For years it was as plain as that big "E" on the wall: Optometrists, who have a doctor of optometry degree, checked you for glasses, and ophthalmologists, who are M.D.'s, treated you for eye diseases. But the lines have blurred, so to speak. Over the past two decades, all 50 states have widened rules to allow optometrists to treat many of the same medical conditions that M.D.'s do. In Oklahoma, despite protests from the American Medical Association, optometrists can now perform some surgeries, too.
While optometrists say that their degree now covers all the skills needed to treat eye diseases, many M.D.'s still argue it's no substitute for medical school. Which should you use? A rule of thumb: For regular checkups and problems affecting the outside of the eye, such as allergies or dry eye, an optometrist is sufficient. (Two sites for locating good ones: the American Academy of Optometry, at www.aaopt.org, and the American Optometric Association, at www.aoa.org.) But if you experience symptoms such as loss of vision or ?ashing light, or if your optometrist finds signs of a cataract or macular degeneration, it merits a visit to an ophthalmologist.
Whether you see an optometrist or an ophthalmologist, most people should get their eyes checked about every two years, according to the American Optometric Association (AOA). A few tests are evergreen: the trusty eye chart, which gives a basic idea of what you can see; a refraction test, in which you look through a machine to determine your exact prescription needs; a cover test, using a paddle, which reveals how well your eye muscles work together; a test for glaucoma; and a "slit lamp" examination and retinal exam, which look for diseases inside your eye.
But some "routine" tests for otherwise healthy patients are probably unnecessary -- especially if they're not included in the basic exam fee. A "visual field examination," in which a machine is used to check side vision, may be one such test, says Walter Beebe, M.D., a cornea specialist in Dallas. It can pick up advanced glaucoma or a brain tumor, he says, but unless symptoms or other signs warrant it, the test is probably not necessary. Another potential overkill fee: "photography of the eye." Many doctors will encourage it on the first visit, but, Beebe says, some want to repeat it every time. "It's hard to make a case for upwards of $100 for everybody who walks through the door," he says.
It's a relatively minor but annoying sign of middle age: Small print starts to get a little blurry, making those stock tables maddeningly hard to read. The medical term is presbyopia, a hardening of the crystalline lens, and it's becoming more common as a nation of aging baby boomers start squinting their way through dinner menus.
The solution many people quietly opt for is a pair of those ubiquitous drugstore reading glasses, which help magnify vision for a low-impact $10 or $20, versus 5 or 10 times that for prescription glasses. The problem with "drugstore readers" or "cheaters," says San Diego optician Carter Shrum, is that since they're massproduced, the magnifying strength is the same for both eyes and is usually centered within each lens. That may be bad for you if that centering doesn't correspond well with the shape of your face or if, like many people, you have a different refractive error in each eye.
And like any mass-produced product, says Minnesota optometrist Kerry Beebe, some readers are better than others. A good eye doctor can suggest which ones are best for your situation, Beebe says, or he can analyze them "to check that the powers are what and where they're supposed to be."
If you need bifocals but can't bear the idea of wearing lenses with etched-in lines, you have another option. Progressive lenses offer varied lens strengths like bifocals, but the varying prescriptions are graduated, so they're invisible to anyone but the wearer. Other than cost -- $400 or more for the lenses alone -- some progressives do have a major drawback: They can be difficult to get used to, causing dizziness, headaches, even teeth grinding as the eyes adjust. When San Diego human resources director Debi Ives first tried them, she got dizzy, had trouble focusing, and lost her balance on the stairs. "I couldn't see where my feet were going," she says.
Adjusting to progressives can take from a few minutes to two weeks or longer; if you experience problems, have your glasses checked to ensure they were ground and fitted properly-a good reason to ask about return and repair policies before you buy. A misplacement of the "near" zone, for example, can make a big difference. When Ives tried progressives again a year later, this time using larger lenses with less variation between zones, she was recoached on "pointing with her nose," rather than shifting her eyes to see different objects. "I've had much more success," she says.
Since the late 1970s, eye doctors have been required by law to provide you with your eyeglass prescription after an exam so that you can buy glasses wherever you want. It wasn't until early 2004 that they had to do the same with contact lens scripts. Under the new law, a doctor can no longer make you buy your lenses from his office once the exam-and-?tting stage is complete. Char Pagar, an attorney with the Federal Trade Commission, points out that a contact lens prescription still isn't ready for release after an initial exam the way glasses are, but often requires one follow-up to ensure that the proposed lenses are right for you. However, "once the doctor is willing to sell you the lenses," Pagar says, "that fitting is complete."
But not all doctors are readily handing over the scripts. Some, Shrum says, "will lead patients into the dispensing place and hand [the prescription] to a person working there." If your doctor balks at giving you your lens prescription, first remind him of the law; if you still meet with resistance, you can file a complaint at www.ftc.gov. In October 2004, the FTC sent warning letters to 25 lens prescribers and sellers who were allegedly violating the rule.
