Ophthalmologist: experience, specialties and training

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An ophthalmologist is a health care provider who specializes in the medical and surgical care of the eyes and vision. Ophthalmologists, also known as ophthalmologists, are the only healthcare providers trained in the comprehensive diagnosis and treatment of eye conditions. They can perform eye exams, dispense medications, prescribe corrective lenses (glasses or contact lenses), and perform eye surgeries.

Ophthalmologists should not be confused with optometrists (who treat certain eye conditions but do not perform surgery) or opticians (who design, install, and sell corrective lenses).

Ophthalmologists in the United States must complete four years of college, four years of medical school, and four to five years of additional specialized training.

Get Medical Information / Jessica Olah

Concentration

Ophthalmology is a specialty associated with the medical and surgical care of the eyes, the orbit (orbit), the optic tract (the network of the optic nerve), and the visual cortex (the part of the brain that processes nerve impulses from the eyes). .

Ophthalmologists treat a variety of eye conditions, from common visual impairments to conditions that can lead to partial or complete blindness. Ophthalmologists often work with other professionals when vision loss is secondary to another medical condition, such as diabetes or the human immunodeficiency virus (HIV).

An ophthalmologist can diagnose and treat the following conditions:

  • Amblyopia (also known as "lazy eye")
  • Anisocoria (unequal pupils)
  • Astigmatism (blurred vision caused by an abnormal cornea)
  • Cataract (clouding of the lens of the eye)
  • Chalazion (swollen lump on the eyelid)
  • Conjunctivitis (inflammation, also known as pink eye)
  • Cytomegalovirus retinitis (a serious viral eye infection, more common in people with advanced HIV infection)
  • Dermoid cyst (benign tumor of the eye)
  • Detached retina (a critical layer of tissue is separated from the blood vessels that feed it)
  • Diabetic retinopathy (damage to the retina caused by diabetes)
  • Eye cancer (most commonly basal cell carcinoma)
  • Occlusion of the eye (also known as "eye punch")
  • Eye injury (from abrasion to orbital fracture)
  • Fuh's dystrophy (corneal opacity)
  • Glaucoma (loss of vision, often due to increased pressure in the eye)
  • Ophthalmic herpes zoster (shingles)
  • Farsightedness (farsightedness)
  • Hyphemia (broken blood vessels in the eye)
  • Keratoconjunctivitis sicca (dry eye syndrome)
  • Keratoconus (abnormal swelling of the cornea)
  • Macular degeneration (loss of vision associated with aging)
  • Macular dystrophy (inherited loss of central vision)
  • Milia (eyelid cyst)
  • Myopia (myopia)
  • Nystagmus (uncontrolled eye movement)
  • Ophthalmic herpes (caused by herpes simplex virus type 1 )
  • Optic neuritis (vision problems associated with inflammation of the nerves)
  • Pingueculae (benign neoplasms on the eyeball)
  • Proptosis (bulging eyes)
  • Pterygium (also known as "surfer's eye")
  • Ptosis (droopy eyelids)
  • Retinitis pigmentosa (a genetic disorder that causes the destruction of cells in the retina)
  • Strabismus (slanted or deviated eyes)
  • Tear duct obstruction
  • Uveitis (inflammation of the middle layer of the eye)

Procedural experience

The ophthalmologist usually works in an office equipped with vision detection equipment . More sophisticated imaging or exploratory tests may be done in a hospital or healthcare facility. While some eye surgeries can be performed in a healthcare provider's office, others may require an operating room in a hospital.

Vision test

A vision test is a series of tests that assess your vision and your ability to focus and distinguish between objects. The benchmark test includes:

  • A visual acuity test that uses a vision chart or other instruments to assess how well your vision compares to the standard definition of normal vision ( 20/20 vision).
  • Refraction tests with a retinoscope or autorefractor to measure how light bends as it passes through a lens.
  • Pupil function test, which assesses the shape, size, and response of the pupil to light (often with an oscillating flashlight test used to assess optic nerve response)
  • An eye motor test , which measures the strength of your eye muscles, usually asks you to follow the doctor's finger with your eyes.
  • Visual field test, which tests your peripheral vision by asking you to count the number of fingers outside of your central visual field.
  • Slit lamp test using a tabletop microscope to see inside the eye where a small beam of light is directed through the pupil.

An ophthalmologist, optometrist, or orthopedist (a medical technician who has received special training in the diagnosis and treatment of eye movement disorders) can perform an eye exam.

Specialized tests

In addition to a basic eye exam, an ophthalmologist may order specialized tests and imaging studies, some of which require a trained technician. Examples include:

  • Applanation tonometry is a method that uses a tonometer to measure the pressure required to align the cornea.
  • Corneal topography , in which a topographic map of the cornea is created using a non-invasive computerized imaging device.
  • Eye ultrasound , a non-invasive imaging technique that uses high-frequency sound waves to form a vivid image of your inner eye.
  • Fluorescence angiography with a fluorescent dye and a special camera to assess blood circulation in the eye.
  • Optical coherence tomography is an imaging technique that uses light waves to create two-dimensional and three-dimensional images of the inner eye.

Treatment

Ophthalmology uses an almost encyclopedic range of medications (including eye drops, injections, and oral medications). Some are over-the-counter medications and supplements used to treat dry eye or prevent progressive diseases such as macular degeneration. Others require a prescription and / or under the supervision of a healthcare professional.

