It’s certainly possible this thread might sink like a stone, but I figured I would give it a shot anyway. Maybe some other people on this board are interested in Optometry as a career, or are curious about the training Optometry students go through. It’s currently blizzarding outside, so I have some free time to answer questions!
To get the thread rolling, I’ll start by saying that Optometry is actually one of the most misunderstood careers out there, considering that nearly everyone has come into contact with an optometrist at one time or another – people generally think that a) I’m studying to be an optician, and have will graduate with a two-year post-high school degree, or that b) I’m going to medical school to learn to perform surgery on the eye. I’m sure Dopers are more savvy than most, though.
I’m a fourth-year Optometry student, meaning I have a four year college degree and went to graduate school for four years after that, so 8 years of higher education in total (plus a possible 9th, as I’m applying to residencies for next year at this moment.)
Currently I’m doing a clinical externship at a nationally known low vision center; I work with people who have “low vision,” or are legally blind, and I use eyeglasses, magnifiers, telescopes, and various electronic devices to help them see, read, or perform daily tasks.
Prior to that, I did an externship at a VA (Veteran’s Administration) hospital, where I did a lot of “primary-care” optometry (basically, prescribing eyeglasses; contact lenses are not a big part of VA eyecare, at least at this hospital) and a fair amount of management of ocular disease, such as glaucoma.
Since I’m still a student, all of this is done under supervision, meaning a supervising optometrist comes in and either talks about the case to me, or looks over the chart before the patient leaves and makes necessary changes.
So, any questions?
are you trained in both manual old fashioned methods as well as the latest automated equipment?
are cataracts viewed as normal and there is no need to discuss with a patient until they complain? are cataracts mentioned to the patient as starting to develop but problems or actions are many years away?
Sure! I have one.
A few years ago, I was at my optometrist’s office complaining that I had some dizzy spells.
He pulled out a blood pressure cuff and verified that my pressure was normal, and then recommended that I see my GP, since he couldn’t find any vision-based issues. (I did - turns out I’m pre-diabetic. Fun stuff.)
Prior to that visit, I had never seen the blood pressure cuff there.
My question is - how much “general” medical training do you go through, as opposed to eye/vision specific? Is there much overlap? And I don’t mean that to trivialize what you’re learning and doing - just differentiating.
I’m at that age where I’m starting to have a bit of trouble reading very small print. Should I bother getting checked out by an optometrist for a proper prescription for glasses, or just buy a pair off the rack at the drugstore?
Yup. One interesting example is the method used to get an estimate of your eyeglass prescription. Most optometrists’ and ophthalmologists’ offices use something called an autorefractor, which is quick, easy and (nowadays, at least) fairly accurate. However, the old-fashioned way is retinoscopy, which involves simply shining a light into a patient’s eyes, then using lenses held in front of the eye and seeing the pattern of the streak that shines off the retina to get an estimate of the Rx. (That description might sound simple, but’s actually kind of complicated, and takes a lot of practice to do accurately.)
So why bother with a retinoscope given the ease of use of an autorefractor? Well, not everyone can get into the autorefractor. Infants and very young children, or the wheelchair bound, or those with ocular disease or media opacities (such as cataracts) either can’t get look into an autorefractor or will not give an accurate result. The VA hospital I worked in had a retirement home that was associated with it, and on occasion we’d get a patient who simply could not sit up and be tested via autorefractor; retinoscopy was the only way to get a starting point for an accurate Rx for these patients. So it was important to teach us both methods.
There’s a lot of interesting retinal imaging technology that we learn about too. In the past few years OCTs (ocular coherence tomography) and other equipment used to analyze the health of the retina and optic nerve has gotten quite sophisticated, and we are trained to use/analyze those imaging devices (OCT, HRT, GDx.)
Depends on the doctor, but I can tell you that nearly everyone over a certain age has some lens changes, though they might not cause symptoms. In some cases these are actual opacities which obscure vision and in some cases just lens “yellowing,” but technically any lens change is a cataract. If someone comes in with some lens yellowing and no complaints of blurred vision, haloes or glare problems, and still sees 20/20, I personally won’t mention it, because why say the word “cataract” and get them nervous? If their vision is slightly reduced, I would tell the patient they have a “small cataract” but it’s not having a great effect on their vision and doesn’t need immediate removal if it’s not bothering them. I also let them know that there’s really no way to know in the future if it will get bigger or not, but if they’re having problems with glare or blur, to feel free to come in and get it checked out.
