I admit it - I don't know much about having - wearing - or needing glasses. I know even less about contacts. I've been very lucky. There's only been one time in my life when I needed the aid of glasses. Then I lost them. But because I waited a year to have the prescription replaced, my eyes recovered to their original 20/20 vision. I no longer needed glasses. For me the problem had simply been eye strain. But millions of Americans aren't so lucky. And with an aging population of Baby Boomers and Generation X-ers in their 30's - it has become clear that an aging demographic needs to understand their eyes health - and who they should see in order to maintain healthy vision.
What kinds of afflictions can we expect as our eyes age? The most common development is the need for reading glasses in and around our 40's. This occurence also serves as a mechanism for people to get their eyes regularly checked.

Well, the average person knows that an optician sells glasses. But how much further does their knowledge go when it comes to who you see for eye care and an exam? There are ophthalmologists and optometrists. Some of them even work with opticians in a more sort of full-service business. And it is also true that as time goes on the lines between these fields have become more blurred - though ophthalmologists are medical doctors and generally are the only ones who can perform surgeries.

I hit the streets of New York City to find answers to my questions. I began my eye care journey on the upper east side of Manhattan - I wanted to talk to someone from each part of the eye care field. I started with Morgenthal-Frederics, known for their hand-crafted double laminated plastics, metal lace inlays, and sophisticated frame fashions. The Zagat Guide calls them "The Rolls Royce" of opticians. And celebrities like Jack Nicholson, Claudia Schiffer, and Renee Zellweger sport their creations.
Morgenthal-Frederics is at the top of the eye glass food chain. Every pair of glasses is ground specially for the client's prescription and the frames are custom fitted to their face. The service is as individual as it gets. Roth explained you can fill a prescription six different ways depending on the factors involved, but Morgenthal-Frederics fits the prescription and frames to each indiviual customer specifically. "We're creating an image for the customer's face - to a lot of our customer's glasses are their image - it is part of their lifestyle," explained Roth.
Optometry is a two year program that culminates in an Associates Degree. These days a lot of optometrists and ophthalmologists employ opticians because as Roth explains,"that's where the money is. You don't make your money if your an optometrist giving an eye exam for $50.00. You make your money with the product." According to Roth, optometrists can even take on the role of optician - "they have enough training to do that."

I traveled from Manhattan to Queens in search of a neighborhood optometrist. I ventured to Forest Hills to meet with Dr. Charles Klein, an optometrist who's been in practice for nearly 40 years. Dr. Klein has the most enduring practice in the neighborhood. Klein followed in his Dad's footsteps because he liked everything about the field. Klein's practice is called Euphoropia. This past February Klein's practice merged with Continental Vision - and their website promises "wonderful new collections of exclusive frame lines and lots of high tech lens options." Just a few doors down is a Cohen's Optical. Klein wasn't worried about the competition.
According to Klein optometry requires four years of college, followed by four years of optometry school. There is no medical school training and no residency. Klein sees the role of optometrist as sort of the middle-man of the eye care field. In his words "soup to nuts." "The principle of optometry has always been that you provide a service from start to finish essentially. Patients come in with a problem - 'I need my eyes examined. I want to mkae sure they're healthy.' And they need to see better and they walk out having having had an eye exam and having been provided appropriate eye wear or contact lenses. So they're not walking out with a piece of paper and then going to somebody else to get that prognosis and then dealing with somebody else," continued Klein. "They walk out with a finished product and that's always been the principle of optometry that you were sort of soup to nuts."
According to Klein the only real eye care mergers that seem to work effectively, are those between an optometrist and an optician. The reason, he says, is because optometrists have the training to understand opticianry - and optometrists have the training - since they are physicians (not MD's) to understand the medical problems being corrected. They can cross-check a prescription or a piece of eye wear. But opticians and ophthalmologists generally can't cross-check each other. Klein's specialty is contact lenses. "The bulk of my practice is problem cases - people who are sort of contact lense failures," said Klein. "They've been enticed to know they want to continue persevering contact lense wear - but they have not been pleased with the lenses that have been offered to them." Dr. Klein doesn't keep lenses in stock. He deals with a myriad of lense vendors in order to get the exact lense needed for a patient. Most of these are small companies - each with a specialty - whether it be an innovation in materials or lense design.
Optometrists in New York State can be licensed to do eye health examinations and treat eye diseases. Optometrists in New York state can not give drugs or perform surgeries. The laws from state to state vary. For more information on your state contact the American Optometric Association at www.aoa.org.

