Published on in CHOP News
Eye care is an important part of your child’s overall health. Whether you've noticed a specific problem with your child’s vision or have been referred by your child’s pediatrician, there are a wide range of eye care professionals who can address your needs.
But how do you know who to see for your child's appointment? What’s the difference between an optometrist and an ophthalmologist? What about an orthoptist? Here is some basic information to help you understand the different types of eye doctors or eye specialists your child might see.
Choosing the right eye care professional for your child
While each type of eye care professional can offer some of the same elements of vision care (such as vision testing, prescription of eyeglasses and medications for non-surgical eye health conditions), there are a few key differences.
Ophthalmologists (MD) are medical doctors and surgeons. They deal with the medical and surgical aspects of eye care. You’ll see an ophthalmologist when your child has a diagnosed problem with the health of their eyes. Ophthalmologists also perform surgical procedures if necessary. They have four years of medical school followed by a three-year residency in ophthalmology and, usually, an additional one to two years of specialized fellowship training.
Optometrists (OD), on the other hand, are doctors of optometry. They perform vision tests and routine eye health services. They may be thought of as the primary care doctor for the eyes. They may prescribe glasses or corrective lenses to patients with otherwise healthy eyes. An optometrist can also prescribe eye drops and other medications to promote eye health. Optometrists have four years of post-graduate doctoral training.
Orthoptists (CO) are eye care professionals who address specific eye problems related to vision, eye alignment, and eye movements. Orthoptists work with ophthalmologists to examine patients and help develop treatment plans. Orthoptists have an undergraduate degree, two years of orthoptic fellowship training and must be certified by the American Orthoptic Council (AOC).
Where to start with eye care?
If your child has a medical eye problem, such as strabismus, ptosis, or excessive tearing, they will be referred to an ophthalmologist. Otherwise, you will most likely see an optometrist first to assess your child’s eyes. They will determine your child’s needs and refer to a CHOP ophthalmologist for additional medical care if necessary.
Seeing an optometrist
The optometrist will check things like visual acuity or clarity (basically, how well your child is seeing). They will also assess eye alignment and movement, color blindness, depth perception, peripheral (side) vision and eye pressure. When needed, the optometrist may prescribe glasses, topical medications like eye drops and ointments, and some oral medications.
What to expect during your child’s eye exam with an optometrist
The optometrist's exam consists of a comprehensive eye exam to identify potential eye-related diseases, a refraction test that assesses your child’s vision, and a visual function and eye health assessment. Your child’s eyes will be dilated at the first visit and may be dilated on future visits at the discretion of the optometrist.
Then, depending on the outcome of the testing, the optometrist may write a prescription for glasses to be filled by an optician. Similarly, the optometrist may write a prescription for medications to treat nonsurgical eye health conditions if needed. If your child requires further medical attention, the optometrist will refer you to an ophthalmologist.
Seeing an orthoptist
If your child has been diagnosed with eye alignment and/or eye movement problems, the ophthalmologist may suggest follow-up visits with an orthoptist. The orthoptist will carry out the medical treatment plan prescribed by the ophthalmologist.
Orthoptists can address problems with vision and eye movement that are the result of the way muscles and nerves function in and around the eye. Some of these eye conditions include misalignment of the eyes like crossing, drifting or wandering eyes, lazy eye (amblyopia), double vision (diplopia), eye muscle weakness (palsies), and involuntary shaking of the eyes (nystagmus).
What to expect when taking your child to an orthoptist
The orthoptic exam consists of a consultation that includes a vision test and an assessment of eye movements and alignment. After the consultation, the orthoptist notes any changes to the condition discovered during previous consultations, and works with an ophthalmologist to correct any problems they identify.
The orthoptist also develops treatment plans (ranging from eye exercises, eye drops, patching treatment, and discussion of surgical options with the ophthalmologist) to address or correct the identified eye movement or alignment issue. If a surgical plan is necessary, they will coordinate your child's care plan with a pediatric eye surgeon.
At what age should your child see an eye care professional?
Eye care at CHOP can start at birth. Your child will receive a regular eye screening by their pediatrician and/or at school if they are of school age. The pediatrician or school nurse will refer you to an eye care professional if they have concerns about your child’s eye health or if your child's screening shows a change in vision or eye function.
If you notice or suspect an eye problem, or there is a family history of a concerning eye problem, seeing an ophthalmologist or optometrist immediately can help diagnose (or rule out) a suspected eye condition, prevent a current problem from worsening, or help increase treatment success.
No matter which type of eye specialist your child sees, our experts work together to provide the best possible care for your child.
Contributed by: Carly Grondin, OD, MPH, Salvatore Bellante, MSc, CO