Digital is the new Analog posted:
No offense taken! We take physiology, general anatomy (concentrating on head/neck), biochemistry, pharmacology, immunology, microbiology, pathology, neuroscience, as well as eye-specific anatomy and disease courses and vision/optics courses; I can copy and paste a list of coursework from my school’s website if you’re really curious. As far as blood pressure goes, we take a class in general medical techniques that teaches blood pressure and pulse measurement, lymph node palpation, setting up IVs, and some other stuff.
Blood pressure in particular is tested on the Optometry licensing exam, because hypertension can cause retinal signs and potentially, an eye doctor could be the first person to see the signs of hypertension in an otherwise healthy patient. However, the thing about blood pressure is it’s not something that we do every day in clinic, and so I suspect many of my classmates, myself included, are not as great at it as we could be. I certainly know I need to review before my licensing exam. I’d like to get good at it as it’s an important skill.
Robot Arm posted:
I think you should go to an optometrist, but not necessarily for a “proper” prescription – if you can see clearly in the distance, chances are that over the counter readers will work just fine for you, as they’re designed for people who have no distance prescription and just need reading correction (or, of course, just want reading correction to wear over their contact lenses.) One possible exception is if you have very small or very large distance between your pupils, or an uneven ear height, or some other issue that makes OTC glasses problematic.
I just think that people who are approaching middle age should have their eyes examined and be dilated to make sure everything’s ok. While you’re there of course the optometrist can determine your prescription. You never know, it’s possible you’re walking around with slightly reduced vision in the distance and never noticed — maybe things can be made even clearer.
I have astigmatism and need glasses to see far away so I guess I’m nearsighted. For some reason though I can read things such as the microprint security features on checks and the fine printing on gold objects that have the 14k stamps for example. I can basically see things with the naked eye that other people can’t. Is this normal? My optometrist said that I may never need reading glasses like most people do when they get older.
Any insight?
Thanks:)
It’s certainly possible; it really depends on your prescription. In general, the point at which things are clear for a nearsighted person wearing no eyeglass correction is the inverse of the dioptric power of their refractive error, in meters. (I know that sounds scary, but it’s actually very simple. 2 diopter myopes (i.e. nearsighted people) can hold things (1/2diopters), or .5m, or 50 cm away. A 4 diopter myope will need to hold things about (1/4 diopters) or .25 m, or 25 cm, to see it clearly.)
If you’re a 2.5-3 diopter myope then you basically will have the same power with your glasses off as a “normal-sighted” person who is wearing reading glasses, and at a comfortable reading distance (about 40-33 cm away.)
If you’re a nearsighted person with an even stronger prescription, (say, 4-5 diopters) you will have to hold written material closer with your glasses off, but you get correspondingly greater magnification by doing so. So, you will be able to see very small print, including print that many normally-sighted people would need a magnifying glass to see. A higher prescription than 5 diopters works the same way, except that people may need to hold things so close without their glasses that there is a chance they might see double (if you hold your finger very close to your nose, you’ll see it may look double too, unless you concentrate very hard. This is rather unpleasant while reading, as you might imagine.)
Reading glasses for patients with low vision are often made in very high amounts, such as +10.00 diopters. In that case, people with reduced vision need the high magnification that comes from holding things quite closer to the eye. To compensate for the double vision induced by reading, prism is ground into the glasses to move the images and make them single.
Anyway to sum up all that, it’s certainly possible that you can see very fine print and small things with your glasses off, if you are nearsighted and have a sufficiently high prescription.
Ophthalmologists are trained in surgery while optometrists are not; if you think that you are interested in surgery or laser treatment of the eye, it makes sense to see an ophthalmologist.
