Medical Optometrist: Careers in Medical-Model and Ocular Disease Optometry

A medical optometrist is a licensed doctor of optometry whose practice emphasizes diagnosing and managing eye disease, rather than centering on routine vision checks and eyewear.

The label describes a mode of practice, not a separate license: per BLS, all states require optometrists to be licensed, and medical optometrist describes how that license is used.

The caseload is disease-led: conditions such as glaucoma, diabetic eye disease, macular degeneration and dry eye, alongside acute visits and the pre- and post-operative care that an OD-MD group may divide between optometrist and ophthalmologist.

Those are job duties described here — this page is career information, not guidance on any individual patient's care.

The same career travels under other names: ocular disease optometrist, medical-model OD, or a primary care practice with a medical emphasis.

The vocabulary is the field's own — board certification for this mode of practice exists as the American Board of Certification in Medical Optometry (ABCMO), which uses a passing score on NBEO's ACMO examination, built from simulated ocular-disease cases.

One practice can also hold both models at once, with routine exams and medical visits sharing a single schedule.

What makes an OD a medical optometrist is where the center of gravity of the week sits.

Day to day, the work starts with the medical examination: dilated fundus evaluation, slit-lamp examination, and the testing that documents whether a condition is stable or progressing.

Prescribing for eye disease sits on that foundation, in each state's terms — what an OD may prescribe is set by state law, which is covered below.

Chronic disease shapes the calendar.

Managing glaucoma, diabetic eye disease or dry eye means follow-up work, and that ongoing recall is what separates a medical-model schedule from a one-visit-and-glasses rhythm.

Acute problems — infections, inflammations, injuries — fill the gaps between those recalls.

Documentation is imaging- and function-led: optical coherence tomography (OCT), visual field testing and fundus photography are the tools the disease work is recorded with, and the OD reads and acts on the results.

Practices also staff up around the doctor — ophthalmic medical technicians held 14.70% of wage-and-salary jobs in offices of optometrists in May 2025 (BLS OEWS, NAICS 621320) — and where a group puts pre-testing with its technicians, the OD's time goes to examination and interpretation.

Co-management is the other half of the rhythm.

Where an OD-MD group divides the work that way, the ophthalmologist covers the operation and the optometrist carries the medical eye care around it — the work-up before surgery and the recovery visits after — within each state's scope rules.

Per BLS, the largest employers of optometrists in 2025 were offices of optometrists (61%), offices of physicians (14%), retail trade (13%), self-employed workers (5%) and outpatient care centers (4%).

BLS's table splits industries, not practice models, so medical-model work appears across these slices — and private offices of optometrists run medical models too.

• OD-MD and ophthalmology groups. BLS's employer table placed 14% of optometrists in offices of physicians in 2025. Separately, the BLS OEWS May 2025 median wage for optometrists in that industry was $145,630 (SOC 29-1041, wage-and-salary ODs). Where a group divides the work, the OD carries the medical caseload and the ophthalmologist covers surgery.
• The VA. Over 1,000 VA optometrists work at more than 350 VA facility sites, in the VHA Optometry Service that Public Law 94-581 created on October 21, 1976. VA optometrists are Title 38 Chapter 73 providers working as medical staff in medical centers, outpatient clinics, community living centers, blind rehabilitation centers and community-based outpatient clinics (CBOCs), and each facility decides its own hiring. VA's job series for optometrists is 0662.
• Indian Health Service and tribal programs. IHS and tribal facilities hire optometrists through three systems: the U.S. Public Health Service Commissioned Corps, federal civil service and direct tribal hire. IHS and tribal programs operate in 35 states, and IHS markets a Loan Repayment Program to optometry candidates.
• The military. Federal law (10 U.S.C. 2123) sets Health Professions Scholarship Program members' active-duty obligation at no less than one year for each year of participation; the statute leaves profession designations to each service. The Navy and Air Force also take licensed ODs onto active duty. The Navy requires active-duty optometrist applicants to be currently licensed and practicing in the U.S. — new graduates get a year after starting active duty. The Air Force requires an unrestricted state license to practice optometry using therapeutic pharmaceutical agents (service recruiting pages, October 2026).
• Hospitals and outpatient centers. Outpatient care centers employed 4% of optometrists in 2025, and the BLS median wage there — $207,030 in May 2025 — was the highest of the industries BLS lists, for wage-and-salary ODs.
• HMOs. Kaiser Permanente hires optometrists directly as employees, per a Southern California posting viewed in October 2026 — a medical-center employment model rather than a retail lease.

Two labels matter on the wage figures: they are BLS OEWS May 2025 medians for optometrists (SOC 29-1041), and OEWS counts employees only, so practice owners and sublease ODs are outside those medians.

The employer shares come from a different BLS table that lists self-employed workers as their own 5% row.

A residency is optional for licensure.

Per BLS, after finishing the O.D. degree optometrists may choose one year of advanced clinical training in the area they wish to specialize in — areas that include primary care, cornea and contact lenses, and ocular disease.

Nothing in the model requires it; what it buys is depth and a hiring signal.

