One of the first things you should understand is that eye care professionals have many different types of training and certification:
- Ophthalmologists: medical doctors who train 3-4 years after Medical school to specialize in the diagnosis and treatment of ocular pathology. 12 years minimum training after high school: 4 years of college, 4 years of medical school, 1 intern year, 3-4 Ophthalmology residency, 1-3 of subspecialty fellowship training.
- Optometrists: doctors of optometry who complete four years at Optometry school after undergraduate studies, but do not perform eye surgery. Eight years after high school: 4 years of College and 4-years Optometry School.
- Opticians: trained in the measurement and dispensing of glasses and contact lenses
- Ophthalmic technicians: trained in assisting Ophthalmologists to take care of patients
The most highly trained are Ophthalmologists. They obtain an undergraduate degree, then attend four years of medical school to obtain their Medical Doctor or Doctor of Osteopathy degree, so they are either MDs (medical doctors) or DOs (doctors of Osteopathy). They then train for three or four years in a certified residency program to become an Ophthalmologist. Residency programs are usually at large universities with a teaching program as part of their medical school. This is where the majority of research, teaching, and training is done. General Ophthalmologists train in the diagnosis and medical and surgical treatment of every type of pathology of the eyes. Often Ophthalmologists undergo further training to become subspecialists in retina, glaucoma, neuroophthalmology, orbit, refractive surgery, pediatric ophthalmology and strabismus, orbit, medical retina, or oculoplastic surgery of the lids and lacrimal apparatus. Each of these subspecialties may be able to help those with bad eyesight.
Optometrists are Doctors of Optometry who go to a college of optometry and are trained in the measurement and prescription of contact lenses and glasses. While they also learn pathology, they generally refer patients to Ophthalmologists to surgically and medically manage ocular pathology.
Opticians are trained in the dispensing of glasses. They generally work in optometrists’ offices to measure and create glasses for patients. In ophthalmology offices, there are different levels of technicians as well, who assist the ophthalmologist or optometrist in the care of the patient. They are trained in the collection of data, as there are many diagnostic devices to help measure the eyeballs of our patients. They assist in surgery and help manage patients in many other ways. Bad vision has thousands of potentially different causes but can best be divided into the anatomic differences in the eye and each condition that can affect each anatomical structure.
What causes bad eyesight? What causes poor vision?
To answer this question, we should divide the eye into each of its anatomical structures from front to back:
- the eyelids
- orbit, bones around the eye
- lacrimal structures: lacrimal gland, glands of zeis and glands of moll, meibomian glands
- optic nerve
- extraocular muscles
Any sort of dysfunction of any of the above anatomical structures can cause poor vision, double vision, floaters, decreased peripheral visual field, pain, dryness, headaches, double vision, loss of vision, bleeding in the eye, cloudy vision, blurry vision, light sensitivity, and other problems. All can lead to bad eyesight.
Poor eyesight causes in the United States, in fact causes of bad eyesight in the world, are most commonly due to refractive error, or the need for glasses. This is our passion and our mission at SharpeVision to surgically and permanently allow our patients to see clearly without any glasses or contacts in a painless six to seven minute procedure. Refractive surgery means to change the focus of the light that enters your eye through surgical means. Type of refractive surgery that is best known as LASIK. However, there are many other types of practice surgery including PRK, SMILE, RLE, ICL, IOL, or cataract surgery. Each of these can change the way the light focuses in your eyes so that you can eliminate glasses and contact lenses. Indeed glasses and contact lenses also modify the way the light entering your eye is focused. However, in refractive surgery, it means that you don’t have to wear glasses or contact lenses because the light is focused perfectly either by using a laser to change the shape of your cornea, with an artificial lens inside your eye in addition to the natural lens of your eye, or with an artificial lens that replaces your natural lens. Each of these is best suited to your particular age, amount of glasses prescription, anatomy, and other factors. We also take into account your needs and desires. It’s a wonderful field and I am thrilled, privileged, and delighted to be able to perform surgery to help my patients see clearly without needing glasses or contact lenses.
Is bad eyesight genetic?
Bad eyesight can certainly be genetic, but genetic causes of poor vision are in the minority. Most of the time it’s refractive (glasses and contacts) or cataract, which we all will get if we live long enough. In each of the above anatomical structures, there are heritable traits and genes that can cause pathology and dysfunction in any of the above structures from your orbit to your extraocular muscles and everything in between. This also is best diagnosed by an ophthalmologist. There are even medical genetic specialists for the eye. These typically are for people with rare or familial diseases. Most of the time they will be at a large academic center such as Wills Eye hospital in Philadelphia, Bascom Palmer in Miami Florida, University of Iowa, and others have people subspecialty ophthalmologists who have made their entire careers with a mission to help those with rare genetic ocular disorders.
If you are simply asking yourself “Why is my eyesight so bad?“ then the best place to start is with an Ophthalmologist. He or she can diagnose you for refractive error, cataracts, macular degeneration, glaucoma, or many other conditions that you may not ever have heard of. We do screening tests such as measuring your visual acuity, refractive error, glasses prescription, eye pressure, retinal and optic nerve photography, eye shape with corneal topography, visual field (also called perimetry), color vision, pupillary responses, binocular vision (depth perception), and many more. We don’t do every test on every patient at every visit, but for your first exam we do take a lot of measurements and document the current status of your ocular health. This is important to monitor over time for many reasons. Sometimes the answer to the question “why is my eyesight so bad?“ is as simple as needing glasses, contact lenses, or refractive surgery. However, it’s always good to make sure that your eyes are otherwise healthy because many times people think they just need glasses, when in fact it is a progressive and irreversible condition such as glaucoma that is making their vision worse. This is tragic any time, but if it’s something that could have been prevented had someone come for an exam earlier, it’s even more upsetting. I’ve seen this a few times in my career, and I’m always saddened by it.
It’s my passion and mission to help those with poor vision or bad eyesight. Often we cannot do anything about conditions after they have damaged the delicate structures of the eye, but if we catch and diagnose the conditions early, we are much better able to help those with worsening eyesight. This is why I cannot emphasize strongly enough the need for you to have regular eye exams. One of the most insidious causes of loss of vision is glaucoma, which may not have any symptoms until there is extensive damage to the optic nerve that is not reversible. If we catch it early, eyedrops, laser surgery, or intraocular surgery can potentially slow or stop the progression of the glaucoma so that our patients can continue to have good vision for the rest of their lives. Get regular eye exams!
I hope this brief discussion on causes of bad eyesight has helped you to further your knowledge and refine your research. May you have a lifetime of excellent vision!
-Dr. Matthew Sharpe