What is an ophthalmologist?
An Ophthalmologist, or Eye MD, is a doctor of medicine or an osteopathic doctor who specializes in the medical and surgical care of the eye. Ophthalmologists are specially trained to provide the full spectrum of eye care, from performing complex microsurgery, to diagnosing and treating eye diseases and condition, to prescribing glasses and contact lenses. Many ophthalmologists are involved in scientific research into the causes and cures for eye diseases. An ophthalmologist completes a minimum of 12 years of education, including 4 years of college, 4 years of medical school, 1 year of general clinical training or internship, and 3 or more years in a hospital-based ophthalmic residency program, often followed by 1 or more year(s) of subspecialty fellowship. The ophthalmologist then typically passes a medical licensing examination and is board certified by the American Board of Ophthalmology (ABO) www.abo.org. To maintain licensure and board certification, continuing medical education is required and monitored carefully by state medical boards and by the ABO.
Optometrists receive a Doctor of Optometry (OD) degree and are licensed to practice optometry, not medicine. The practice of optometry traditionally involves examining the eye for the purpose of prescribing and dispensing corrective lenses, screening vision to detect certain eye abnormalities, and prescribing medications for certain eye diseases. An optometrist typically has 6 years of post-high school training, consisting of 2-4 years of college and 4 years in an optometric college.
Opticians are trained to design, verify and fit eyeglass lenses and frames, contact lenses, and other devices to correct vision. These technicians use contact lens or eyeglasses prescriptions supplied by ophthalmologists or optometrists, but do not test vision or write prescriptions. Opticians are not permitted to diagnose or treat eye diseases.
Ophthalmic Technicians help ophthalmologists collect data and measurements to allow the correct diagnosis and treatment of eye diseases and problems. They perform tests of vision and eye pressure and help explain diagnostic and treatment procedures to patients.
Other Eye Facts
Did You Know That Exercise is Good for Your Eyes?
You may already know that regular physical exercise helps your heart and your energy level, but did you know that it also has benefits for your eye health? Many eye diseases are linked to other health problems, including high blood pressure, diabetes and high cholesterol levels. Exercise helps keep these problems at bay or limits their impact if they do occur.
Two studies have shown that people who exercise regularly were less likely to develop serious eye disease. In one study, researchers followed more than 5,600 men and women to see if there was a link between moderate exercise and ocular perfusion pressure, an important factor in the development of glaucoma. People who engaged in moderate physical exercise were 25 percent less likely to develop glaucoma than people who were largely inactive. "We cannot comment on the cause, but there is certainly an association between a sedentary lifestyle and factors which increase glaucoma risk," said Paul Foster, MD, the author of the study.
In another study, researchers looked at the medical history of more than 3,800 people to see if there was a relationship between developing age-related macular degeneration (AMD) and being physically inactive. The scientists found that people who exercised three times a week were less likely to develop AMD than people who didn't exercise.
The great news about exercise is that you don't have to be a marathon runner to reap the benefits. Taking a brisk walk, climbing the stairs and dancing are all great ways to get a good work out that will help you and your eyes stay healthy.
Don’t Lose Sight of Your Eye Health
A comprehensive eye examination can catch problems with your eyes well before your vision is affected. The New England Ophthalmological Society would like to encourage you to get a baseline eye examination at age 40, the age when early signs of eye disease and changes in eye health may first appear.
NEOS recommends that individuals consult their ophthalmologist to determine how frequently their eyes should be examined. After an initial screening examination, healthy individuals at low risk for eye disease may be followed every two to four years. By age 65, the usual recommended follow up is once every year or two. Individuals with a family history of eye disease, diabetes or those who take certain medications (for instance, corticosteroid medications or hydroxychloroquine0 may need to schedule more frequent eye examinations.
By 2020, 43 million Americans will be at risk for significant vision loss or blindness from age-related eye diseases, such as cataracts, diabetic retinopathy, glaucoma and macular degeneration, an increase of more than 50 percent over the current number of Americans with these diseases. We hope you will arrange for an eye exam today, because knowing your risks can save your sight.
How Does Nutrition Affect The Eye?
Foods rich in vitamins C and E, zinc, lutein, zeaxanthin, and omega-3 fatty acids DHA and EPA are good for eye health as well as general health, according to the Age-Related Eye Diseases Study (AREDS), funded by the National Eye Institute, and other research. These nutrients are linked to a lower risk for age-related macular degeneration, cataract, and dry eye. Choosing healthier foods is a good thing no matter how early or late in life we begin. It is important to consult your eye doctor regarding specific recommendations for you as far as vitamin supplements are concerned.
Frequently Asked Questions
Below are some of the most frequently asked questions posed to ophthalmologists. The answers are intended as general summaries of typical conditions and illnesses of the eye. For specific personal information, please consult your ophthalmologist.
Eye Care Links and Resources of Interest
Questions for an Eye MD – links to: www.geteyesmart.org/eyesmart/ask/index.cfm
About Eye Smart: Eye Smart, the public awareness campaign of the American Academy of Ophthalmology, has created an online resource which enables the public to submit questions about eye health.
