Ophthalmology CRO is a medical field focused on the study, diagnosis, treatment and prevention of eye and vision problems. Ophthalmologists – doctors who specialize in ophthalmology – use eye exams, medications, lasers, and first-line surgical treatments to help manage and treat eye problems.
Differences between ophthalmology, optometry and optician services
Although ophthalmologists, optometrists, and opticians work with eyes, they have different levels of training and expertise.
An ophthalmologist is a medical doctor (MD) or doctor of osteopathic medicine (DO) who specializes in the eyes and visual system. Ophthalmologist education includes graduation from medical school followed by internship and residency. Many ophthalmologists also complete an internship after residency.
Ophthalmologists certified by the American Board of Ophthalmology can diagnose and treat all types of eye diseases, perform surgeries, provide laser treatments, prescribe medications, and fit glasses and contact lenses. Some ophthalmologists participate in scientific research, such as clinical trials, related to their specialty.
Optometrists provide primary vision care and are licensed to practice optometry. This may include vision testing, prescribing and fitting glasses and contact lenses, and diagnosing and treating vision changes. Ophthalmologists also diagnose and prescribe medications for some eye conditions.
Trainees must complete at least several years of college and four years of optometry school to earn their Doctor of Optometry (OD) degree.
People who need an eye exam or who have eye concerns can start by seeing an ophthalmologist or optometrist. Ophthalmologists may refer patients with more complex problems to an ophthalmologist if needed.
It should be noted that the responsibilities of an optometrist vary from state to state. For example, in some states optometrists can perform laser eye surgery; in other states, they can only provide pre- and post-operative care, not perform the procedures themselves.
Opticians design and fit eyeglass lenses and frames, contact lenses and other vision correction devices. They do not test eyesight or write prescriptions for vision correction; they use prescriptions written by ophthalmologists or optometrists. Opticians do not diagnose or treat eye diseases. The requirements to become an optician vary, but many employers require an associate degree or optician certification.
The complex ophthalmology-body connection
An ophthalmologist specializes in eye and vision care. But there’s also a deep connection between the eyes and the rest of the body, says Castle Connolly top doctor Pamela F. Gallin, MD, Vial, clinical professor of pediatric ophthalmology at New York Presbyterian-Columbia University Medical Center. The eyes can actually be a window to other parts of the body, says Dr. Gallin.
“People think the eyes are an isolated island, but they’re actually the command center,” he says. “Most systemic and genetic diseases have some impact on the eyes.” For example, diabetes, high blood pressure, neurological diseases and autoimmune diseases can all cause eye problems.
Sometimes ophthalmologists diagnose systemic diseases because of certain findings in the eyes. And although some eye problems—such as cataracts or nearsightedness—affect only vision, other problems are sometimes caused by systemic (body-wide) disease or conditions elsewhere in the body.
Treatment of a wide range of medical conditions
Ophthalmologists diagnose and treat a wide variety of eye diseases and conditions. However, the patient’s eye symptoms, level of pain, and overall health determine the type of care needed—whether it’s a trip to the hospital’s emergency department, urgent eye care, or a non-urgent eye visit.
Specialists in ophthalmology
In addition to general ophthalmologists, there are six types of subspecialists who diagnose and treat these specific eye problems:
Corneal conditions: A cornea specialist diagnoses and treats problems with the cornea, the clear dome-shaped covering of the iris, and the pupil. Corneal subspecialists can perform corneal transplants, manage corneal trauma, and perform refractive surgery such as laser-assisted subepithelial keratectomy or LASIK.
Glaucoma: A glaucoma specialist diagnoses and treats glaucoma, an eye disease in which the fluid in the eye does not move properly, causing a build-up of intraocular pressure. The optic nerve connects the eye to the brain, and if left untreated, increased pressure inside the eye can damage the optic nerve.
Neuro-ophthalmology: Neuro-ophthalmologists diagnose and treat vision problems caused by the interaction of the eyes with the brain, nerves and muscles. These problems include double vision and unequal pupil size.
Oculoplastic surgery (“oculoplasty”): Oculoplastic specialists address problems with your eyelids, bones and other structures around the eye, or the tear drainage system. They can also perform cosmetic surgery using medical injections around the eyes and face.
