General | Cataract | Glaucoma & Macular Degeneration | Ocular Surface Disease & Eyelids | Retina | Miscellaneous
How Are Ophthalmologists, Optometrists, and Opticians Different?
Ophthalmologists (Eye M.D.s) are different from optometrists and opticians in their training and in what they can diagnose and treat. Dr. Haas is an ophthalmologist.
As a medical doctor (physician), an ophthalmologist is licensed to practice medicine and surgery. He or she diagnoses and treats all eye diseases, performs eye surgery, and can prescribe and/or fit glasses and contact lenses. Though Dr. Haas can give a written prescription for glasses, he does not sell glasses or contact lenses at his office.
- four years of college;
- four years of medical school;
- one year of internship; and
- at least three years of residency (hospital-based training) in the diagnosis and medical and surgical treatment of eye disorders.
While all ophthalmologists specialize in eye problems and can treat all conditions, some decide to concentrate in a specific area of medical or surgical eye care. These ophthalmologists are called subspecialists. They usually complete a fellowship, which requires one or two more years of training in the chosen area. Dr. Haas is a comprehensive ophthalmologist who specializes in cataract surgery, but sees and treats all other medical disorders of the eye, including macular degeneration, diabetes, glaucoma and dry eyes. He works with local subspecialists when a patient’s medical condition requires care beyond his training.
Optometrists are doctors of optometry, licensed to practice optometry. They complete
- two to four years of college;
- four years of optometry school;
- optional medical residencies for additional training.
Optometrists focus on performing examinations for glasses and contact lens fittings, but some will perform non-surgical medical examinations as well for various eye disorders. In some states (including Colorado), optometrists can prescribe certain kinds of drugs to help diagnose and treat different eye conditions. Optometrists generally do not perform surgery, but may work with ophthalmologists in performing medical examinations and post-operative visits in patients after their surgery.
An optician is licensed by the state to make optical aids. He or she fits, adjusts, and dispenses eyeglasses, contact lenses, and other optical devices according to the prescription of a licensed ophthalmologist or optometrist. Training for opticians varies from a preceptorship to two years of opticianry school.
Complete Eye Examination
A complete eye examination does more than determine how clearly you see from a distance and which lens prescription will give you the best possible vision. Dr. Haas will also run a number of tests to check the health and function of your entire eye.
If you have never had an eye examination or are seeing us for the first time, we will begin by asking you questions about your medical history, your family’s medical history, and any vision problems you may have.
A complete eye examination will include many or all of these painless tests:
A visual acuity test measures how well you can see from a distance. Covering one eye at a time, you will look at an eye chart and be asked to identify letters that get smaller as you read farther down the chart.
If your visual acuity test indicates that you need corrective lenses, you may be given a refraction test to determine the correct prescription. Dr. Haas or his staff may use retinoscopy to estimate your prescription by shining a light into your eyes to see the movement of the light reflected by your retina. We will finalize your prescription by asking you to look through a device called a phoroptor that has many different lenses in it. You will be asked to compare a series of two lens choices and evaluate which lens combination provides you with your best possible vision correction.
To test the function of your eye muscles, Dr. Haas or his staff will have you follow the movement of an object in many directions, looking for weak muscles or poor control of the muscles that move your eyes.
To test your peripheral vision, which is what you are able to see to the sides of your visual field when you look straight ahead, we use a visual field test. You may be asked to cover one eye at a time and, while looking straight ahead, tell us when you can see a hand or other object as it moves inward from outside your visual field. Or, a computer program may be used to test your visual field. If so, you will look straight ahead into a special device, often a lighted bowl-shaped instrument, and press a button each time you see a flash of light. Dr. Haas can use your responses to see if there are any blind spots in your visual field.
Dr. Haas will use a slit-lamp microscope to examine the front part of your eye, including the cornea, conjunctiva, sclera, iris, anterior chamber and lens. You will sit at the slit lamp, which greatly magnifies your eye and shines a bright line of light into it, allowing Dr. Haas to examine your eye closely. Before the test, you may be given eyedrops with fluorescein, an orange dye, to make your cornea easier to see. This dye will wash away naturally.
To test for glaucoma, a disease that can cause blindness when too much pressure in your eye damages the optic nerve, Dr. Haas or his staff will use a tonometer to measure your intraocular pressure.
Applanation tonometry is another option. Dr. Haas or his staff will give you eyedrops containing an anesthetic and fluorescein dye to numb the front surface of your eye and will then use a manual tonometer to gently touch your cornea and measure the force required to flatten it. This procedure is quick and painless (significantly more so than the air puff test), and the anesthetic will wear off in 15 or 20 minutes.
We may use pachymetry to measure the thickness of your cornea, which helps evaluate the accuracy of your intraocular pressure measurement. After applying numbing eyedrops, Dr. Haas or his staff will use ultrasonic waves to measure your corneal thickness. This test is also a critical component of evaluating a patient’s candidacy for LASIK surgery.
A retinal examination explores the back of your eye including the retina and optic nerve. First, depending on the type of retinal examination Dr. Haas chooses, your pupils will be dilated with eyedrops. If he chooses to use direct examination, he will shine a light in your eye and use a device called an ophthalmoscope to look at the back of your eye. Alternatively, using a method called indirect examination, Dr. Haas may use a much brighter light mounted on his forehead to examine your eye while holding it open.
