What is the difference between an
Ophthalmologist, Optometrist and Optician?
An optician can either be a dispensing optician or an ophthalmic optician (see below "Optometrist"). Unlike an ophthalmologist or an optometrist, a dispensing optician is not qualified to test sight.
The term 'optician' is loosely used in the UK to describe an individual who deals with all things eye-care related. This includes those who work in a high street store to fit contact lenses. In the past, the opticians even made lenses. Now, this is mostly outsourced to separate manufacturers to maximise time and money.
The dictionary definition of an optician is:
'a person qualified to prescribe and dispense glasses and contact lenses, and to detect eye diseases (ophthalmic optician) or to make and supply glasses and contact lenses (dispensing optician).'
An ophthalmologist is a doctor/surgeon who has become specially trained in eye care. They identify and treat conditions or diseases that manifest in the eye through medicine and surgery.
An ophthalmologist is required to go through years of pre-medical education and medical school with medical practitioners. This is usually followed by an internship, and several more years of practical, hands-on surgical training. After this, they are certified to practice as a medical doctor officially.
The ophthalmologists also specialise in different diseases of the eye, such as strabismus, glaucoma, and macular degeneration. They may also assist in the monitoring of systemic diseases such as diabetes mellitus.
Optometrists are qualified eye care professionals and involved in a routine eye check. They do not prescribe eye medications and performed eye surgeries.
SMILE Laser Eye Surgery
Research is showing SMILE produces virtually the same visual acuity as LASIK for the correction of nearsightedness, without the need to create a LASIK-style corneal flap.
In one study of 328 people who underwent the SMILE procedure, all but one had uncorrected visual acuity (UCVA) of 20/40 or better after surgery, and 88% had UCVA of 20/20 or better.
Also, it appears there may be less risk of dry eye symptoms after SMILE, compared with LASIK. SMILE does not require a large corneal flap like LASIK, so fewer corneal nerves are affected by the procedure. This may be why there is less risk of dry eyes after SMILE vs. LASIK.
The very small SMILE incision may also enable the cornea to maintain more of its strength and resistance to traumatic injuries after the procedure, compared with LASIK.
Also, research suggests SMILE eye surgery may be able to correct high amounts of nearsightedness than LASIK, with less risk of needing an enhancement procedure to attain a perfect correction.
Are there any downsides to SMILE when compared with LASIK or PRK?
For starters, SMILE can only correct nearsightedness. LASIK and PRK can also correct farsightedness and astigmatism.
Also, LASIK and PRK can treat higher-order aberrations (HOAs) that can affect night vision, whereas SMILE cannot. In fact, SMILE might increase HOAs to some degree.
And if you have residual refractive error after SMILE eye surgery, PRK usually is used for the enhancement procedure.
Most U.S. refractive eye surgeons charge about the same price for SMILE eye surgery as they do for all-laser LASIK — somewhere in the range of $2,000 to $3,000 per eye.
Factors that contribute to the fee surgeons charge for SMILE include:
The surgeon's experience
The practice location
Whether follow-up exams and enhancements (if needed) are included
If you are nearsighted and meet the other criteria stated above, you might be a good candidate for SMILE laser vision correction.
The next step is to have a comprehensive eye exam with your eye doctor and a consultation with a refractive surgeon.
LASIK Eye Surgery
Your eye doctor will perform a thorough eye exam to ensure your eyes are healthy enough for the procedure. He or she will evaluate: the shape and thickness of your cornea; pupil size; refractive errors (myopia, hyperopia and astigmatism); as well as any other eye conditions.
The tear film on the surface of your eyes also will be evaluated, and a precautionary treatment may be recommended to reduce your risk of developing dry eyes after LASIK.
Usually, an automated instrument called a corneal topographer is used to measure the curvature of the front surface of your eye and create a "map" of your cornea.
With wavefront technology associated with custom LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye to provide an even more precise map of aberrations affecting your vision.
Your eye doctor also will ask you about your general health history and any medications you are taking to determine if you are a suitable candidate for LASIK.
You should stop wearing contact lenses for a period of time advised by your doctor (typically around two weeks) before your eye exam and before the LASIK procedure. This is because contact lens wear can temporarily alter the natural shape of your cornea.
Before your LASIK surgery begins, numbing eye drops are applied to your eye to prevent any discomfort during the procedure. Your doctor may also give you some medication to help you relax.
Your eye will be positioned under the laser, and an instrument called a lid speculum is used to keep your eyelids wide open.
The surgeon uses an ink marker to mark the cornea before creating the flap. A suction ring is applied to the front of your eye to prevent eye movements or loss of contact that could affect flap quality.