FAQs about eyes
On occasion, I see little wavy lines or dots that seem to swim in my eyes. What is this, and should I be concerned?
What you are describing could be either floaters or flashes, both of which might be an indication of a quite serious problem, or it could be nothing! Floaters are tiny clumps of cells in the clear jelly-like fluid (the vitreous gel) inside your eye that cast shadows on the retina, the part of the eye that allows us to see. Sometimes floaters resemble dots, circles, clouds, or cobwebs. Flashes resemble streaks of lightning or bursts of light, indicating that the vitreous gel is tugging on the retina. Floaters and flashes become more common as people age, and they should always be examined immediately by an ophthalmologist to rule out bleeding in the eye from a retinal tear--a critical problem that might lead to retinal detachment and loss of sight. Often floaters and flashes are more a nuisance than a serious problem, and they may fade with time, but if you notice new ones, always have an eye examination immediately to rule out the need for immediate surgery to repair tearing.
What is glaucoma and can it cause blindness?
While glaucoma is the second leading cause of blindness in the United States, loss of sight from glaucoma is preventable, but only if detected early enough. Glaucoma is a disease of the optic nerve (the part of the eye that carries the images we see to the brain), caused when pressure in the eye builds up because the eye's usual drainage capability becomes blocked. Consequently, if the pressure inside the eye becomes too high, the optic nerve may become damaged, causing blind spots. If the glaucoma either has gone undetected for a while or the pressure increases rapidly, the entire nerve can be destroyed, and blindness results. Glaucoma can strike at any age, but at greatest risk are African Americans, people with a family history of glaucoma, those aged 40 or older, or anyone who suffered a serious eye injury. Most forms of glaucoma are painless, so early detection and treatment by your ophthalmologist are the keys to prevention. Treatment commonly consists of medicated eye drops, but laser surgery is beginning to be used as well.
How are diabetes and blindness related?
One of the complications of diabetes that affects the eyes is called diabetic retinopathy, caused by deterioration of the blood vessels that nourish the retina. If these weakened vessels leak fluid or blood, they can damage or scar the retina and ultimately blur vision. About 60 percent of people with diabetes more than 15 years have some blood vessel damage in their eyes. However, only a small percentage of those people have serious vision problems, and even fewer ever become blind. Nonetheless, diabetic retinopathy is the leading cause of new blindness among adults in the U.S., and diabetics are approximately 25 times more prone to blindness than non-diabetics. Pregnancy and high blood pressure may worsen this condition in diabetic patients. The best protection against the progression of diabetic retinopathy is awareness of the risks of developing sight disturbances and having regular exams by an ophthalmologist. When treatment is necessary, the most common method is laser surgery to seal the leaking blood vessels.
When should an adult with diabetes first be seen by an eye care provider and how often should they be evaluated thereafter?
Although approximately 80% of Type 1 diabetics (i.e., insulin-dependent) have retinopathy after 15 years of disease, only about 25% have any retinopathy after 5 years. The prevalence of proliferative diabetic retinopathy (PDR) is less than 2% at five years and 25% by 15 years. For Type 2 diabetes (non-insulin-dependent), however, the onset date of diabetes is frequently not precisely known and thus more severe disease can be observed soon after diagnosis. Up to 3% of patients first diagnosed after age 30 (Type 2) can have clinically significant macular edema or high-risk PDR at the time of initial diagnosis of diabetes.
Thus, in patients over the age of 10, initial ophthalmic examination is recommended beginning 5 years after the diagnosis of Type 1 diabetes mellitus and upon diagnosis of Type 2 diabetes mellitus.
Even if there is no or minimal retinopathy, annual follow-up is required since 5-10% of patients with no retinopathy will develop retinopathy within one year and existing retinopathy will be exacerbated by a similar percentage. Extensive retinopathy can exist even without symptoms. This minimum annual follow-up requirement assumes no abnormal findings. Abnormal findings necessitate more frequent follow-up. Symptoms and findings which suggest a higher risk of complication and should trigger more rigorous follow-up include floaters, distortion of vision, difficulty with night vision or reading vision, poor systemic control, advanced nephropathy, and concurrent hypertension.
Are there situations where a patient with diabetes should be evaluated more or less often?
Puberty and pregnancy can accelerate retinopathy progression. The onset of vision-threatening retinopathy is rare in children prior to puberty regardless of the duration of diabetes. However, if diabetes is diagnosed between the ages of 10 and 30, significant retinopathy may arise within six years of disease. However, there is as yet no published data demonstrating that there is a statistically significant increased risk of retinopathy at 5 versus 3 years after diabetes diagnosis in this age group.
Thus, the current recommendation is for initial ophthalmologic examination within 3-5 years after diagnosis of diabetes once patients are age 10 years of age or older.