These include expensive anti-vascular endothelial growth factor (anti-VEGF) drugs used to treat macular degeneration and some types of eye cancer.

In addition to medications, the ophthalmologist may prescribe corrective lenses, including bifocal , multifocal, and progressive glasses and contact lenses.

Unlike optometrists, ophthalmologists can perform more complex medical procedures and surgeries. Some of the most common include:

  • Bionic eye implants , which are currently available as the Argus II Retinal Prosthetic System, are used for people with severe retinitis pigmentosa.
  • Botox (botulinum toxin) injections , which are sometimes used in place of surgery to correct eye misalignment by temporarily paralyzing the orbital muscles.
  • Cataract surgery , in which a cloudy lens is replaced with an artificial one.
  • Corneal transplant , in which diseased or damaged corneal tissue is replaced with healthy tissue from an organ donor.
  • Enucleation and prosthesis of the eye , removal of a diseased or damaged eye after the installation of a non-functioning artificial eye.
  • Glaucoma surgery with laser or standard surgical instruments to increase fluid drainage from the iris or to remove part of the iris.
  • Oculoplastic surgery , a specialty of ophthalmology that deals with the reconstruction of the eyelid, the orbit, the tear ducts and the face.
  • Orbital decompression , used to reduce bulging of the eyes, characteristic of Graves' disease.
  • Refractive surgery , including LASIK surgery , to correct refractive errors, reduce or eliminate the need for corrective lenses
  • Strabismus correction surgery to correct eye muscles and straighten misaligned eyes
  • Vitrectomy , a procedure to remove a gel-like substance in the eye called the vitreous humor to correct vision problems.

Subspecialties

According to the American Medical Association (AMA), although many ophthalmologists choose to work in a general ophthalmic practice, up to 40% will specialize in a specific field of ophthalmology. This includes:

  • Cataract and refractive surgery
  • Cornea and external diseases
  • Glaucoma
  • Neurophthalmology (brain and optic nerves)
  • Ocular pathology (diagnosis of eye diseases)
  • Oculoplasty (cosmetic and reconstructive surgery)
  • Ophthalmic Oncology (Cancer Related)
  • Pediatric ophthalmology (treatment of children)
  • Uveitis and Ocular Immunology (Inflammatory Eye Diseases)
  • Vitreoretinal diseases (involving the retina or vitreous humor)

Training and Certification

An ophthalmologist is a physician (MD) or an osteopathic physician (DO) who specializes in eye and vision care. To enter medical school, you must first complete a bachelor's degree, complete advanced medical studies (including advanced math, science, and biology), and take the Medical Competency Test (MCAT).

Medical school includes two years of classroom instruction and two years of clinical rotation in various healthcare settings. Upon graduation, you will need to obtain a medical license from the state where you want to study.

Typically this includes taking the United States Health Care Licensing Exam (USMLE) if you are a physician, or the Comprehensive Osteopathic Medicine Licensing Exam (COMLEX) if you are a physician. Some states also require a government exam.

Once licensed, you will need to complete a one-year internship in direct patient care. This will be followed by a one-year residency in general surgery and a three-year residency in ophthalmology.

Upon completion of your residency, you can earn a board certificate by passing a written and oral exam conducted by the American Board of Ophthalmology (ABO). The certificate is valid for 10 years, during which you must complete regular continuing education (CME) courses to be eligible for recertification.

Some ophthalmologists will undertake an additional 1 to 2 year internship to specialize in a specific area of practice. For example, a pediatric scholarship offers an additional year of study, while a corneal scholarship generally requires two.

Recording tips

Seeing an ophthalmologist can be stressful for people who find eye procedures nervous or uncomfortable. To calm your nerves, it helps to know what to expect if you are referred for treatment.

Your first visit to an ophthalmologist will require a comprehensive exam, which will take about an hour and a half to complete. It may take longer if you need a specialized exam or if you have a complex eye condition.

Be sure to bring your ID, insurance card, and a list of all the medications you are taking. If you have had eye surgery in the past, take any medical records you have with you or ask your healthcare professional to send them to you electronically prior to your visit.

Feel free to ask any questions that will help you better understand your condition and its procedures. Examples include:

  • Can you do a vision test and tell me what these tests mean?
  • What is the reason for the loss of vision?
  • Is my condition stable or can I lose sight more?
  • What symptoms should you watch out for?
  • What treatments are available and what do they include?
  • What is the probability of success?
  • What are the risks and possible side effects?
  • What should I avoid during treatment?
  • Are there alternative treatments I should consider?
  • What can happen if I decide not to receive treatment?

Always check if the recommended treatments are covered, at least in part, by your health insurance. This includes checking to see if health care facilities and labs are network providers .

Otherwise, ask your healthcare provider or insurance company for a list of in-network providers if availability is an issue. You can verify your credentials on the health care provider confirmation web page .

Get the word of drug information

There are qualities and characteristics that every ophthalmologist needs to be successful. These include exceptional manual skills, excellent hand-eye coordination, and the ability to communicate effectively and compassionately to alleviate patient anxiety.

Training can be especially tedious for young ophthalmologists, given the stress associated with vision loss and the minute details related to work. According to a 2018 survey by the University of Washington, at least 63.3% of residents experienced burnout while studying.

As with other healthcare providers, ophthalmologists can manage their own practice or join a group practice with healthcare provider partners. They may also work as employees of a hospital, an outpatient clinic, an academic or research setting (a Ph.D. is usually required).

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