Ophthalmology Services: Comprehensive Eye Exams, Disease Management, and Surgical Options

Ophthalmologists are medical doctors (M.D./D.O.) specializing in medical and surgical eye care. Their scope exceeds optometrists (O.D.) and opticians.

Comprehensive Eye Examination

• History: Visual symptoms, systemic disease (DM, HTN, autoimmune), medications, family history, trauma.
• Visual Acuity: Snellen/Early Treatment Diabetic Retinopathy Study (ETDRS) charts; distance & near.
• Refraction: Manifest (phoropter) ± cycloplegic (children, preoperative).
• Pupils: Size, shape, reactivity (direct/consensual), RAPD (swinging flashlight).
• Extraocular Motility & Alignment: Cover/uncover, alternate cover, versions, ductions, Hirschberg.
• Intraocular Pressure (IOP): Goldmann applanation (gold standard), Tonopen, iCare, non-contact (screening).
• Slit-Lamp Biomicroscopy: Lids, lashes, conjunctiva, cornea (stain with fluorescein), anterior chamber (cell/flare), iris, lens.
• Gonioscopy: Angle anatomy (open/closed, synechiae, neovascularization).
• Dilated Fundus Exam: Direct/indirect ophthalmoscopy (+90D, +78D, +20D lens) – optic nerve, macula, vessels, periphery, retina.
• Ancillary Testing (As Indicated): OCT (macula, RNFL), Visual Field (Humphrey), Fundus Photo, FA/ICG, Corneal Topography, Biometry (IOL calc), UBM.

Medical & Surgical Disease Management

When to See an Ophthalmologist vs. Optometrist

• Ophthalmologist: Surgery, complex medical eye disease, emergencies (trauma, acute vision loss, chemical burn), systemic disease ocular manifestations.
• Optometrist: Routine exams, refractive correction, contact lenses, primary glaucoma/AMD/DM monitoring (co-management), low vision rehab.

Annual dilated exam recommended for adults >60, diabetics, glaucoma suspects, family history. Immediate eval for flashes/floaters, curtain vision loss, pain, trauma, double vision.

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Category	Conditions	Key Treatments
Cataract	Nuclear sclerotic, cortical, PSC, traumatic, congenital	Phacoemulsification + IOL (monofocal, toric, multifocal, EDOF, light-adjustable)
Glaucoma	POAG, angle-closure, NTG, secondary, congenital	Drops (PGAs, beta-blockers, alpha-agonists, CAI, Rho-kinase), SLT, MIGS (iStent, Hydrus, OMNI), Trabeculectomy, Tube shunt, Cyclophotocoagulation
Retina/Vitreous	AMD (wet/dry), DR/DME, RVO, Retinal detachment, Macular hole/ERM, Inherited dystrophies	Anti-VEGF (intravitreal), Laser (PRP, focal), Vitrectomy, Pneumatic retinopexy, Scleral buckle, Gene therapy (Luxturna)
Cornea/External	Keratoconus, Fuchs, Infections, Dry eye, Pterygium, Dystrophies	CXL, DMEK/DSEK/PKP, Scleral lenses, Amniotic membrane, Intense Pulsed Light (IPL), Neurotrophic keratitis (cenegermin)
Pediatric/Strabismus	Amblyopia, Strabismus, Congenital cataract/glaucoma, ROP	Patching, atropine, glasses, prism, muscle surgery (recession/resection), ROP laser/anti-VEGF
Oculoplastics/Orbit	Ptosis, Dermatochalasis, Ectropion/Entropion, Thyroid eye disease, Orbital tumors, Lacrimal obstruction	Blepharoplasty, Ptosis repair, Orbital decompression, DCR, Botox, Teprotumumab (TED)
Refractive	Myopia, Hyperopia, Astigmatism, Presbyopia	LASIK, PRK, SMILE, ICL, RLE, Corneal inlays
Neuro-Ophthalmology	ON, IIH, CN palsies, Visual field defects, Pupillary anomalies	Medical (steroids, acetazolamide), Surgical (optic nerve sheath fenestration, strabismus surgery)