Who do I refer this patient to for their vision complaints?

There are optometrists and ophthalmologists and LensCrafters and vision therapy. Then there are all of those other specialties. But where do we send our struggling student or recent stroke survivor? While the question seems simple, the answer is confusing and has many factors. Here are professionals that perform eye exams.

Ophthalmology

Ophthalmologists are medical doctors that specialize in the health of the eyes. They are frequently the first stop for children with congenital eye problems. There are pediatric specialists, retinal specialists and retina surgeons as well as neuro-ophthalmologists for stroke and TBI survivors with vision complaints. They are trained to refract and assess binocular vision and can prescribe glasses as well as medications to manage conditions like macular degeneration and glaucoma. They typically take vision or medical insurances and Medicare.

Typically, ophthalmology does not support vision rehabilitation or vision therapy though this is slowly changing as evidence builds for treatment for some conditions.

Optometry

Optometrists are eye care specialists trained in the measurement of the eye. They learn to refract and complete binocular assessments. They learn about the use of lens and prism to help with vision. They are not medical doctors but do learn to interpret imaging and other tests to diagnose conditions of the eye like macular degeneration. Optometrists can prescribe some medications depending on their state regulations but in many states, these patients are referred to ophthalmology to manage their care. Their services are typically covered by vision insurance but in some cases, they may be billing, medical insurance instead.

While optometry schools teach similar entry level skills, many optometrists will specialize in adults, pediatrics, or low vision. Pediatric specialists can be helpful when a child’s vision condition is more complex than simple glasses. Many ODs get additional education to further specialize.

Vision Therapy Doctors

Some ODs continue their education through the College of Optometrists in Visual Development (COVD) to learn about providing vision therapy and possibly sports vision training.

The VTODs go beyond the simple “better or worse” refraction to assess visual skills that may be affecting learning and visual perception. They will offer in-clinic treatment for various conditions. They typically do not take insurance and may not available in all areas.

Neuro-Optometric Rehabilitation

Some ODs continue to get additional training to treat the visual problems associated with stroke, TBI and concussion through the Neuro-Optometric Rehabilitation Association. NORA is an interdisciplinary organization that trains not only OD but therapists and other rehab professionals to improve outcomes for patients. Some of these doctors work in inpatient hospitals as part of the rehab team helping to address vision problems early and improve outcomes. They may also offer outpatient in-clinic treatment. In this context, the doctors may take insurance or they may take only cash. These doctors are more scarce than COVD docs so they may not be available in many areas.

Who is the best?

The decision of which doc to refer is more likely dictated by many factors. The first being access. Which doctors are available to the patient locally? Some areas may only have large corporate optometry practices. How far are they willing to travel? Can the family afford a cash-based provider or does the doctor take the insurance that the patient has?

Like many of the decisions we help our patients with, the decision of where to get their eyes examined is complex. The important idea is that every child needs regular comprehensive eye exams. Following neurological events, the patient should have an eye exam as soon as possible to assess for changes that may have occurred. If problems persist, then a second opinion may be needed with one of the more specialized eye care professionals.

Want to learn more?

The The Childhood Vision Toolkit contains more information on how you can assess treat ocular motor problems

Leave a Reply

Your email address will not be published. Required fields are marked *