Originally published in NKCF Update (February 2024).
Optometrists and ophthalmologists are two different kinds of eye care professionals with different training and skills. Both types of eye doctors provide expertise in treating keratoconus.
Optometrists are the eye doctors that most people see for their routine eye exams. Optometrists perform vision tests and write prescriptions for corrective eyeglasses and contact lenses. They also fit contact lenses and educate their patients about contact lens care. An OD degree (optometry doctor) is awarded after four years of additional training after a bachelor’s degree. Optometry training involves classroom and clinic work in a variety of settings. Some optometrists, especially those who work with keratoconus patients, will spend another year completing a post-graduate residency where the focus is ocular surface diseases like dry eye or keratoconus, or a residency in cornea and contact lenses, where the trainee develops proficiency in fitting specialty and scleral contact lenses.
Optometrists monitor keratoconus over a lifetime. If your disease is progressing, your optometrist will likely refer you to an ophthalmologist who will perform additional tests and treatments like crosslinking.
Ophthalmologists are fully trained medical doctors (MD). After earning a bachelor’s degree, medical students complete four or more years covering basic science and clinical specialties like medicine, surgery, pediatrics, OB/GYN, and emergency medicine.
To become an ophthalmologist, trainees must then complete a one-year internship in general medicine or surgery and three additional years of an ophthalmology residency where they manage medical conditions associated with the eye, and perform gradually more complex eye surgery. Most MDs who specialize in treating keratoconus have spent an additional fellowship year in cornea, external disease and refractive surgery. An ophthalmologist who is a keratoconus expert will likely have about 9 years of medical and specialized eye training after graduating from college.
Ophthalmologists perform cataract surgery and use lasers to treat conditions affecting the retina. Only ophthalmologists can perform corneal crosslinking (CXL) or corneal transplants. A small number of ophthalmologists will also fit contact lenses; most work with optometrists or hire opticians (licensed technicians) who work with the doctor and patient to get the right fit for the corrective lenses.
For a disease like KC, the team approach offers the most comprehensive care. One type of doctor specializes in assessing and correcting vision, while the other performs delicate surgery or procedures that enhance or save vision. The two types of eye doctors may work alongside each other in a single practice or your doctor may refer to a consultant with different training and different expertise as needed.