QUESTION: What’s the difference in the US between an optician, an optometrist, an ophthalmologist and a retinal specialist (RS)?
ANSWER: Briefly, a retinal specialist is an ophthalmologist who specializes in retinal disorders. An optometrist or an ophthalmologist is capable of diagnosing problems such as AMD, PVDs (Posterior Vitreous Detachment), cataracts, etc. An optician uses a prescription from an optometrist or ophthalmologist to ‘fit’ corrective lenses. Those are the terms used in the US – they are different in other countries.
Eye Doctors in the US: Who’s Who.
In the US, we have Optometrists (ODs), Ophthalmologists (MDs) and Retinal Specialists (RSes). For information about their training, please refer to ‘Assembling a Team of Macular Degeneration Specialists’
Notice it says ‘team.’ Many people have more than one eye specialist on their team.
Diagnosis of AMD
Any of them can DIAGNOSE dry and wet AMD.
Dry AMD
If the diagnosis is dry AMD (early, intermediate, advanced dry AMD/geographic atrophy), any of them can diagnose and monitor you. There are no treatments yet for dry AMD, so there’s nothing medically or treatment-wise an RS can do. ALL of them can counsel you as to diet, supplements, and other things you can do to hopefully slow down the disease process. Do they? THAT varies a lot as does the advice (especially regarding supplements). Not all RSes do this. We find you really need to do your own research in addition to considering the advice of your eye specialist.
Dry AMD often progresses slowly or not at all!!!! Only 10-15% of those with early dry or intermediate dry AMD progress to wet AMD. That means that 85-90% of the people with AMD do NOT need to see an RS to have injections. Injections are NOT inevitable!
If you are concerned that the Optometrist or Ophthalmologist is qualified to make an AMD diagnosis, you can ask if they have testing equipment such as for an OCT and camera with autofluorescence/FAF (big words, I know). They’ll know what they are.
If Dry AMD Turns to Wet AMD
If you start with Dry AMD under the care of an Ophthalmologist or Optometrist and it turns wet, they will refer you to an RS as soon as possible. They are able to get you a timely appointment with an RS for wet AMD or any emergency they can’t handle. Some of you may need a referral to an RS, others may not.
Do You NEED To See An RS?
Is an RS ‘better’ for all types of AMD? An analogy is if you have hypertension, which of course is serious as is AMD, it’s your primary doctor who monitors and treats it. If they feel that the situation is more serious, they’ll refer you to a cardiologist.
Often an RS will refer a patient whose WET AMD is stable back to their Optometrist or Ophthalmologist to monitor. If the condition advances, they’ll go back to the RS. RSes are often very, very busy.
If the diagnosis is WET AMD, it’s the RS you’ll need to see for treatment (anti-VEGF injections). Wet AMD needs to be treated ASAP. As I said above, often an Optometrist or Ophthalmologist can get you an appointment with one sooner than you can. Depending on your insurance, you may need a referral – or not.
If the diagnosis is uncertain or not obvious, you will be referred to an RS.
An Optometrist is often the one who first diagnoses AMD partly because many people think the symptoms are because they need new eyeglasses.
Of course there are cases of being misdiagnosed by an Optometrist or an Ophthalmologist, but it can happen with an RS as well. We have had examples of misdiagnosis by an RS.
Other considerations For Those With DRY AMD
Some people live where the options are limited, so the choice may be between an Optometrist or Ophthalmologist. You may have to travel to find an RS if you have wet AMD.
Personalities can come into play. With any medical field, there are ‘good’ and ‘bad’ doctors, or maybe doctors you feel more comfortable with. If you are seeing an Optometrist or Ophthalmologist and have dry AMD, you can see another Optometrist or Ophthalmologist. You don’t automatically need to see an RS.
It’s often the case where a practice has doctors of all 3 specialties, so it’s a ‘one stop shop.’
Eyeglasses and contacts
Both Optometrists and Ophthalmologists can prescribe them. Rses can, too, but they are often too busy. Sometimes they’ll have a technician deal with eyeglass & contact prescriptions.
Documentation for Disability Claims
Any of the 3 specialties can and do complete this documentation.