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What’s the Difference Between an Optometrist and an Ophthalmologist?

The general public often does not know the difference between an optometrist and an ophthalmologist, let alone what the two professions do. I’m an ophthalmic tech, so I’ll do my best to describe the difference between the two.

Patients often ask us about this when they call to schedule appointments, and they always assume the ophthalmologist is the better of the two.

We always correct them and explain optometrists can still perform full eye exams, as well as diagnose and treat eye disease. Optometrists are licensed to do everything ophthalmologists can do, except for surgery.

We will go over some differences between the two professions.


The ophthalmologist is an MD, or doctor of medicine. Ophthalmologists have four years of undergraduate school and four years of medical school. After medical school, they are general doctors. They are even trained to deliver babies.

Following medical school, they go into residency for ophthalmology and for whatever specialty they would like to go into. That is a lot of schooling!

Ophthalmologists can go to school for up to twelve years or more, depending on their specialty.

Ophthalmic specialties

The eye is an amazing thing. Different eye diseases call for different treatments and patients will often need to see specialists for treatment. There are corneal, retinal, glaucoma, and of course oculoplastics. It is a huge part of a technician’s job to know what ophthalmic imaging may be needed with some signs or symptoms.

Ophthalmology sub-specialties

  • Anterior segment surgery – This includes cornea, iris, ciliary body, and lens.
  • Cataracts and refractive surgery
  • Cornea and external disease – Diseases of the cornea, conjunctiva, sclera and even the eyelids. (Corneal dystrophies, inflammation, microbial infections, and or tumors of cornea and conjunctiva.)
  • Glaucoma – Narrow angle glaucoma, open angle glaucoma, etc.
  • Retina
  • Neuro-ophthalmology – Includes non-surgical, too.
  • Ocular oncology – Ocular cancer
  • Oculoplastics and orbit surgery
  • Pediatric strabismus
  • Uveitis


An optometrist is an OD, or doctor of optometry. Optometrists have four years of undergraduate school, then four years of optometry school, which includes externship rotations.

These rotations helps each optometrist choose if they want a specific sub-specialty. Following optometry school, they may opt to go through one year of residency. Optometrists are in school for seven to nine years, and additional years, depending on their specialty.

Optometrist sub-specialties

  • Low vision
  • Pediatric care
  • Refractive surgery co-management
  • Vision therapy
  • Sports vision
  • Contact lens fitting
  • Geriatric care
  • Dry eye
  • Glaucoma co-management
  • Binocular disorders

It’s sometimes helpful to think of the difference between optometrists and ophthalmologists in terms of actual patient care.

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Surgery vs. treatment

In our practice, I am lucky enough to work with an amazing ophthalmologist and an optometrist. When patients call in to make appointments, if they are not established patients, they are always asking to see the ophthalmologist, because patients often think “they are better.”

We always try and explain that optometrists are licensed to do everything an ophthalmologist can do except surgery. The optometrist can still treat and co-manage eye disease. I work for a small private practice with two doctors who work well together. The two doctors really make an unbeatable team.

If another specialty is required for a patient’s care we have a list of referrals to make sure that every patient is taken care of. A good example of surgery versus treatment would be a patient coming in for refractive surgery, which frequently occurs.

Our ophthalmologist will perform the initial exam and calculate treatment for the procedure, perform the procedure, and then see the patient for the first postoperative visit.

Co-management would begin when the patient is released to see the optometrist for the following appointments: one week, postoperative, one month, six month, and then annually.


Refracting for any doctor is very important. This is a skill that I quickly learned can be time-consuming, and the technician has to realize there is a lot of variables for a patient having clear vision.

Optometrists and ophthalmologists both give new glasses and contact lens prescriptions especially ones that see patients for annual or general eye exams. Depending on their speciality, some ophthalmologists may not give prescriptions.

Retinal specialists would usually not be giving glasses prescriptions due to treating other eye issues that may be affecting vision, such as retinal detachments, age related macular degeneration, or diabetic retinopathy, etc. Unfortunately, a prescription for glasses are not going to help the aforementioned patient see better.

Contact lenses

This is sometimes an optometrist’s sub-specialty. Ophthalmologists and optometrists usually share this task. Contact lens fittings take a lot of patience and expertise, depending on the patient’s disposition.

There may be a keratoconic patient that needs to be fit with a gas permeable lens to slow progression and improve vision. Keratoconus is where the cornea becomes cone shaped usually steeper on the lower or inferior part of the eye.

There are also hybrid lenses the doctors may recommend, these are usually hard in the middle and have a soft skirt around the edge. My clinic I work at my optometrist specializes in contact lens fittings so our ophthalmologist purposely refers his patients who need contacts to our optometrist. Other doctors in other clinics may have a different routine.

What the difference between an optometrist and an ophthalmologist means for the tech

That said, when working as ophthalmic assistants, we need to be familiar with what each doctor needs – or expects – in a work up. Regardless of the type of doctor, first and foremost, you need to be aware of what any doctor wants of you as a technician. And that will vary widely depending on the doctor.

Doctors can be very particular, whether they’re ophthalmologists or optometrists. One of the challenges when I first started working in eyes was trying to get to know each doctor and what information they preferred to be presented to them.

If you have read my other blogs, you know I started out as a scribe for six ophthalmologists and four optometrists. After one year I could almost guess or quote what the doctor would say or his routine when performing exams.

Paying great attention to detail is definitely appreciated when working for an ophthalmologist as well as an optometrist. That’s a part of what makes a great technician, thinking ahead and knowing what your doctor needs.



Autumn Wilcox

I'm a certified ophthalmic assistant at Davis Vision Center in Utah.

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  1. Thank you for all this great information about choosing an optometrist. One thing that really stood out to me is that you say that optometrists actually help you with low vision and vision therapy! Since I have really bad eyes, this sounds like something that would be smart for me.

  2. I appreciate that you mentioned that the ophthalmologist will be the one to do the initial exam. I have been seriously considering LASIK recently, but I would like to know what my best options are. It’s good to know that they will make sure that I’ll get the correct treatment done with their advice.

  3. Autumn, thank you for providing some great information about the difference between ophthalmologists and optometrists. As an OD I would like to point out that most patients with primary open angle glaucoma can be successfully treated by a Doctor of Optometry without the need for co-management with an MD.

  4. Thanks for helping me understand that optometrists have studied for four years in undergrad schools, four years in optometry school, and externship rotations as well. This is great to know since it means that they really are experts regarding eye care. I just want to know if they will be able to help my grandmother have a better vision due to the cataract that might develop soon.

  5. It really is nice that your article goes over some of the different kinds of ophthalmologists that you can find. After all, not many people know that ophthalmologists can have specialties. However, if you think that you have glaucoma then you’ll want to make sure that the one you’ve chosen can treat that.

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