What Is an Ophthalmologist?

An ophthalmologist is a healthcare provider who specializes in vision, medical, and surgical care of the eyes. They can perform eye exams, dispense medications, prescribe corrective lenses (eyeglasses or contacts), and perform eye procedures.

Ophthalmologists are the only healthcare providers trained to provide comprehensive diagnosis and treatment of eye disorders. Ophthalmologists are often confused with optometrists (who treat certain eye disorders but do not perform surgery) and opticians (who design, fit, and dispense corrective lenses).

This article describes some of an ophthalmologist's concentrations, as well as the expertise they must have with equipment and treatments. It also points out some of the subspecialties they have to choose from and the training they must undergo before they can work in the field.

Concentrations

Ophthalmology is concerned with the medical and surgical care of the eye, eye orbit (socket), optic tract (the visual nerve network), and visual cortex (the part of the brain that processes nerve impulses from the eyes).

Ophthalmologists treat a variety of eye disorders, from common vision deficiencies to conditions that can lead to partial or complete blindness. They often work with other specialists in cases in which vision loss is secondary to another medical condition, such as diabetes or human immunodeficiency virus (HIV).

Ophthalmologist are trained to diagnose and treat a wide range of conditions. Although this is not an exhaustive list, it gives you an idea about what the scope of their work includes:

• Amblyopia, also known as lazy eye
• Astigmatism, blurring of vision caused by an irregular cornea
• Cataract, clouding of the lens of the eye
• Conjunctivitis, inflammation also known as "pink eye"
• Dermoid cyst, a benign eye tumor
• Detached retina, when a critical layer of tissue pulls away from the blood vessels nourishing it
• Eye cancer (most commonly basal cell carcinoma)
• Eye occlusion, sometimes called "eye stroke"
• Eye trauma, ranging from abrasion to orbital fracture
• Fuch's dystrophy, clouding of the cornea
• Glaucoma, loss of vision often due to elevated eye pressure
• Hyperopia (farsightedness)
• Macular degeneration, an age-related loss of vision
• Macular dystrophy, an inherited loss of central vision
• Myopia (nearsightedness)
• Ptosis (drooping eyelids)
• Tear duct obstruction
  

Subspecialties

Some ophthalmologists further specialize in specific areas of eye care. Your doctor may have a subspecialty or work in a group practice in which doctors with various subspecialties practice. If that's not the case, you may be referred to another ophthalmologist with a subspecialty if needed.

Some of these subspecialties include:

• Cataract and refractive surgery
• Cornea and external diseases
• Glaucoma
• Neuro-ophthalmology (related to the brain and optic nerves)
• Ocular pathology (the diagnosis of eye disease)
• Oculoplastics (reconstruction of the eyelid, orbit, and tear ducts)
• Pediatric ophthalmology (treatment for children)
• Vitreoretinal diseases (involving the retina or vitreous humor)

Procedural Expertise

An ophthalmologist typically works in an office outfitted with equipment for eye exams. More complex imaging or exploratory tests may be conducted in a hospital or medical facility.

While some eye surgeries can be performed in a healthcare provider's office, others may require an operating room in a hospital.

Eye Examination

An eye exam consists of a series of tests that assess the state of someone's vision and their ability to focus on and discern objects. The basic test includes:

• Visual acuity exam, using an eye chart or other tools to evaluate how a patient's vision compares to the standard definition of normal vision (20/20 vision)
• Refraction testing, using equipment that measures how light bends when it passes through the lens
• Pupil function exam, which evaluates the pupil's shape, size, and reaction to light (often with a swinging-flashlight test used to assess the optic nerve response)
• Ocular motility testing, which measures the strength of eye muscles, typically by asking the patient to follow the healthcare provider's finger with the eyes
• Visual field testing, which examines peripheral vision by asking the patient to count the number of fingers held outside of their central field of vision
• Slit lamp testing, using a table-mounted microscope to view the interior of the eye as a small beam of light is directed through the pupil
  

An eye examination can be performed by an ophthalmologist, optometrist, or orthoptist (an allied medical technician trained in the diagnosis and management of eye movement disorders).

Specialized Tests

In addition to a basic eye exam, an ophthalmologist may order specialized tests and imaging studies. Examples include:

• Applanation tonometry, a technique using a tonometer to measure the amount of pressure needed to flatten the cornea
• Corneal topography, in which a topographic map of the cornea is created using a noninvasive computerized imaging device
• Eye ultrasonography, a noninvasive imaging technique that uses high-frequency sound waves to form a live image of the inner eye
• Fluorescein angiography, using a fluorescent dye and a specialized camera to evaluate blood circulation in the eye
• Optical coherence tomography, an imaging technique that uses light waves to create two- and three-dimensional images of the internal eye
  

Treatments

There is an almost encyclopedic range of drugs (including eye drops, injections, and oral medications) used in ophthalmology.

Some are over-the-counter remedies and supplements. Others require a prescription and/or administration by a medical professional.