Residency positions are awarded through ORMatch, run by National Matching Services for ASCO.

In the 2026 Match, 283 programs at 271 sites offered 518 positions; 455 applicants participated and 356 matched — 78% of participants — leaving 162 positions (31%) unfilled in the Match.

Unfilled positions can be filled in the Post-Match Process, so final residency counts run higher than the match figure.

Set against VA's estimate of 1,500-1,600 OD graduates a year, the 356 matches equal roughly a quarter of one class — a computation from the two sources, not a published rate.

VA runs training at scale on the federal side.

VA says its optometric clinical training program is the largest in the United States, with over 215 ACOE-accredited residency positions and about 1,400 externship positions a year, and prior VA residents get preference for VA staff positions (March 2026 brochure).

VA residency applicants must be U.S. citizens with an O.D. from an ACOE-accredited school by July 1 of the residency year, must obtain a state license before completing the residency, and apply through ORMatch.

Employers can prefer the credential even where no rule requires it.

A Kaiser Permanente posting in Southern California (October 2026) lists completion of a one-year ACOE-accredited residency as preferred, and VA says entry grade and salary depend on education, training and experience such as an ACOE residency, NBEO certification and FAAO.

Board certification is the optional layer on top, and it is not the licensing exam: NBEO discontinued its own board-certification program in February 2019, and board certification for ODs now comes from the American Board of Optometry — or ABCMO for medical optometry.

The ABO charges a $300 application, asks Active Candidates to reach 150 qualifying points within 3 years, then administers its exam at a standard fee of $950.

An ACOE-accredited residency completed within three years earns all 150 points at once; practice years earn 5 points each, capped at 50, which is why a residency is the fast track.

Certification is voluntary and is kept current through Maintenance of Certification.

Routine practice solves refractive needs: measuring vision, prescribing corrective lenses, fitting contact lenses and the dispensing work that follows.

Medical practice treats the eye as an organ with disease: it adds diagnosis and management of pathology, chronic follow-up and co-management to the week.

The same OD can carry both in one schedule — the model describes where the weight sits, not a wall between the two.

The depth of the medical half depends on your state.

Per BLS, all states allow optometrists to prescribe medication, but states vary in which medications ODs may prescribe and in whether ODs may perform surgery or other procedures such as vaccinations.

Your scope of practice — set by your state's statute and board rules — decides which parts of the medical model you can personally deliver.

That is why geography matters in a medical OD job search.

The same title can mean a different legal toolkit across a state line, and that changes the caseload you can carry and the co-management arrangements a practice can offer you.

The sources show both sides.

BLS reports pay by industry, not by practice model, so the medians below describe settings, not the medical model itself.

The upside:

• Pay medians by setting. BLS median optometrist wages in May 2025 were $129,250 in offices of optometrists, $145,630 in offices of physicians, $159,250 in retail trade and $207,030 in outpatient care centers (SOC 29-1041, wage-and-salary ODs — owners and sublease ODs are outside these figures).
• Federal benefits on the public side. VA's 2024 brochure lists FERS retirement (pension, Social Security, TSP), 208 hours of annual leave a year and 104 hours of sick leave a year for its optometrists, alongside Title 38 Chapter 73 provider status.
• Loan repayment where it exists. IHS markets its own Loan Repayment Program to optometrists — while optometrists are not an eligible discipline for the NHSC Loan Repayment Program in 2026, so aim the application at the right program.
• A teaching ladder. About 58% of VA optometrists hold faculty appointments at affiliated optometry schools, per VA's 2024 brochure — one route into academic work alongside clinical practice.

The downside:

• A residency costs a year, and the Match is not a formality. Of the 455 applicants in the 2026 ORMatch, 356 matched, so the remainder went unmatched in the Match itself — even though 162 positions went unfilled and could be filled afterward.
• Employer conditions can be demanding. One October 2026 Kaiser Permanente posting required full-scope practice, evening and Saturday work, and rotation among medical office buildings — a single posting, but a fair window on the model.
• Your legal toolkit depends on the state. States vary in which medications ODs may prescribe and in whether ODs may perform surgery or procedures such as vaccinations, so the same career looks different across a state line.
• Credentials cost money and time. American Board of Optometry certification takes a $300 application, 150 qualifying points within 3 years and a $950 standard exam fee — and practice years alone earn 5 points each, capped at 50 of the 150 required.

Medical optometrist roles are posted across every setting in this guide: OD-MD and ophthalmology groups, VA medical centers, IHS and tribal programs, military and other federal facilities, hospitals and outpatient centers, and HMO clinics.

Browse medical optometrist jobs on OptometryHires — a board that lists only eye care work.

Building the practice side instead?

Practices and OD-MD groups that need to hire a medical optometrist can start at the OptometryHires hiring hub.

Career information, not medical, licensing or legal advice. Scope of practice, licensure and certification rules change — confirm your specifics with your state board of optometry, and program or credential details with the bodies named above: NBEO, ACOE, ASCO's ORMatch operator National Matching Services, the American Board of Optometry, VA and IHS.