After the corneal flap is created, the surgeon then uses a computer to adjust the excimer laser for your particular prescription.
You will be asked to look at a target light for a short time while your surgeon watches your eye through a microscope as the laser sends pulses of light to your cornea.
The laser light pulses painlessly reshape the cornea, although you may feel some pressure on your eye. You'll also hear a steady clicking sound while the laser is operating.
LASIK is performed on each eye separately, with each procedure taking only about five minutes.
Upon completion of your LASIK procedure, your surgeon will have you rest for a bit. You may feel a temporary burning or itching sensation immediately following the procedure.
After a brief post-operative exam, someone can drive you home. (You cannot drive after LASIK until your eye doctor sees you the following day and confirms your uncorrected vision meets the legal standard for driving.)
You should expect some blurry vision and haziness immediately after surgery; however, clarity should improve by the very next morning.
Your eyesight should stabilize and continue to improve within a few days, although in rare cases it may take several weeks or longer. For most people, vision improves immediately.
You may be able to go to work the next day, but some doctors advise at least one day of rest instead.
Also, it is usually recommended that you refrain from any strenuous exercise for at least a week, since this can traumatize the eye and affect healing.
Generally, you will return to see your eye doctor or your LASIK surgeon the day after surgery.
At this initial check-up, your visual acuity will be measured to make sure it is safe for you to drive without glasses or contact lenses. In most states, this requires visual acuity of 20/40 or better.
As with any other surgery, it's very important for you to follow your doctor's instructions and take any medication prescribed.
Also, avoid rubbing your eyes, as there's a small chance you could dislodge the corneal flap if you rub your eyes vigorously before the flap has securely reattached to the underlying cornea stroma.
Laser eye surgery offers numerous benefits and can dramatically improve your quality of life.
You may still need to wear glasses or contact lenses following laser vision correction, though your prescription level typically will be much lower than before.
While LASIK has an excellent safety profile, LASIK complications can occur. These include infection and night glare (from starbursts or halos appearing around lights).
A small percentage of people will need a LASIK enhancement, or "touch up" procedure, a few months after the primary LASIK surgery to achieve acceptable visual acuity.
While LASIK surgery has a high success rate, it is important that you discuss with your ophthalmologist or surgeon any concerns you may have before you consent to having the surgery.
PRK Eye Surgery
PRK, LASIK, LASEK and other laser eye surgeries are performed with slightly differing techniques. These techniques, along with recovery time and cost, are what may make one kind of laser vision surgery a better option for you than another.
For example, PRK completely removes the epithelium to access the cornea, and then the epithelium grows back. In LASIK and some other types, a flap is created in the epithelium and part of the cornea instead. The flap is folded back for surgery and put back in place afterward.
Because no flap is created in PRK, it is often recommended for people who have very thin corneal tissue. It can also be a good choice for those who have dry eyes, since the flap method sometimes makes dry eye symptoms worse.
PRK may also be a better option for people who are at higher risk of eye injury, such as from sports or certain jobs. Being hit or bumped in the eye can move the flap out of place, even after it’s healed.
Good candidates for laser vision surgery need to meet certain criteria, such as having overall good eye health and a stable lens prescription. Having PRK and other laser eye surgeries won’t stop myopia or hyperopia that are still progressing. If your lens prescription isn’t stable for at least a year before surgery, your vision could potentially regress after surgery.
It’s also important to note that PRK won’t prevent or correct presbyopia, the age-related loss of near vision that begins around 40. For most who develop presbyopia after PRK, wearing reading glasses for close-up tasks is the easiest solution.
To find out if you’re a candidate for PRK, you’ll need to visit an eye doctor for a comprehensive eye exam. The doctor will check to make sure you meet all the criteria and then help you decide if PRK is right for you.
It’s important to nap for a few hours right after PRK. When the numbing drops wear off, you will likely experience some soreness, a “foreign body” sensation, and slight burning and stinging. Napping the first few hours helps bypass the worst of the discomfort.
The epithelium that was removed will grow back on its own in about a week, and then your eye doctor can take out the bandage contact. During the first one to two weeks, you’ll still have blurry vision and extra light sensitivity.
Your surgeon will prescribe anti-inflammatory and antibiotic eye drops to use during your recovery. You’ll also need to use lubricating eye drops for several months after PRK to help combat dry eye symptoms. After the first day, most people find that over-the-counter pain relievers manage any lingering discomfort.
It’s a good idea to take this time off work and arrange for someone to drive you to your PRK follow-up exams. You’ll also need to be extremely careful not to touch your eyes or get water, soap or sweat in them — so no swimming or strenuous exercise. Limiting screen time and UV exposure are also crucial during healing.