Other than that, there’s a bit of overlap; optometrists treat and diagnose eye diseases, and of course prescribe eyeglasses and contact lenses. Obviously ophthalmologists are trained to treat and diagnose eye diseases as well. I do think that some people don’t realize what optometrists receive training in, however; when I was at the VA hospital I had one patient who said to me (not realizing, I think, that the person who had just given him a dilated eye exam was an optometric extern) that he had diabetes and therefore had been told he “had to see an ophthalmologist.”
Still, there are cases where it makes sense to see an ophthalmologist over an optometrist; for example if you have an eye emergency that you think might require immediate treatment, I would recommend seeing an ophthalmologist who specializes in that particular problem if time is of the essence. If you suddenly saw bright, flashing lights and a “curtain” fall over your vision in one eye, it wouldn’t make sense to run off to the general ophthalmologist or an optometrist — in that situation you should visit a retinal specialist; a type of ophthalmologist who specializes in treatment of retinal diseases. If someone came into an optometrist-only office with a retinal detachment, they would be sent to a retinal specialist as soon as it was diagnosed.
On the other hand there are many people who probably would be better off seeing an optometrist as opposed to an ophthalmologist – people who simply have “blurry vision,” would be better off going to see an optometrist first, who could determine if it’s purely refractive (i.e. can be corrected with glasses or contacts) or something else. It’s kind of like going to a primary care doctor if you have an upper respiratory infection rather than a pulmonologist straight off. Any optometrist worthy of the degree will refer to an ophthalmologist if necessary.
And there are plenty of people who – not to offend any medical colleagues – think optometrists are, on average, better at “refracting” – that is, coming up with the eyeglass prescription – than are many ophthalmologists. (This isn’t always the case – I’ve met some ophthalmologists who are quite good at this, one of whom works at the low vision center where I’m an extern. But there are some ophthalmologists who don’t put a lot of time into the refraction, or else have a technician working for them to do it, which can lead to a less accurate result.)
So, I guess I’ll just sum up by saying it’s kind of controversial, but there are probably plenty of people who could see either an optometrist or an ophthalmologist, and be well-served by either. But if you’re sure you’ll need surgery, it makes sense to go straight to an ophthalmologist, and if you know you need new eyeglasses or a contact lens fitting, it makes sense to go straight to an optometrist. There are a variety of eye diseases that are treated by both optometrists and ophthalmologists, and it’s certainly part of our training. For example, at the VA hospital where I externed, the diagnosis and treatment of glaucoma were heavily emphasized.
One caveat – places like Lenscrafters and Walmart/Target Opticals are perfectly fine places to get an eye exam and a pair of glasses, but they generally do not have the technology (such as imaging devices, visual fields, etc) to manage chronic conditions; they exist basically to support the optical side of the practice and not the “eye health” side of the practice. So maybe this goes without saying, but I wouldn’t go to one of those places if I thought I had been diagnosed with an eye disease; I would go to a clinic, a hospital, or a medically oriented private practice employing either optometrists or ophthalmologists.
Those “Which is better, 1 or 2?” questions when you’re flipping around lenses always stress me out since it seems a lot of the time there’s no discernible difference in what’s being shown to me, but I think it will negatively impact my prescription should I “choose wrong.” How much is it going to screw up my contact lens prescription should I get choose the wrong value a few times?
I have a few questions too - I am going to see my Opthamologist next month for follow-up, just to let you know up front.
I have/had cataracts in both eyes; the left was the worst. I had the surgery on the left eye and oh boy is my vision improved in that eye! I won’t have an actual eye test until 1/11 when I see the optometrist, so I don’t know if I’m 20/20 in that eye, but I may well be. I have been glasses-free, only needing the reader glasses to read with.
Since the surgery it seems that my right eye has gotten much worse, however! And the yellowing of vision is really noticable now. I want to get the other eye done - cataracts don’t come back now, do they? Could the right eye have gotten that much worse so quickly?
It feels so strange to go without glasses! I’d worn them since I was 7 or so!! I am enjoying it, really, just still seems strange. And the best thing is that now I can actually see when I’m in the shower!! I hope you’re able to figure out my questions, btw. Sorry!
Depends on the skill of the person doing the refraction. We’re trained not to be misled by too great an amount – there is usually a starting point, such as an old Rx, a retinoscopy value, or an autorefractor value – and we know your starting visual acuity, so with experience the refractionist has a good idea of how much your prescription should change, and values that seem “wrong” are double-checked.
