Who should care for your glaucoma?

Polls show that Americans have trouble telling the difference between the various kinds of eye care people. Let’s make it easy. There is an optician, who makes glasses and frames, but doesn’t look into the eye or treat eye disease. They essentially follow written instructions from eye doctors, and often perform important services in making glasses effective and comfortable. The optometrist goes to school for four years in studying normal eye function and eye diseases. They are not doctors of medicine (M.D./D.O.) and do not go to medical school to study general body disease. During their 4 year study, they typically get to examine people with eye disease under a faculty of other optometrists, but only in some optometric schools that partner with eye surgeons do they see persons who are being actively treated surgically. Many optometrists then take an extra year or more of specialized training in care of eye diseases. During the 1990s, state legislatures all over the U.S.A. passed laws permitting optometrists to prescribe eye drops for glaucoma, but not to treat glaucoma with laser or surgery. Only a small proportion of the prescriptions written for glaucoma in the U.S.A. are now written by optometrists alone. At the Wilmer Glaucoma Center, we have several excellent optometrist faculty members and work in a team approach, but the care of those with glaucoma is performed by ophthalmologists.

An ophthalmologist is an M.D. or D.O. who went to four years of college, four years of medical school, one year of internship, then three years of specialized resident training in eye disease and eye surgery. After this training, an extensive written and oral set of examinations is given by the American Board of Ophthalmology, and only those who pass both are Board-certified ophthalmologists. You can find out if the ophthalmologist you want to see is Board-certified by going to the following web site: https://www.abms.org. You will need to provide an email address and a password that you make up to log in. The web site does not indicate which specialty board the doctor is certified, but if you are looking up an ophthalmologist, it is likely that it indicates board certification in eye medicine.

Many ophthalmologists do one to three more years of specialized fellowship training in an area of eye disease, such as glaucoma care. This involves working in an office that has a large proportion of patients with glaucoma and observing and participating in laser and surgery procedures. Those fellowship-trained glaucoma specialists who are known to their colleagues as having excellent training and experience can be voted into membership in the American Glaucoma Society. At its web site (https://www.americanglaucomasociety.net/), there is a patient resource center that allows anyone to find the names and addresses of Glaucoma Society members. All board-certified ophthalmologists have studied and passed testing on all aspects of glaucoma care, and much of the care given to glaucoma patients in the U.S.A. is carried out by non-glaucoma specialists, including laser and surgical procedures. Some glaucoma specialists are full-time employees of universities and teach fellows, residents, medical students and other eye doctors about glaucoma. Our Wilmer Institute Glaucoma Center of Excellence currently has many full-time faculty members who only care for glaucoma and its associated problems. Most often, academic university glaucoma doctors see only persons with glaucoma and work with other advanced specialists at their Institution in other areas of ophthalmology. University faculty glaucoma specialists also perform research both with human patients and in laboratories.