I began the last leg of my eye care odyssey. This one would take me back into Manhattan. But this time the upper west side of 165th Street - between Broadway and Fort Washington Avenue, to the neighborhood of Columbia-Presbyterian Medical Center. Ultimately to the opthalmology division of The College of Physician's and Surgeons of Columbia University. I was here to see Dr. Richard Braunstein,M.D. - the Director of Laser Vision Correction and an Assistant Professor of Opthalmology specializing in Cataract and Cornea Surgery. Dr. Braunstein has been in practice since 1994. At a young 39 he reflects on the work he's put into his career.
" I went to medical school here at Columbia University," said Braunstein. "I did my residency training here, a year of internal medicine at North Shore Hospital on Long Island. And I did my ophthalmology training here at Columbia from 1990 to 1993. Then I did a fellowship in cornea and external disease at Hopkins from 1993 to 1994. My practice is pretty much limited to cornea - cataract and laser vision correction." The national demographic for cornea problems is growing - because we, as Americans, are getting older. Dr. Braunstein explained how corneas form and agreed that if a person lives long enough, there's no escaping its development. "The cells inside the lens in the eye are like skin cells and they continue to divide throughout your life," said Braunstein. "The difference is your skin cells fall off when they die - the cells in your lens get pushed toward the middle of the lens. So you've got this lifetime of dead degenerating cells to look though. And eventually, they're going to be less clear."
Knowing that his practice was so highly specialized I was curious if he would see someone to give an eye exam. "It depends," said Braunstein. "In general in my particular practice most people who come to me are going to need surgery. And usually they are referred by someone else for surgery - but there are many people who see ophthalmologists for primary eye care. There are some people who see optometrists for primary eye care...but my practice is limited mostly to surgical management."
I wanted to know what the most common complaints were when a patient first arrived at his practice. "The most common complaint is blurred vision - and if someone has never needed glasses their initial complaint is usually reading vision complaints," said Braunstein. "And that is commonly corrected with reading glasses which are magnifying spectacles. But we see a lot of people in my practice who have tearing, burning, discomfort, red-eyes, blurred vision, difficulty driving, glare, halos, night vision problems, inability to read, etcetera. It's a wide range of complaints and some complaints are more specific and suggestive of certain diagnosis and others really require a good exam."

A standard eye care exam - whether given by an optometrist or an ophthalmologist requires a history of current problems as well as a history of previous eye problems. Dr. Klein said you should bring any pair of old eye-wear with you for comparison of vision degeneration. You need to give your medical history - if you are being treated for any systemic diseases. They need to know what medications a person is taking - whether eye-related or general. Health care professionals also need to know any pertinent social or family history. When they examine your eyes - they will do it without glasses or lenses of any kind and then do what is called testing with manifest refraction. A test that uses a series of lenses in order to determine what your best vision is - then they compare that to your best previous pair of glasses or (if you've never worn glasses) to your uncorrected vision. Professionals look at the pupils to check for optic nerve or neurologic disease. They do a screening visual field test which also looks for optic nerve or neurologic problems as well as retinal. they check the motility of the eyes - to make sure they move together properly. Then professionals perform what's known as a slit lamp examination - inwhich a high powered microscope is used to examine the lids, the cornea, and the inside of the eye (including the lens). Doctors measure the pressure and screen for glaucoma, they dialate the eyes and and look at the health of the retina - checking for evidence of glaucoma, macular degeneration, or any other retinal diseases. All of this takes place in about an hour.

My head was spinning from all the information - but one thing seemed clear. Your first visit doesn't have to be dramatic or highly priced. However, you do have to find a good doctor. Generally people find good doctors by talking to friends and associates. The American Medical Association provides a list of physicians for patients and consumers (www.ama-assn.org). Also, in New York State, the official website for the state provides a "New York State Physician Profile" that gives valuable information about licensed doctors (www.nydoctorprofile.com).
Optician - eye-wear. Optometrist - eye-wear and eye exams, in some states low level eye treatment for diseases. Ophthalmologist - eye exams, prescriptions and surgeries.
My journey was over.