By Karen Finucan Clarkson

"Your eyesight is precious, and, because there do exist hidden threats to eyesight, you should be proactive in the care of your eyes," said Dr. Douglas E. Gaasterland.

Eye care professionals, be they medical doctors or others who treat eyesight, agree with Gaasterland, an ophthalmologist with Eye Doctors of Washington in Chevy Chase. Finding a doctor to meet your eye care needs can help preserve your vision for a lifetime.

"It's important for patients to understand the three Os—ophthalmologists, optometrists and opticians—and the differences [among] them," said Dr. James Heltzer, an ophthalmologist with Champlain Ophthalmology in Bethesda.

Ophthalmologists complete four years of medical school, a one-year internship, and three or more years of specialized medical and surgical training in eye care. They can provide total eye care, including eye exams, vision services, and the diagnosis and treatment of disease. "For example, blurred vision could be a refractive problem correctable by glasses but it could also be related to a medical problem. An ophthalmologist is trained to evaluate the health of the eye," said Heltzer.

Optometrists graduate from an accredited college of optometry, not medical school. They are trained to examine the eyes and diagnose and treat some diseases of the eye and visual disorders. They do not perform surgery. "We have both ophthalmologists and optometrists in our group," said Gaasterland. Opticians, who generally have a two-year technical degree, analyze and interpret eye prescriptions and determine the lenses that best meet a person's vision needs.

To find a good ophthalmologist, begin with friends and colleagues, suggests Heltzer. "But also ask your primary care doctor for a recommendation. Interactions with other doctors will tell a whole lot about the eye care they deliver," he said.

"A lot of internal medicine people have at their fingertips a list of doctors they know are good in different areas. The internal medicine people often serve as a health care coordinator or director for their patients. Doctors of a diabetic, for instance, might ask a patient if he's has his retina exam for the year," said Gaasterland.

During a search, it's worth keeping in mind that some ophthalmologists have a subspecialty. For Gaasterland and Heltzer, that's glaucoma. Other subspecialties include cataract and refractive surgery, pediatric ophthalmology, and vitreoretinal disease. "The literature is huge and keeping up is daunting; thus a lot of ophthalmologists, particularly around Washington, emphasize one area or another," said Gaasterland.

"Board certification—that concept of being either board eligible or being board certified five years from the end of training—is a good marker," said Heltzer. While the American Board of Ophthalmology (www.abop.org) certifies physicians, it does not have a searchable database online. Instead, it refers inquiries to the American Board of Medical Specialties at www.abms.org.

Several groups, including the American Academy of Ophthalmology (www.aao.org), the American Society of Retina Specialists (www.asrs.org) and the American Glaucoma Society (www.glaucomaweb.org), have physician search engines.

Insurance is another consideration for many. Some insurance plans only will cover medical problems—such as glaucoma or a detached retina—while others also cover routine exams. "Patients need to understand their insurance and vision-care plans," said Heltzer. "It could be that your particular plan will only pay for a medical problem and what you have is a vision problem."

"The first question our desk staff asks is, ‘What insurance coverage do you have?'" said Gaasterland. "Each company has an array of three of four different types of coverage. Not every plan covers everything."

An ophthalmologist's hospital affiliation is no longer a concern, according to Gaasterland. "Ophthalmology has become a specialty that is largely practiced on folks who are ambulatory," he said. "If they have surgery, they go to an ambulatory center and go home two hours later."

Once you've narrowed down the list, call and make an appointment. "What you want is to see if the doctor's personality, the care you received and the office itself [are] the right fit," said Heltzer.