But remember, if there’s no discernible difference, it’s because you’re being shown two lenses (or cylinder axes) that are very similar, and you can let the doctor know that too. The whole point of the exercise is to get to two lens values where the patient is unable to discern a difference, actually. Unless you really have a poor refractionist, they’re not going to be misled too much by your responses.
tarragon918 posted:
Congrats! It sounds like your surgeon did a great job. I think there are two questions here. One is if cataracts can change quickly – yes, they can. Sometimes it’s because of medication or systemic issues. Not to scare you, because your cataract probably has nothing to do with either of these things, but systemic steroids are notorious for causing cataracts (and other medications can as well,) and uncontrolled blood sugar can lead to lens changes as well.
But it can very well happen on its own, with no systemic “cause”. Sometimes the cataract is there all the time and simply becomes noticeable suddenly. You can particularly see that with what are known as “cortical” cataracts, because they are “spoke-like” in formation. Here’s a picture:
http://www.opt.indiana.edu/NewHorizons/Cortical.html
(scroll down a little bit for the photo.)
You can see in that picture that a small cataract that grows just a little bit can go from “peripheral” in the lens to “central,” and central cataracts will have a much greater effect on vision.
The other question is if cataracts grow back. The cataract itself does not grow back because it’s removed during cataract surgery. Modern cataract surgery leaves behind the posterior lens capsule as a means of stabilizing the new lens implant. That capsule can occasionally opacify, and a procedure called a “YAG capsulotomy” involves using a YAG laser to clear the opacification. So you’ll sometimes hear patients say “my cataract grew back,” although that isn’t exactly what happened. I wouldn’t worry about it, though; the laser procedure is quick, easy, and painless and has an excellent success rate.
I was going to ask you a question about using this old manual lensmeter, but I managed to figure it out before I hit submit. (I was trying to confirm a prescription using a narrow-lensed pair of glasses that has progressive bifocals, and figured out how to tell if it’s in plus-cylinder mode.)
On that note - are you trained to favor plus-cylinder or minus-cylinder refractions? It seemed like plus is favored by research (which I’m in) and minus by clinics, but IIRC my husband’s prescription from Lenscrafters was given in plus-cylinder.
I have a question I should have asked one of the many optometrists I’ve seen in the almost 35 years that I’ve been wearing glasses. I did mention the problem, and the optometrists had to deal with the difficulty caused by the problem, but somehow it never occurred to me ask “Why is it this way?”
In a nutshell, bright lights (even one as simple as the flashlight used by general practitioners) have always made it very, very difficult for me during any type of eye exam whatsoever. I’ve had to break off and pull my head away, which of course resulted in the optometrist (or any eye examiner) having to try 2 or 3 times to get the one result. It’s not really pain, per se, but the strain I have to exert to keep my head stationary and my eye as wide open as I can is considerable. Usually I can feel the cords in my neck standing out. I know it’s only a few seconds, but as each second passes, the effort required to keep my eye open in the face of a very bright light being shone into it builds and builds. At least once per exam, I’ve had to pull my head away, breaking off the exam; sometimes it’s at least once per eye per exam. I’ve always managed to finish an examination, but my eyes will water a considerable amount, such that I need to wipe them dry between attempts (obviously I’m not wiping the eyeball itself dry, just the tears around my eye).
I don’t really notice any other problems with bright light, strong sunshine, etc., as long as I don’t look directly at the source for more than a second. I gather this is normal, and happens to almost everyone. Going outside on a sunny day may call for sunglasses, but they aren’t required.
Is this a common problem? None of the optometrists (or their assistants who’ve conducted such exams) I’ve encountered have really had anything to say about it, and as I said I’ve never asked directly. Is it uncommon, but still seen more than a little in the average practice? How many times have you yourself had a patient who exhibited this problem? As I stated, I’ve known I had this problem for as long as I’ve worn glasses, over three decades now, but I haven’t noticed my vision worsening in the presence of or due to bright lights.
