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Optometrist vs. Ophthalmologist: Which one is better?

By Joel Hunter, MD | 1/17/19 7:00 AM
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There’s an old joke (okay, I’m just making it up right now) that offers some wisdom in the answer to this question. Why make up a joke? Because you can’t beat an old-timey anecdote when trying to convey some good, down-to-earth wisdom. Just ask Mark Twain. Also, jokes are fun.

A man and his son are having breakfast and talking about the big day ahead. For the boy, it is his first day of the new school year. For his father, it’s the day he’s going to go skydiving for the first time. They wish each other luck as they pack up and walk out the door. Later that day, when the teacher tells the class to get out their binders the boy opens his backpack, stares into it for a moment, and then raises his hand. When she calls on him and asks where his binder is, he says, “I know you’re probably gonna be mad at me for not bringing a binder. But my dad is gonna be way madder because I took the wrong backpack to school.”

Now, even if that joke isn’t funny I hope it still can get my point across. I assume it can because, to be honest, some of Mark Twain’s “jokes” are real head-scratchers for me in the comedy department. Yet they always convey the message he was going for. Since I am no Mark Twain, I’ll take the precaution of clarifying this message. (By the way, neither you nor I foresaw the volume of Mark Twain references contained in this article when we started it.)

What’s the difference?

Asking if an optometrist or an ophthalmologist is better is like asking if a parachute or a well-packed school bag is better. It’s a question that can only be answered in reference to what you need. If you have an eye disease or injury, you should almost certainly seek out an ophthalmologist. Because an ophthalmologist is a medical doctor who specializes in eyes and eye surgery. If you can’t see well and want to see better with glasses or contacts, you should see an optometrist. Because an optometrist is an eye doctor who specializes in glasses and contacts.

The Ophthalmologist/Optometrist Crossover

The reason for confusion on who does what is that there is some (usually unfortunate) crossover. An ophthalmologist can prescribe glasses and contacts. Yet, it is rare that an ophthalmologist has specialized training in glasses and contact prescriptions and fitting. So almost always, “can” prescribe contacts doesn’t mean they “should” prescribe contacts. Similarly, an optometrist can diagnose and treat a variety of eye diseases and injuries. Yet, it is rare for an optometrist to have specialized training in those areas. Therefore, once your eye condition is given a name like “cataracts” or “macular degeneration” or “diabetic eye disease,” it’s advisable to find an ophthalmologist who specializes in that problem and get their opinion.

In an ideal world, we’d all let our guard down and be willing to say, “Even though I’m good at the thing I do, I’m not good at the stuff I’m not trained in.” We live in the real world, though. So there are ophthalmologists that try to prescribe glasses and contacts because they refuse to believe a specialist (i.e. an optometrist) could do it better. And I (an ophthalmologist) will see patients sometimes who have had a surgical solution to their poor vision for years, but they never knew because an optometrist (who I know meant well) kept trying different types of contacts.

Which one should you see?

In summary, if you have an eye with a condition that has a name, an injury, or that needs surgery, then you should probably see an ophthalmologist. If you don’t know what’s wrong, but you want to see better and know if your eyes are healthy, then an optometrist can probably help you best. If you can find a clinic that has both, then you’ve hit the jackpot. You’ve got your parachutes and schoolbags all in one place, and you can be directed to which will help you most.

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These articles are brought to you by Hunter Vision. We help people in Orlando discover life after glasses and contacts.
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