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Eye Exams

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Q: My child just turned 5 and I’m not sure when I should take him for an exam with an ophthalmologist. Is there a set suggested time for this? And does it matter if he sees an ophthalmologist or an optometrist? (And what’s the difference, by the way?)

A: You would think this is an easy one to answer. But, as you know from your years of reading this column, there are no easy questions.

First, let me address the difference between the various eye professionals you are likely to see in your life.

An optician makes your glasses. Opticians usually have at least an associate’s degree, and in many, but not all, states, will be licensed. She will help you choose a style of optical wear, measure your face and eyes for fashion and function, and ensure that the finished frame and lens combination works as intended. An optician does not perform any medical exam. Opticians usually work with optometrists or ophthalmologists but can be independent practitioners.

Optometrists have undergone a much more rigorous course of study than opticians, including a college degree and four years of optometry school, leading to the degree of doctor of optometry (O.D.).

Optometrists examine patient’s eyes, determine the need for glasses or contact lenses and provide the proper prescription for the optician. Optometrists also diagnose and participate in the treatment of eye diseases such as glaucoma and diabetic retinopathy.

Optometrists may work with ophthalmologists, or in independent practices, or frequently with large commercial retailers such as Lenscrafters, Pearle Vision, Empire Vision Centers or Sterling Optical.

Ophthalmologists are medical doctors who have attended eight years of college and medical school. They then undergo another three to four years of internship and residency before becoming certified in their specialty. Ophthalmologists can prescribe glasses or contact lenses, but their main job concerns diagnosis and treatment, both medical and surgical, of diseases of the eye, and surrounding structures.

I’m sure all three categories of eye professionals described above would claim that I’ve oversimplified their jobs, but I think I’ve given you a fairly accurate representation of their education and responsibilities.

So, now we return to the question of who to see, and when to see that eye professional. This is where things become more confusing. The answer is, it depends whom you ask.

The American Association of Pediatric Ophthalmology and Strabismus (AAPOS), as well as the American Academy of Pediatrics (AAP) both recommend routine exams of the eyes at your primary care provider, that is, your pediatrician or family practitioner. These academies do not believe that routine referral to either ophthalmologists or optometrists is medically or economically a sound policy. The AAPOS and the AAP advocate referral only if abnormalities are suspected or detected. Testing for visual acuity is recommended as soon as the child can cooperate—usually 3 to 4 years of age. A child who cannot be tested by 4 to 4 1/2 years of age should probably be referred to an ophthalmologist or optometrist.

The American Optometric Association (AOA), in contrast, suggests that an optometrist perform a first comprehensive exam between 6 and 12 months of age. Through a public health initiative, participating optometrists will perform this exam free of charge. There are at least 10 optometrists in the Syracuse area who participate in this InfantSEE (pronounced infancy) program. As best I can tell, the participating providers appear to be in independent optometry practices rather than large retail establishments. Following this first recommended exam, the AOA then recommends a comprehensive exam at 3 years of age and every two years thereafter.

So, we have come to where ophthalmologists and optometrists part company. Is one group right and the other wrong? Are we dealing with a turf war, or are there different opinions both of which may be reasonable?

Does Dr. Lanny have the answer? No, I don’t. I check children’s eyes at every well-child visit, but I don’t really know how accurate my brief exam is, and I don’t know what other practitioners do in their practices. I pay close attention to a parent who says, “There’s something wrong with my child’s eye.” I believe that few problems slip past me, because I find very few problems surfacing at later visits or in school.

Philosophically, I tend toward fewer tests and fewer drugs than many of my peers, and I’m hesitant to send children for every-two-year exams without suspicion of a problem. The free InfantSEE exam is tempting, as long as it is not an entrée into more and possibly excessive care. As with any medical service, InfantSEE is probably only as good as the skill and integrity of the provider.

As an M.D., I lean toward trusting my profession, but I also believe that there are honest and competent professionals with other letters than M.D. after their name. I have always had truly stinky vision, and with age things are only getting worse. I go regularly to an independent optometrist, and I trust that he will refer me to an ophthalmologist when and if that’s what I need.

Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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