If your child is straining to see the chalkboard, don't assume glasses are the answer. Unfortunately, too many eye doctors do. A 2004 study by Vanderbilt University professor and pediatric ophthalmologist Sean P. Donahue found that kids were more likely to be prescribed unnecessary glasses if they saw an optometrist or general ophthalmologist than if they went to a pediatric ophthalmologist. Donahue estimates almost one in five kids who wear glasses don't need them. Worse, superfluous glasses may cause headaches or even legitimate vision problems.
A pediatric ophthalmologist is attuned to how kids' eyes develop, says David Granet, M.D., director of pediatric ophthalmology at UC-San Diego. "You have to understand those changes, or you can do the wrong thing." Rather than taking your child to your eye doctor, he says, let the pediatrician examine him during annual checkups and refer you to a specialist if needed; to locate specialists in your area, go to www .aao.org/find_eyemd.cfm. If your child ultimately does need glasses, avoid mass retailers and use a shop specializing in kids' glasses, since fitting their frames can be tricky.
Since new prescription glasses can easily cost hundreds of dollars, a good number of savvy consumers take their prescriptions elsewhere, often to mass chains or warehouse stores, looking for a break on price. And more often than not, they get it. According to optical trade organization Vision Council of America, the average price for eyeglasses exceeds $200 per pair: Frames cost an average $117, and a pair of lenses, an average of about $101. But some retailers offer lower prices: At wholesale club Costco, for example, the median price for eyeglasses is more than $50 below the norm.
But what do you give up when you go the megastore route? Some selection, particularly among the higherend merchandise, more-personalized service, and that's about it. What about shopping for frames on the Internet? Judy Reggio, a stay-at-home mother in Cranford, N.J., was hit with a serious jolt of buyer's remorse when she spotted her brand-new $400 DKNY frames for $100 less on a Web retailer's site. But the truth is, she's better off having paid the extra money. Ordering glasses online can be complicated (do you really want to attempt to measure your own pupil distances?), and the nuances of a wellmade pair of glasses are best handled at a bricks-and-mortar store, where you get a hands-on fitting and can more conveniently come back for adjustments.
No matter where you shop for glasses, though, be sure your lenses are ground and fitted by a professional optician. To verify that you're dealing with a reputable outfit, look for technicians who have been certified by the American Board of Opticianry/National Contact Lens Examiners, which requires rigorous testing.
When Brian Wade, a teacher in Los Angeles, bought new glasses, he got scratch-resistant, polycarbonate lenses and paid $45 extra for an antiglare coating. But a few months later, his lenses were covered with scratches. He took them back to his optometrist and learned that the antiglare he chose was vulnerable to scratching regardless of the quality of lens beneath it. The technology behind coatings has improved a great deal in the past decade, says Janice Jurkus, a professor at the Illinois College of Optometry, but overall, "You get what you pay for." At the very least, look for a one-year warranty on coatings, optician Shrum says.
Frames should be covered for defects for at least 90 days, but ideally, a full year. And paying a little extra, Shrum adds, can reap big rewards. Most vision-care plans, he says, cover a $75 frame, but if you spend as little as $25 more, "you'll get a three-times-better frame." Frames in the $160 to $180 range, he says, are typically made more carefully, with stronger plastic or metal, and hold their shape better. But anything over $250, experts agree, means you're likely paying for style or a designer name.
Laser surgery-the most common form of refractive surgery, which alters the eye to correct vision-continues to boom. In 2007 some 1.5 million Americans had a Lasik procedure, according to Jobson Optical Research. While many people are under the impression that the laser surgery known as Lasik is a uniform procedure, in reality, several different companies make the lasers used in the procedure, and not all of them are created equal.
Laser manufacturer Visx, which has the largest U.S. market share, is well regarded by many doctors. But even with the best equipment, surgeons must be consistent in getting their lasers updated regularly to help guarantee safe, precise performance. So when shopping for a laser surgeon, ask doctors how often they have to perform retreatments or enhancements-as well as how often they have their laser upgraded. (In most cases, the answer should be at least once a year.) A good place to check out laser options: the FDA's informational site at www.fda.gov/cdrh/lasik.
Some studies of the newest forms of Lasik put your odds of 20/20-or-better vision at roughly 94 to 98 percent. Still, up to 10 percent of Lasik patients need a follow-up procedure or enhancement. But even with an enhancement, don't count on perfect vision forever. As the eyes age, you may still need reading glasses. Matt Wapner, a lawyer from Hoboken, N.J., had Lasik surgery in 1998, and his vision improved from 20/400 to 20/10-better than perfect. Shortly after, he started seeing halos at night, and within a few years had regressed to 20/40. Wapner has since reverted to glasses. "I see so much crisper with glasses that I've started wearing them all the time," he says.
While new versions of Lasik likely offer better long-term results than that, talk to your doctor about expectations. "If a patient says, 'I want to see as well as I do with glasses and want it guaranteed,' that's unrealistic," Kerry Beebe says. "A realistic expectation is that you'll be less dependent on your glasses."