Here’s the quick answer: ophthalmologists are eye surgeons who complete medical school, earn an MD degree, complete an ophthalmology residency and specialize in treating eye diseases and performing eye surgery. Optometrists are family eye doctors who complete optometry school, earn an OD degree, and specialize in primary eye care; treating vision defects with glasses and contacts and treating and managing eye diseases.
Now, let’s dive in for a longer answer.
A Touchy Subject
We’ll start off by disclaiming that this can be a very polarizing topic. Here’s why.
40 years ago, Ophthalmology and Optometry were two very different professions. Ophthalmology was focused on the medical and surgical aspects of eye care, while optometry was almost completely focused on prescribing glasses and contacts. But over the past four decades the scope of optometry and optometric education has expanded significantly. Today, many optometrists are well-qualified to treat and manage a wide range of eye diseases.
As you might imagine, this has caused some bickering between representatives of the two professions. Optometric associations typically push for an expanded medical role for the profession of optometry, while ophthalmic associations typically push back to protect the traditional scope of practice for ophthalmology.
There are good, valid arguments for both sides, and also times when both sides of those arguments are overzealous in their cause. So let’s try and get away from polarized arguments, and focus on actual facts.
Typically, both optometrists and ophthalmologists complete a 4-year college degree before entering their professional programs. There are some programs that might make exceptions, but they’re the exception, not the rule.
Both MD and OD schools typically require the completion of core undergrad science courses, like chemistry, biology and organic chemistry. But, it’s entirely possible to choose an unrelated major. Dr. Hoehn, for example, chose a piano performance major in her undergrad education, while Dr. Sweeney chose a (perhaps more sensible) degree in general science.
From there, Ophthalmologists enter medical school, while optometrists enter optometry school. Altogether, going from a college degree to being a practicing optometrist typically takes between 4 and 5 years, while going from a college degree to being a practicing ophthalmologist typically takes between 8-10 years.
Optometry school is designed to produce eye doctors that are more-or-less ready to start seeing patients the day they graduate. With that goal in mind, optometry students begin their optical education on day one of their first year. The first three years of optometry school are typically a mix of biological and visual science education in the classroom and laboratory, and progressive involvement in clinical eye care. The fourth year of most optometry programs is entirely clinical, with 4th year OD students seeing their own patients under the supervision of their professors.
When they graduate, optometrists are eligible to be become licensed ODs immediately, though today many graduates go through one or more internships (which typically last a month or two), or a residency, which is typically one year long. These programs offer real-world experience and training in a specific area of practice, like low vision rehabilitation, or ocular disease.
For the first four years of their medical education, ophthalmologists receive the exact same training that cardiologists, orthopedic surgeons, general practitioners and physicians going into every other medical specialty receive. It’s not until the 3rd and 4th years of medical school that students even select the specialty they plan to pursue.
After graduating from medical school, all physicians are required to complete a one-year internship before becoming a licensed MD. Many ophthalmologists choose internal medicine or transitional internships that let them experience a broad range of patient care.
After completing an internship, the next step is to start a 3-year ophthalmology residency. This is where ophthalmologists receive their training that’s specific to the eyes. During their program, ophthalmology residents receive hands on training in the medical and surgical aspects of their profession. They start out working closely with more experienced ophthalmologists at the beginning of their program, and by the end of their program they’re essentially practicing independently under the supervision of their attending physicians.
After successfully completing their residency, ophthalmologists can either begin practicing right away, or pursue a fellowship in a sub-specialty like retina, cornea or pediatric ophthalmology. Ophthalmology fellowships are 1-2 years long.
Expertise & Scope of Practice
When we say “scope of practice”, we mean “what is that profession allowed to do by law.” In most of the country, the clearest difference between an optometrist’s and an ophthalmologist’s scope of practice is that ophthalmologists are licensed to perform eye surgery, and optometrists are not.
The exception to that rule are three states, Oklahoma, Kentucky and Louisiana, where laws have been passed that allow optometrists to perform specific types of laser eye surgery.
There are some finer-grained differences in terms of what particular classes of medications optometrists are allowed to prescribe. Here’s a great infographic that goes into more detail. All 50 states allow ODs to prescribe glaucoma treatments, nearly every state allows ODs to prescribe oral medications. 34 states allow ODs to prescribe oral steroids, and 12 states allow OD’s to administer injections.
Ophthalmologists of course prescribe and administer a comprehensive range of medications just like any other MD.
But that’s just scope of practice, which is quite different from expertise and experience.
Here’s a great illustration. Students going through optometry school receive a significant amount of training and hands-on experience in performing refractions for glasses and contacts. It’s a big part of their education and it’s something ODs come out of school very well prepared to do in their practices.
Want to know how much training in performing refractions for glasses or contacts the average ophthalmologist receives during their residency? In our informal survey, the answers ranged from “a couple days” to “an afternoon.”
That’s certainly not a distinction made by any law. It’s just difference in the focus of the two professions.
So, if we were to generalize about areas of eye care that are in each profession’s wheelhouse, we’d come up with lists that look something like this:
Things Typically in an Optometrist’s Wheelhouse
- Performing Refractions for Glasses or Contacts
- Fitting Contacts
- Annual Vision Exams
- Diagnosing & Treating Vision Conditions Like Nearsightedness, Farsightedness & Astigmatism
- Vision Therapy
- Diagnosis, Treatment & Management of Eye Diseases Like Glaucoma, Macular Degeneration & Diabetic Retinopathy
- Pre and Post-Operative Care Before and After Eye Surgery
Things Typically in an Ophthalmologist’s Wheelhouse
- Eye Surgery
- Medical Eye Exams
- Diagnosis & Treatment of Eye Diseases like Glaucoma, Macular Degeneration & Diabetic Retinopathy
- Injections for Macular Degeneration & Other Eye Diseases
- LASIK and Other Laser Eye Surgeries
Now, these lists are a generalization and there are certainly exceptions. There are some ophthalmologists who have quite a bit of experience prescribing glasses and contacts. There are some optometrists who have made medical eye care a focus of their practice and experience. But, in general, optometrists have more of a focus of experience, training and practice in refractive eye care, while ophthalmologists have more of a focus of experience, training and practice in medical and surgical eye care.
Can’t We All Get Along?
Yes. We can. Or at least we should be able to. In our humble opinion, the best approach is the two professions working closely together. It’s why we’ve designed our practice the way we have.
If Dr. Sweeney or Dr. Hattan have a patient who could benefit from a cataract consult, there’s an ophthalmologist just down the hall. If Dr. Hoehn has a patient who could benefit from advanced contact lenses to treat their keratoconus, there’s two well qualified optometrists just down the hall.
Like too many things in this country, the differences between optometrists and ophthalmologists have become hotly polarized. To the point that it’s sometimes difficult for patients to clearly understand what their options are. More importantly, patients may be getting less than ideal care because representatives for both professions are more concerned about pushing an agenda than working closely together.
Which seems like the perfect opportunity to leave you with a timeless message from Canned Heat.