CertificationJul 12, 20266 min read
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Optometrist pay and benefits
Optometry is a doctorate, and most of its jobs sit behind a retail optical. The patient who booked for glasses is often the one whose retina needs photographing, and telling those two visits apart is the daily skill.
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Two businesses, one job title
A vision-plan practice runs on routine exams paid at the plan's fee schedule, with the margin sitting in the optical. A medical-model practice bills medical insurance for glaucoma, dry eye and urgent visits, and owns the imaging those need. In 2019, 62.7% of optometrists billed Medicare fee-for-service for at least one service, and 29.5% billed for a visual field test. Fewer than half of the optometrists who bill Medicare at all do visual fields, so the equipment list in a posting tells you which kind of practice you're looking at.
Your questions about optometrist jobs, answered
- What's the difference between an optometrist and an ophthalmologist?
The difference is training and the operating room. An optometrist holds a doctor of optometry degree, examines eyes, diagnoses disease and prescribes correction and medication. An ophthalmologist is a physician who completed medical school and a residency, and performs eye surgery. Many practices employ both, with the optometrist carrying the medical and refractive care and referring the surgical cases across.
- Does optometry scope of practice vary by state?
A great deal. Every state allows refraction and the medical management of eye disease to some degree, and they part on the authority above that line. 17 states have passed laws letting an optometrist perform in-office lasers, and two of those aren't live yet: Tennessee's starts in January 2028 and Vermont's that July. Injections are far more common. 42 states allowed some form as of January 2025, and in 17 of them the authority covers anaphylaxis and nothing else. A posting saying full scope means something different in each state.
- Do optometrists do a residency?
It's optional, and most don't. A one-year residency after the degree specializes you in areas such as ocular disease, pediatrics, low vision, or hospital and VA practice, and it's what hospital-based and academic postings tend to want. Private and retail practice hires straight out of school.
Optometrist career guides