Diabetic retinopathy can also become particularly aggressive during pregnancy in patients with diabetes. Ideally, patients with diabetes who are planning pregnancy should have a comprehensive eye examination within one year prior to conception. Patients who become pregnant should have a comprehensive eye examination in the first trimester of pregnancy. Close follow-up throughout pregnancy is indicated with subsequent examinations determined by the findings present at the first trimester examination. This guideline does not apply to women who develop gestational diabetes, because such individuals are not at increased risk of developing diabetic retinopathy.
What is amblyopia?
Amblyopia or "lazy eye" is reduced vision in an eye due to a lack of normal visual development during childhood. An amblyopic eye that does not see well early in life does not develop normal vision even with glasses. Amblyopia affects 3-4% of children and usually involves one eye though rarely can involve both. It may be the result of needing a different spectacle prescription in each eye, an opacity such as a cataract, or misalignment of the eyes. After the first nine years of life, the visual system is usually fully developed and cannot be significantly changed. The best time to correct amblyopia is during infancy or early childhood.
The presence of amblyopia is not always easy to recognize. Children should have their vision tested by their pediatrician or ophthalmologist before the age of four or earlier if there is any "wandering" of the eyes. Children with a family history of amblyopia should be checked even earlier within the first two to three years of life. Failing a vision screening does not always mean there is amblyopia as vision is often improved back to normal by prescribing glasses.
Amblyopia is treated by patching the stronger eye to strengthen the weaker eye. Patching may vary from a few hours a day to almost the entire day depending upon the visual acuity. Sometimes drops are used instead of patching to blur the better eye if cooperation is a problem. If amblyopia is not treated, the weaker eye may permanently have poor vision which is uncorrectable with glasses. If the problem is detected early, patching can help to improve vision in most children.
What is keratoconus?
The word "keratoconus" literally means "cone-shaped cornea." The normal cornea is the clear dome on the front of the eye. The cornea bends, or refracts, the incoming light to help focus it on the retina. In order for you to see clearly, the cornea must be perfectly smooth and round, much like the surface of a billiard ball.
In keratoconus, the cornea is shaped more like the end of a football. This abnormal curvature makes the image formed on the retina quite blurry.
We do not know the cause of keratoconus but keratoconus is more common in people who have eye allergies and rub their eyes a lot.
In patients with mild keratoconus, often just a pair of glasses is all that is needed.
If the cone shape becomes more severe, however, glasses will not correct the problem. It is then necessary to use rigid contact lenses. These lenses sit on the tip of the cone and--while they're in place--create an optically smooth round surface, so the patient can see.
If keratoconus becomes very severe, the cone protrudes quite a bit, and contact lenses can no longer stay in place or become very uncomfortable. At this stage,a corneal transplant would be very likely to help the condition. In a corneal transplant, most of the cone-shaped cornea is removed and replaced with a normal donor cornea from a deceased person. The success rate of corneal transplants for keratoconus is excellent: about 95%.
Not everyone who has keratoconus will progress through these stages and need a transplant. Many patients have very mild disease and require just glasses.
Some Recent NEOS Public Education Projects
NEOS is dedicated to public health and education. The NEOS Public Health and Education Committee designs and executes campaigns to disseminate eye health information directly to the public and allied health professionals.
Glaucoma Awareness Billboard Campaign
Glaucoma is a disease of the optic nerve that is usually related to high eye pressure. It is sometimes referred to as the "silent blinder" because it is, until the end stage of the disease, asymptomatic. There is no pain or blurred vision until the disease is quite advanced. For this reason, and because it is common, glaucoma presents a public health challenge.
The Public Health and Education Committee of NEOS has campaigned to increase glaucoma awareness. With the help of a grant from the Clear Channel Corporation, over 100 billboards in Eastern Massachusetts called attention to the importance of glaucoma screening.
IFIS Awareness Project
“Intraocular Floppy Iris Syndrome” was described in 2005. It is the irregular behavior of the iris tissue during intraocular surgery related to systemic alpha-1 blockers commonly prescribed for benign prostatic hypertrophy (BPH). The iris may not dilate well preoperatively, may constrict intraoperatively, or may have poor muscle tone. The medication most commonly associated with IFIS is the selective apha-1 blocker Flomax (tamsulosin HCL). The surgery most commonly affected is cataract surgery.
NEOS members have authored articles to educate about the relationship between Flomax and cataract surgery. Since most Flomax prescriptions are written by primary care doctors, effort has been directed toward PCP’s and urologists. Dr. Brendan McCarthy of the NEOS Public Health and Education Committee writes to the American Urological Association:
“Communication between ophthalmologists and those prescribing medicines for BPH is important for protecting patient’s well being. If possible, we would recommend asking patients if they have been diagnosed with cataracts and if they are having vision problems before prescribing a selective alpha-blocker. This might help avoid the all too common occurrence of patients being started on selective alpha-blockers just prior to cataract surgery. For patients on a non-selective or other agent in whom BPH therapy is being advanced, a comprehensive eye exam by an ophthalmologist can help determine the time frame for cataract surgery if indicated.”