The reasons are several, but there a couple things in particular which have been on my mind as of late. This is the first.
As part of our training (after college, after medical school), we as ophthalmologists do a year of internal medicine. At least at my current program. There are some which do a year of surgery to start, but frankly I find this useless since what a general surgeon does has basically no relation to what we do other than good sterile technique. As a medicine doc, though, there are many things important to us.
During my cardiology rotation, the attending once told me that as an eye doctor, I must never forget to treat the eye in the patient as a whole. We met again just a few months ago and revisited one of his favorite topics - plaques in the eye. It is felt amongst the eye community that certain of these plaques, calcium or platelet ones in particular, originate more likely from the heart than the carotid arteries, the source of cholesterol plaques. So, if seen by us, we order an echo evaluation of the heart. And yet, he complains bitterly, stating that all plaques come from the carotids and some super specialized retina doctor isn't thinking properly about the patient by ordering "unnecessary" tests. In his mind, only carotid dopplers should be done for any plaque.
Hold on a minute. The whole reason we order the echo is to make sure the heart is okay and screen for stroke risk. We ask them to have their lipid and CBC profiles checked. We always get carotid dopplers to rule out coinciding carotid disease AND address stroke risk. How is this not treating the patient as a whole, and thinking outside the eye? It's not about the academic argument of where such plaques come from; it's about protecting the patient from future, potentially life-threatening events.
We screen patients ALL the time with diabetes and hypertension. And you know what I always ask them first? Hint: It's not, "How's your vision?" It's, "How's your blood sugar doing? How is your diabetes? Are you checking your blood pressure regularly?" Again I ask, how is this not treating the patient as a whole?
This, I think, is the biggest separation between an ophthalmologist and an optometrist. An optometrist attends college, followed by optometry school where they become master refractionists (most better than most ophthalmologists in this particular area) and gain a solid understanding for most eye diseases. They don't attend the four years of medical school every MD or DO does. They don't undergo the extensive licensing exams every MD or DO does. They are not governed by the medical board as every MD or DO is. I have or am all of the above.
If you want to see a doctor who treats the eye and can give you good glasses, go to an optometrist. If you want to see a doctor who treats the eyes of a human body and understands physiology and surgery, go to an ophthalmologist. They each have their place and neither is fit for everything.
I will expand more on this in part II.
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