The difference between an optometrist and an ophthalmologist?

An optometrist (O.D.) is a primary health care professional for the eye. Optometrists examine, diagnose, treat and manage diseases, injuries, and optical disorders of the visual system and the eye and related structures. They identify related systemic conditions and refer to ophthalmologists or sub-specialists for treatment when indicated.

An ophthalmologist is a physician (M.D.) who specializes in diagnosing and prescribing treatment for defects, injuries, diseases of the eye and related systemic conditions. They treat optical disorders and are skilled at eye surgery, such as that required to remove cataracts, treat retinal diseases, and conditions of the eye area.

Determining the right resource for you depends on many factors, including your age, health, and the visual symptoms you are experiencing. Certainly, you can be evaluated by an optometrist who can assess your visual health and if necessary refer you to an ophthalmologist if your care requires a greater level of expertise.

Insurance Coverage – Will my insurance cover my eye exam?

Most insurance plans cover an exam for a specific medical problem, but not all insurances cover “routine” eye care – meaning you have come in for an eye examination without any medical eye problem and there are no symptoms except for a change in your vision that can be corrected with eye glasses or contact lenses.

Some insurance plans cover “routine” eye exams, but limit the frequency of exams to annually or every other year. Some medical insurance plans “carve out” their routine eye care to Vision plans, such as EyeMed or VSP. Vision plans often limit the coverage to every 12 or 24 months.

While we try to ensure exams are covered by your insurance, patients should contact their insurance if they are unsure of what will be covered.

For my eye exam, do I need a referral from my primary care doctor?

If you subscribe to a managed care plan you will need to obtain a referral from your primary care physician before your visit. Medicare does not require referrals but some replacement or supplemental plans do.

What is a refraction?

Refraction is a testing process that determines your best corrected vision and most often results in a prescription for glasses that you need to achieve your best vision. Some insurances include refractions as part of the complete eye exam — some exclude it. For a Medicare covered patient, refractions are excluded as a covered benefit.

What should I expect at my appointment?

Plan to be at your appointment for a minimum of one hour. Please arrive 15 minutes ahead of time and bring with you: your insurance card, a co-payment if required, any eye drop medications you are taking, your glasses and contacts if you wear them with packaging. If you usually wear contact lenses please wear them to your appointment. Please also print out these forms and bring them with you.

Why do you ask about my medical history and medications?

Medications and medical conditions can affect the health of your eyes, even if it’s only a minor side effect. By better understanding of your health, we gain a better understanding of your eyes.

Will my eyes be dilated as part of my exam?

As part of your eye exam, your eyes may be dilated to allow the doctor to thoroughly evaluate the health of your retina and optic nerve. Dilation will cause your near vision to blur slightly and your eyes will be sensitive to light for a few hours following your visit. Temporary sunglasses are available to reduce the glare from light.

Will I get a visit summary from my doctor?

Following your appointment you will receive via email an invitation to obtain your office visit summary through our Patient Portal.

How can I start wearing contact lenses?

You need a comprehensive eye exam before being fitted for contact lenses. If your insurance will not cover your eye exam, the cost of the exam will be your expense. If you’ve had an eye exam at our office or at another office within the past year, this requirement may be waived.

After your eye exam, you will have a contact lens evaluation and fitting. This is usually a 45 minute appointment to determine the lens that best corrects your vision and to train you in using contact lenses.

The cost of a new contact lens fitting can ranges from $125 to $200 depending on the complexity of the fit and the number of follow-up appointments required. Some contact lens fits for conditions such as keratoconus may be covered by insurance, other contact lens services may be covered by a vision plan. Service not covered by insurance are at your expense payable at the time of your exam.

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