Pediatric Subspecialist: A pediatric subspecialist treats eye diseases in infants and children. Babies aren’t just “little adults” when it comes to their eyes. They often have eye problems specific to their development, such as eye movement disorders nystagmus or strabismus.
Retina Subspecialist: Retina subspecialists manage conditions that include age-related macular degeneration and diabetic eye disease. The retina is a layer of tissue that lines the back of the eye. A retina subspecialist can repair detached retinas and treat problems with the vitreous, the gel-like substance that fills the eyeball.
Ophthalmological tests, procedures and operations
The tests, procedures, and surgeries performed by an ophthalmologist depend on your specific eye problem. An ophthalmologist may perform tests that include:
Vision tests and eye examinations
For children: Ophthalmologists perform vision exams to check the growing and changing eyes of children and adolescents. Screening can tell when children need a more thorough eye exam.
For adults: During an adult eye exam, an ophthalmologist will evaluate vision, check for early signs of disease or vision changes, and may perform one or more of the following tests to better assess eye health:
Motility test: Measures how the eye moves, which helps the ophthalmologist evaluate the function of the eye muscles.
Dilated Pupil Exam: The ophthalmologist places drops in the eyes to dilate (dilate) the pupils so he can examine the retina and optic nerve.
Pupillary reaction test: Checks how the pupils react to light.
Slit-lamp examination: An ophthalmologist uses a bright light microscope (slit-lamp microscope) to examine the front of the eye, including the eyelids, cornea, iris, and lens. This exam is used to check for cataracts, dry eye, and corneal scratches.
Visual acuity test: The patient reads an eye chart to help the ophthalmologist measure vision at various distances.
Intraocular pressure test (tonometry): Rapid inhalation of air into the eye may indicate increased intraocular pressure, a sign of glaucoma.
Ophthalmologists may perform a number of other tests to check patients for certain eye conditions. Common additional tests include:
Fluorescein angiography: Uses a camera to take pictures of the retina, which allows the ophthalmologist to better evaluate the blood vessels and other parts of the back of the eye. Fluorescein angiography results can help diagnose macular edema, diabetic retinopathy, macular degeneration, and ocular melanoma. It also helps ophthalmologists track changes in eye disease over time and target areas for treatment.
Examination of the fundus: The fundus is the inner surface of the eye. Using drops to dilate the pupils (“eye dilation”), the ophthalmologist gets a better view of the fundus and uses an ophthalmoscopy to look at the inside of the eye, including the retina, optic nerve head, and blood vessels. Some ophthalmologists also use a fundus camera.
Optical Coherence Tomography (OCT): This imaging technology uses light waves to take pictures of the layers of the retina. This helps ophthalmologists control glaucoma, age-related macular degeneration and diabetic eye disease.
Corneal Topography: Also known as corneal mapping, this digital diagnostic tool shows ophthalmologists a 3D map of the cornea’s surface. Corneal topography can help them diagnose and monitor various eye conditions and is used to plan eye surgery, including refractive surgery.
Common Ophthalmological Operations and Procedures
Ophthalmologists perform many types of procedures and surgeries. Common ones include:
Cataract surgery: In cataract surgery, the doctor removes the cataract (the “cloudy” spot on the lens) and replaces it with an intraocular lens.
Glaucoma surgery: There are many types of surgery to treat glaucoma, an increased pressure in the eye that can cause vision loss. An eye doctor can help patients choose the right surgery for them based on their intraocular pressure, treatment goals, and overall health.
Refractive surgery: Any eye surgery performed to correct vision is refractive surgery. There are several types of refractive surgery, including LASIK.
Resection surgery: Resection surgery is usually done to remove a tumor in the eye. Eye tumors can develop because of cancer elsewhere in the body, and they can arise independently of cancer in another part of the body.
Cataracts, an eye disease that causes the lens to become cloudy, are very common with age. Dr. Gallin says cataract surgery is one of the more common procedures performed by ophthalmologists. And according to the American Academy of Ophthalmology, cataract surgery is the most common surgical procedure performed in the U.S., with more than three million cataract surgeries performed annually.
“Cataract surgery has one of the highest success rates when it comes to solving the problem with minimal complications,” says Dr. Gallin. “This eye surgery is important both for safety – for example, for safer driving – and for improving quality of life, as people who can’t see well often become depressed.”
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