Most people can see well enough to resume driving and normal activities within two weeks. However, it takes three to six months, and sometimes longer, to fully heal. It’s common to experience vision fluctuations, halos and glare, light sensitivity and reduced night vision for several months after PRK. Be sure to attend all of your follow-up exams so your doctor can monitor your healing progress.
According to the American Academy of Ophthalmology, the risks of PRK include:
Under or overcorrection
Decreased night vision
Glare and halos
Overall decreased vision
Most problems after laser vision surgery can be easily addressed with corrective lenses or a second enhancement surgery.
Research shows that about 97% of people achieve 20/20 visual acuity or better by one year after PRK. This doesn’t mean it takes a full year to see clearly, though. Blurriness and other vision fluctuations should decrease more and more after the first few weeks of healing. It takes a bit longer to achieve your best vision after PRK than after LASIK, but the results are just as successful.
CONSIDERING PRK? Schedule an exam with an eye doctor near you to find out if you are a candidate.
ICL Eye Surgery
You’ll visit your ophthalmologist one week before the surgery. They’ll use a laser to make tiny holes between the front of your eye (anterior chamber) and natural lens. This will prevent pressure and fluid buildup in the eye after the procedure.
You might also be given antibiotics or anti-inflammatory eye drops several days before surgery.
The procedure is done by an eye surgeon. Generally, here’s what happens:
- You’ll lie down on your back. You’ll be given a mild topical or local anesthetic. This numbs your eye so you won’t feel anything.
- You might be given a mild sedative to help you relax. You might also get an injection around the eye to temporarily stop you from moving it.
- Your surgeon will clean the eye and the area around it. Your eyelids will be held open with a tool called a lid speculum.
- Your surgeon will make a small incision in your eye. They’ll put a lubricant to protect your cornea.
- They’ll insert the ICL through the incision. The lens is very thin, so it might be folded then unfolded in the eye.
- Your surgeon will remove the lubricant. Depending on the incision, they might close the opening with small stitches.
- They’ll put eye drops or ointment in the eye, then cover it with an eye patch.
The procedure takes 20 to 30 minutes. After, you’ll be taken to a recovery room where you’ll be closely monitored for a few hours.
Your doctor might prescribe eye drops or oral medication for the pain. You can go home the same day, but you’ll need to have a ride.
You’ll have a follow-up appointment the next day. Your surgeon will examine the eye and check on your progress.
Within the next year, you’ll have follow-up visits 1 month and 6 months after surgery. Your doctor will also have you return for regular checkups once a year.
Though ICL surgery has been shown to be safe, it may cause complications such as:
- Glaucoma. If the ICL is oversized or isn’t correctly positioned, it can increase pressure in your eye. This can lead to glaucoma.
- Vision loss. If you have high eye pressure for too long, you might experience vision loss.
- Early cataracts. An ICL can decrease the circulation of fluid in your eye, which increases your risk of cataracts. This might also happen if the ICL isn’t sized properly or causes chronic inflammation.
- Blurry vision. Blurry vision is a symptom of cataracts and glaucoma. You might also have other visual problems, like glare or double vision, if the lens isn’t the right size.
- Cloudy cornea. Eye surgery, along with age, reduces endothelial cells in your cornea. If the cells decrease too fast, you might develop a cloudy cornea and vision loss.
- Retinal detachment. Eye surgery also increases the risk of your retina detaching from its usual position. It’s a rare complication that requires emergency attention.
- Eye infection. This is also an uncommon side effect. It can result in permanent vision loss.
- Additional surgery. You may need another surgery to remove the lens and correct related issues.
ICL surgery isn’t safe for everyone. When considering the procedure, talk to a doctor to determine if it’s right for you.
The surgery may not be a good choice if you:
- are pregnant or breastfeeding
- are younger than 21 years old
- are 45 and older
- have a chronic disease that causes hormone fluctuations
- are taking medicine associated with vision changes
- have a condition that inhibits proper wound healing
- don’t meet the minimum requirements for endothelial cell count
Before the surgery, you’ll also need to take other precautions. For example, you’ll have to stop wearing contact lenses in the weeks leading up to the procedure.
Your doctor can explain the best safety measures for your situation.
Refraction tests should be conducted regularly. People under the age of 60, who are healthy and have no outstanding vision problems, should receive a test every two years. When a child turns 3 years old, they should have a refraction test every year or every other year.
A person who wears corrective lenses (eyeglasses or contacts) should take a vision test every one to two years. Eyes change, and regular testing helps a doctor learn if a new prescription is necessary instead of a patient using corrective lenses that no longer offer adequate vision improvement. A patient who has vision problems between their tests should schedule another test rather than waiting for the next planned test.