We were taught minus cylinder refracting exclusively, although of course we know how to transpose to plus cylinder. The reason my professor gave was that retinoscopy and refraction in minus cylinder work better to control accommodation – generally with retinoscopy, you “ret” the sphere first, and then dial in the cylinder to “ret” the other axis. With plus cylinder, the patient could accommodate through the prescription and give you incorrect cylinder and sphere values. Even with refraction, you generally refine sphere, then cylinder and sphere again. Of course, this assumes you haven’t increased cyl amount above what they actually need, because then they could over-accommodate through minus cylinder. But if you’re starting from the old Rx, you’re usually starting with a lower cylinder amount than what they could potentially accept, since many people “cut the cyl.”
I’ve heard ophthalmologists tend to favor plus cylinder because it is an easier medium for various surgeries, like cataract surgery or Lasik. I’m not sure if that’s true or not though.
tripthicket posted:
You’re sensitive to light. I’ve seen patients like this, some of whom leave an exam with tears streaming down their cheeks, some of whom can’t sit still during ophthalmoscopy (which is where those bright lights come out) at all. Some people are just more photophobic than others – usually light-eyed people, but not always. There are eye conditions that can cause light sensitivity, but the majority of people who act like you describe don’t have any organic problems with their eyes.
Don’t feel bad. The lights used during an eye exam are really bright! Sometimes I feel sorry for my patients – as a student, it might take me longer to get a good view of the retina than someone with more experience, although I’m significantly better at it than I was a year ago. I know it’s not your fault, but blinking or moving your eyes around just makes it more difficult for the doctor. And some patients are so difficult to get a view in due to “lack of cooperation,” (yes, I know that’s not really the issue here, but I don’t have a better term for it,) that docs will just write “patient uncooperative” on the chart.
Some tips: when they shine a light into one eye, try to concentrate and really look at something in your field of view with the other eye. Obviously don’t move your eyes around too much (the retina moves when you do that, and it’s harder for the practitioner to get a good view of what they’re trying to see when the back of the eye is flying all over the place!) but try to really concentrate and study something like, say, a picture on the wall. This helped quite a bit when I had slow classmates practice ophthalmoscopy on me and I was trying my hardest not to blink.
Finally, there’s nothing wrong, if you’re really in discomfort, to ask the doc if they can take a picture (though you might need to be dilated depending on the camera, and of course not all places have a camera. And, finally, cameras generally don’t get as far out into the periphery of the retina as a thorough eye examination with ophthalmoscopy will get).
Thanks for the helpful and quick answer. While I’m a worrier by nature, especially as I get older, this hasn’t really been a worry of mine, other than at the time an exam was happening. Was really just reading along, saw this thread, and thought I’d chime in. Good to hear that I’m “normal” in at least one aspect.
Thanks so much for your encouraging answer, cromulent. I do have diabetes but it’s ::knocks on wood three times:: -fairly- under control. I’m planning to ask the opthamologist when we can schedule the other eye now.
Definitely. Depending on the light, I can sometimes feel the warmth of the light source on my face and eye, and I’m considered a very “good patient” in terms of not being photophobic, not having to blink often, etc. The warmest ones really feel like they’re actually drying out my eye.
I had a coworker who didn’t have problems with the sun, but would have major problems if other coworkers (techs, photographers) were trying to use her as a test person for certifying equipment/personnel and were shining bright lights in her eyes; she would blink and flinch a lot. Typically we would just call it “photophobia” but since she was a friend, we just called her a bad patient.
You might do well to mention that you’re light sensitive ahead of time and just tell them that you have a lot of trouble with pain and eye watering (or however you’d describe the sensation) during tests involving bright light. It’s OK, as people can’t help light sensitivity, and I can assure you they’ve almost certainly had worse, intentional behavior from other patients. I was talking shop with the optometrist during my husband’s eye appointment, and she mentioned one who was startled at the “puff of air” eye pressure test and actually threatened to sue. :smack: No, nothing ever came of it.
I want to get the other eye done - cataracts don’t come back now, do they? Could the right eye have gotten that much worse so quickly?
(I was trying to confirm a prescription using a narrow-lensed pair of glasses that has progressive bifocals, and figured out how to tell if it’s in plus-cylinder mode.)
in at least one aspect.