye exam at least once a year. If you see a therapeutic optometrist and he dilates your eyes and discusses his findings and the risks of diabetes with you, you are being well cared for, and in the long run, it should make no difference which provider type you see. The optometrist is trained to detect at which point in the history of diabetic eye disease that surgical intervention by an ophthalmologist is medically indicated and will refer you at such time.

The simple difference between the two is an ophthalmologist is a medically trained surgeon and an optometrist is not. To have routine annual eye exams by a surgeon is not the most cost effective health care for you and the least efficient use of the surgeon’s time. The examination by either is the same and your concerns about preventive care should be discussed with your optometrist.