Finally, to get the best look at the back of the eye, Dr. Haas may choose to perform a slit-lamp examination, which combines the use of the slit lamp and special lenses. Retinal examinations usually take about five minutes, but the eyedrops will continue to blur your vision for several hours. You may not be able to drive and will be sensitive to bright light, but this is temporary and should resolve in several hours.
Eye Care Facts and Myths
Myth: Reading in dim light is harmful to your eyes.
Fact: Although reading in dim light can make your eyes feel tired, it is not harmful.
Myth: It is not harmful to watch a welder or look at the sun if you squint or look through narrowed eyelids.
Fact: Even if you squint, ultraviolet light still reaches your eyes, damaging the cornea, lens, and retina. Never watch welding without wearing the proper eye protection. Never look directly at a solar eclipse.
Myth: Using a computer screen is harmful to the eyes.
Fact: Although using a computer screen is associated with eyestrain, fatigue and dry eyes, it is not harmful to the eyes.
Myth: If you use your eyes too much, you will “wear them out.”
Fact: You can use your eyes as much as you want—you will not wear them out.
Myth: Wearing poorly fitting eyeglasses damages your eyes.
Fact: Although a good fit is required for good vision, a poor fit does not damage your eyes. In children it is important that glasses are the correct prescription to assure proper development of vision.
Myth: Wearing poorly fitting contact lenses does not harm your eyes.
Fact: Poorly fitting contact lenses can be harmful to your cornea, the clear front window of your eye. Make certain your eyes are checked regularly if you wear contact lenses. Dr. Haas recommends to never sleep in daily wear contact lenses, unless instructed to do so by an eye doctor for medical reasons. Sleeping in any contact lens greatly increases the risk of infection.
Myth: You do not need to have your eyes checked until you are in your 40s or 50s.
Fact: Several asymptomatic yet treatable eye diseases (most notably glaucoma) can begin prior to your 40s.
Myth: Safety goggles are more trouble than they are worth.
Fact: Safety goggles prevent many potentially blinding injuries every year. Keep your goggles handy and use them!
Myth: It is okay to swim while wearing soft contact lenses.
Fact: Potentially blinding eye infections can result from swimming or using a hot tub while wearing contact lenses.
Myth: Children will outgrow “crossed” eyes.
Fact: Children do not outgrow truly crossed eyes. A child whose eyes are misaligned has strabismus and can develop poor vision in one eye (a condition known as amblyopia), because the brain “turns off” the misaligned or “lazy” eye. The sooner crossed or misaligned eyes are treated, the less likely the child will have permanently impaired vision.
Myth: A cataract must be “ripe” before it can be removed.
Fact: With modern cataract surgery, a cataract does not have to mature before it is removed. When a cataract interferes with your regular daily activities, you can talk with Dr. Haas about having it removed.
Myth: Cataracts can be removed with lasers.
Fact: Cataracts cannot be removed with a laser. The cloudy lens must be removed through a surgical incision. However, after cataract surgery, a membrane within the eye may become cloudy. This membrane can be opened with laser surgery.
Myth: Eyes can be transplanted.
Fact: The eye cannot be transplanted. It is connected to the brain by the optic nerve (containing over 1.2 million individual nerves), which cannot be reconnected once severed. However, the cornea can be transplanted.
Myth: All eye-care providers are the same.
Fact: An ophthalmologist is a medical doctor (M.D.) or doctor of osteopathy (D.O.), uniquely trained to diagnose and treat all disorders of the eye. An ophthalmologist is qualified to perform surgery, prescribe and adjust eyeglasses and contact lenses, and prescribe medication. Dr. Haas is a board-certified M.D. (physician-surgeon).
An optometrist (O.D.) is not a medical doctor but is specially trained to diagnose eye abnormalities and prescribe, supply, and adjust eyeglasses and contact lenses. They do not perform surgery. In most states (including Colorado), optometrists can also use drugs to treat certain eye disorders. Dr. Haas works with and corresponds with many of the area optometrists to make sure that that your personal eye-care is tailored to your needs.
An optician fits, supplies, and adjusts eyeglasses and contact lenses. An optician cannot examine the eyes or prescribe eyeglasses or medication.
How to Instill Eyedrops
(Click HERE for video)
Infections, inflammation, glaucoma, and many other eye disorders often are treated with medicated eyedrops.
It is important to remember that all medicines can have side effects. Surprisingly, even the small amount of medication in an eyedrop can create significant side effects in other parts of the body. There are ways to decrease the absorption rate of the eyedrop into the system and to increase the time the eyedrop is on the eye, making the medicine safer and more effective.
Instilling eyedrops may seem difficult at first but becomes easier with practice. To place an eyedrop in your eye, first tilt back your head. Then create a “pocket” in front of the eye by pulling down on the lower with an index finger or by gently pinching the lower lid outward with the thumb and index finger. Let the drop fall into the pocket without touching the dropper tip to your eye, eyelid, or fingers, so as to prevent contaminating the bottle.
Immediately after instilling the drop, press on the inside corner of the eyelids next to the bridge of your nose for two to three minutes with your thumb and forefinger. This prevents most of the drop from traveling down the tear duct to the back of the throat, where it then is absorbed by the rest of the body. Keep your eyes closed for three to five minutes after instilling eyedrops.
Before opening your eyes, dab unabsorbed drops and tears from the closed lids with a tissue.
If you are taking two different types of eyedrops, wait at least five minutes before instilling the second drop. Because the volume of a single drop exceeds the capacity of the surface of the eye, it serves no purpose to use two drops at the same time.