In addition to medications, an ophthalmologist can prescribe corrective lenses, including bifocal, multifocal, and progressive eyeglasses and contacts.

Unlike optometrists, ophthalmologists can perform more sophisticated medical procedures and surgeries. Some of the more common ones include:

• Cataract surgery, in which a cloudy lens is replaced with an artificial one
• Corneal transplant, in which diseased or scarred corneal tissue is replaced with healthy tissue from an organ donor
• Enucleation and eye prosthesis, the removal of a diseased or damaged eye followed by the insertion of an artificial, nonfunctioning eye
• Glaucoma surgery, using lasers or standard surgical tools to increase fluid outflow from the iris or to remove a portion of the iris
• Oculoplastic surgery
• Refractive surgery to correct errors of refraction, reducing or eliminating the need for corrective lenses (e.g., LASIK)
• Repair (from a laceration) of the cornea or eyelid
• Strabismus surgery, used to adjust eye muscles to straighten misaligned eyes
• Vitrectomy, a procedure that removes the vitreous humor, a gel-like substance in the eye, to correct vision problems

Training and Certification

An ophthalmologist is a medical doctor (MD) or an osteopathic doctor (DO). To enter medical school, they first must earn a bachelor's degree, complete pre-medicine studies (including advanced math, science, and biology), and take the Medical Competency Aptitude Test (MCAT).

Medical school follows, with two years of classroom studies and two years of clinical rotations in different medical facilities.

Upon graduation, they obtain a medical license in the state in which they intend to practice. This usually involves passing the U.S. Medical Licensing Examination (USMLE) if they are an MD or the Comprehensive Osteopathic Medicine Licensing Examination (COMLEX) if they are a DO. Some states also require that ophthalmologists pass a state exam.

An internship and residency follow medical school. This step in the process can last from between three and eight years.

Upon completion of their residency, ophthalmologists can obtain board certification by passing a written and oral exam administered by the American Board of Ophthalmology (ABO). The certification is valid for 10 years, during which time they must take regular continuing medical education (CME) courses to be eligible for recertification.

When to See an Ophthalmologist

There are several reasons you may need to see an ophthalmologist:

• You have a personal or family medical history that puts you at increased risk for eye disease (e.g., an autoimmune condition or high blood pressure)
• You have an existing eye condition
• You are experiencing symptoms such as eye pain, change in vision, double vision, flashes, or floaters

If you already see an optometrist and require the advanced care of an ophthalmologist, your provider should refer you. Your primary care provider may also refer you if they diagnose you with a condition that could affect your eyes, like shingles.

Eye conditions can be sneaky. By the time you notice any symptoms, your vision already could be impaired. If it's recommended that you see an ophthalmologist, book an appointment without delay.

It's especially important for people with diabetes to see an ophthalmologist once a year. High blood sugar can damage blood vessels in the eye. An ophthalmologist can detect any signs of vision loss and take steps to stop it from getting worse.

Appointment Tips

Seeing an ophthalmologist can be stressful for people who find eye procedures uncomfortable or unnerving. To allay your nerves, it often helps to know what to expect if you're referred to an ophthalmologist for treatment.

Your first visit to an ophthalmologist will involve a comprehensive evaluation that takes about 90 minutes to complete. It may take longer if you need specialized testing, have a complex eye condition, or your provider suspects that something may be seriously wrong with your eyes.

Bring your driver's license or state ID, insurance card, and a list of any medications you take. If you've had previous eye surgeries, bring your medical records. Otherwise, ask the treating healthcare provider to forward the records electronically in advance of your appointment.

You're there to learn, so ask all the questions you need to better understand your overall eye health and vision. Some examples include:

• Can you go over the eye exam and tell me what the tests mean?
• How do my results compare to normal results? How do they compare to my previous tests?
• How often should I see you for an evaluation?
• Do my medical and family history affect my risk of eye disease? How so?
• Is there anything I should be doing to protect my vision?
  

And, if applicable:

• What is the cause of my vision loss?
• Is my condition stable or might my sight get worse?
• What symptoms should I watch out for/alert you about?
• What treatments are available? What are their pros and cons?
• Are there alternative treatments I should consider?
• What might happen if I decide not to be treated?

Summary

Of opticians, optometrists, and ophthalmologists, the latter have the most expansive scope of work. Ophthalmologists can treat a wide variety of eye disorders and perform surgery, which is not true of the other professionals. They do this in addition to providing vision care.

Some ophthalmologists train in a subspecialty which further broadens the range of procedures they may be qualified to do. Ophthalmologists fulfill extensive educational requirements before they can work in the field.

A Word From Verywell

To find the right ophthalmologist for you, ask your primary care physician, friends, or family members for a recommendation. Online reviews can be helpful, too.

If you need a starting point, try searching the American Academy of Ophthalmology's directory.

Ultimately, providers agree that you should choose an ophthalmologist who you like, trust, and feel comfortable talking to about health matters.