How Do I Find the Best Ophthalmologist?

They may be small, but the eyes, as the saying goes, are the window to the soul. They're also our window on the world and home to that critically important sense of sight. Not content with those big tasks, your eyes can help your doctor gauge your overall health, too.

"When we look in the eyes, sometimes we can see the effects of systemic disease," says Dr. George B. Bartley, an ophthalmologist with Mayo Clinic and chief executive officer of the American Board of Ophthalmology. The eyes often show evidence of "diabetes, high blood pressure and other illnesses affecting the patient," and if you've got a good ophthalmologist taking care of your eyes, information they glean from exams can help improve your overall health. "The eye isn't separate from the body. It's part of the body and we want to be careful to tie that in with what's going on with the patient," Bartley says.

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The doctor charged with taking care of these important organs is an ophthalmologist. The American Academy of Ophthalmology defines an ophthalmologist as "a medical or osteopathic doctor who specializes in eye and vision care." The American Board of Ophthalmology notes that "ophthalmologists are the only physicians medically trained to manage the complete range of the eye and vision care. They can prescribe glasses and contact lenses, dispense medications, diagnose and treat eye conditions and diseases and perform surgeries." Ophthalmologists shouldn't be confused with optometrists or opticians, who also care for eyes, but have different training backgrounds and different roles to play in the care of eyes.

"Ophthalmologists are medical doctors," Bartley says. "We all go to medical school and then specialize in ophthalmology just like you would cardiology or cardiac surgery." To become an ophthalmologist usually requires 12 to 15 years of training, which includes undergraduate and medical school followed by a one-year internship and three or four years of residency training. This is often followed by an additional year or two of fellowship training. Ophthalmologists use an M.D. or D.O. designation after their names indicating whether they are a medical doctor or doctor of osteopathy. Ophthalmologists can perform surgery, and many of these doctors further specialize in a subspecialty within ophthalmology.

Optometrists, on the other hand, "go to college and then go to optometry school," Bartley says. These providers will have an O.D. designation after their names, which means they have a doctor of optometry degree. Optometrists typically have between seven and eight years of training and are licensed to practice optometry, which typically includes conducting vision tests and eye exams and prescribing contacts and eyeglasses. They can test for abnormalities and diseases of the eye and are sometimes thought of as primary care providers for eye health.

When it comes to more complicated problems that require invasive treatments or surgery, that's generally the realm of the ophthalmologist.

Ophthalmologists see a range of different conditions and problems from garden variety eye exams to conjunctivitis (AKA the dreaded pink eye), cataracts, glaucoma, macular degeneration -- "anything related to the eye," Bartley says. "A typical ophthalmology practice can be very wide, which is kind of nice in a way because you see all ages from newborns up to age 100. And you get to see both men and women," unlike other specialties like gynecology or pediatrics where the doctor sees only a specific kind of patient.

However, many ophthalmologists subspecialize to further focus their expertise in one of about 10 areas. "Believe it or not, with something as small as the eye, there are people who take care of just glaucoma, or just do LASIK or refractive surgery, or just treat children. The eyes are a complicated little organ," Bartley says.

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Therefore, if you need to see an ophthalmologist for something more complicated than a general eye exam or needing glasses, you should look for someone with expertise in the problem you're experiencing. "For instance, if you have a retinal detachment, you don't want to see someone like me who's a cornea transplant surgeon, you want to see a retinal detachment surgeon," says Dr. Thomas Mauger, an ophthalmologist at the Wexner Medical Center at the Ohio State University. "There are a lot of different subspecialties within ophthalmology, and depending on what the problem is, you want to see the appropriate person, whether that's a general or comprehensive ophthalmologist for something straightforward like a cataract or red eye or something more specialized that requires a subspecialist," Mauger says. Either way he recommends starting with a referral from your primary care physician. Bartley says seeking recommendations from friends and family is also a good way to find out which local doctors might be right for you.

Both Mauger and Bartley say that board certification is an important indicator of a high-quality provider. "I'm obviously pretty biased as the CEO of the American Board of Ophthalmology, but I think having board certification is an important credential," Bartley says. "It demonstrates to the public that after going through all this training, the doctor has voluntarily taken an examination and proven to the world, the profession and themselves that they have the scientific knowledge to treat patients appropriately." He says more than 90 percent of ophthalmologists who practice in the U.S. are board-certified by the ABO.

Before coming in for your first appointment, Bartley recommends making some notes about when the issue you're dealing with started and the symptoms you've been experiencing. Be as specific as possible. "It's helpful if patients have a good history of when the problem began and the severity of it." He also recommends bringing in all your medications, not just ones related to your eyes. "Any medicines you take, such as for your heart and blood pressure, can have an effect on the eye. And eye medicines can have effects on the rest of the body. The eyes are a window to the body, and we want to know if the patient has these other problems under control."

Mauger says patients should clear enough time in their day for this appointment. "An appropriate history has to be taken from the patient, then the eye needs to be examined and their eyes need to dilate, all of which takes time," he says. You may also need to have additional testing done during the exam to pinpoint the source of the issue. "Depending on what you're coming in for, you should allow at least a couple hours for the exam and be prepared to have your pupils dilated." Because pupil dilation can cause blurry vision, driving home afterwards could be problematic. Therefore, it's often advisable to have someone pick you up or take you to the appointment.

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In addition, Bartley recommends bringing a list of questions with you to make sure you don't forget anything during your visit. "It's very efficient for them and for us to be able to walk through those questions. And patients will remember answers better if they write down the answers."

In the end, finding a good ophthalmologist means finding a partner who listens to you and your concerns. Look for the "whole package," Bartley says, meaning a doctor who can combine scientific knowledge with good communication skills and who will work with you to find the right treatment approach for you.

Elaine K. Howley is a freelance Health reporter at U.S. News. An award-winning writer specializing in health, fitness, sports and history, her work has appeared in numerous print and online publications, including AARP.org, espnW, SWIMMER magazine and Atlas Obscura. She's also a world-record holding marathon swimmer with a passion for animals and beer. Contact her via her website: elainekhowley.com.