(1) Background: To determine the diagnostic accuracy that optical coherence tomography (OCT) can add to fundus photography (FP) in assessing the condition of the retinal posterior pole; (2) Methods: Two blocks of analysis: at first, the posterior pole of each eye was examined using FP non-mydriatic imaging device. Secondly: OCT was used in addition to FP. After consolidating specific diagnostic criteria, the assessments were evaluated by two blinded independent investigation groups (by optometrists, and by ophthalmologists who was considered the gold standard); (3) Results: We calculated the diagnostic accuracy of FP compared to OCT and found that both had similar sensitivity, FP had slightly higher specificity, (p-value: 0.01) and OCT had a higher kappa coefficient 0.50 (95%CI: 0.46-0.55) vs 0.39 (95%CI: 0.34-0.45) of FP; (4) Conclusions: Based on the premise that the role of the optometrist in Spain is not to diagnose but to detect lesions and refer patients to an ophthalmologist, the results of this study support the use of OCT, that it provided gradable images in almost all examined eyes (97.5%), compared to FP (73.5%). However, the optometrist need a detailed and standardized guide in order to evaluate according to the ophthalmologist's criteria.