Ophthalmologist vs Optometrist

[kitty]

This question might have been asked before, but are there any feelings out there as far as who is better trained to manage DES, an optometrist or an MD? I'm getting really frustrated with the two optometrists at my current eye clinic. I'm getting bounced back and forth between them and they cannot seem to reach a concensus on what to do with/for me. I am considering making a change. All I want is someone who has more than a passing interest in DES and putting in plugs. I wish Dr. G. lived here!

[neil0502]

Feeling? Yeah. Knowledge? No.

My *feeling* is that either an MD or an OD is perfectly *capable* of being the best there is at managing dry eye. My (nothing more than an) opinion is that there *may* be some diagnostics that an MD can do that an OD can't (cytology, biopsy, confocal or electron microscopy). Whether or not those *really* drive any changes in actual treatment regimens, though, I just can't say for sure.

I'm just not sure that we're at the point where we know anything more, with certainty, than "these are the things to do to treat aqueous deficiency, and these are the things that we do to treat evaporative."

Even THEN, it's most assuredly art, not science.

I think an MD dry eye specialist (a Pflugfelder or a Tseng or a Latkany, or similar) is something that we *all* should consider seeing at least once to get the most accurate diagnosis that we can. But ... if we've got MGD or blepharitis or KCS or any of the "run-of-the-mill" stuff, then I'm not sure that a caring, dedicated, knowledgeable OD is going to do any worse job of managing you/us than a comparably qualified MD.

The other thing about an OD (take it for what it's worth) is that--since THEY don't cut--they aren't always looking at the most aggressive forms of potential treatment. Maybe that's good; maybe that's bad. I'm not sure.

I think it's a great question, Kitty. Hope to hear others' opinions!

[Rebecca Petris]

Kitty,
Just occurred to me based on your location... I forget quite where you are but if the east side isn't too far to go there's a Dr. Laukitis (sp?) you may want to try and see. A good friend of mine who struggled terribly with dry eyes and went through about 15 drs. cannot speak highly enough of him, he was the first one to diagnose and help her.

[kitty]

Is he an MD or an optometrist? I live on the east side. Thanks much!

[kitty]

Would that be J Steven Laukaitis MD, in Kirkland? You are the greatest Rebecca. Thank you! I see he is now the medical director of a cosmetic surgery center/ medi-spa combo.

[Rebecca Petris]

Yup, that's him! I knew the spelling didn't look quite right... Mind you I've never met or spoken with him, I'm just going off my friend's experience, but she speaks so highly of him and she's been through so much I thought it might be worth a whirl.

On the general question: I think both ODs and MDs are perfectly capable of being great advocates for their dry eye patients if they take an interest and keep up with the literature. I think that attitude, intelligence and a keen interest can be extremely important qualifications for any 'dry eye doctor'.
But there are also some concrete, easier-to-establish considerations that do matter:
- How much theoretical training do they have?
- How much of their practice consists of patients like you?

MDs who are also corneal specialists, and especially if fellowship trained, have the advantages of a great deal more training in this specific disease area and also of probably seeing a much greater concentration of severe dry eye patients than other eye doctors. If I were feeling like I had reached the end of my optometrist's or comprehensive ophthalmologist's resources, I'd look around for a really good corneal specialist and maybe try to chat with their receptionist or technician to find out how much of their practice is with severe dry eye.

[DrG]

This question might have been asked before, but are there any feelings out there as far as who is better trained to manage DES, an optometrist or an MD? I'm getting really frustrated with the two optometrists at my current eye clinic. I'm getting bounced back and forth between them and they cannot seem to reach a concensus on what to do with/for me. I am considering making a change. All I want is someone who has more than a passing interest in DES and putting in plugs. I wish Dr. G. lived here!

Me, too. I wished I lived in many different places!

Thanks for mentioning my name. I've been kind of pre-occupied lately with all kinds of interesting projects. I'll try to keep everybody informed.

[kitty]

If I were feeling like I had reached the end of my optometrist's or comprehensive ophthalmologist's resources...

That is a very nice way of putting it, Rebecca! I will use that phrase soon I am sure. A friend has discussed me briefly with her ophthalmologist who does treat many people with DES. I'm thinking that might be my next step. I will keep the other doctor in mind though.

Dr. G., glad to hear you are still around! I'm interested in hearing what you have been up to!

[DrG]

Dr. G., glad to hear you are still around! I'm interested in hearing what you have been up to!

Well, mainly I'm just keeping busy treating the all the post-RS patients and doing dry eye workups.

But, I'm also really, really excited about new technology to better serve all of my highly aberrated friends. I just acquired a research grade wavefront aberrometer, one of the best for reading highly aberrated eyes, so I can measure all of those corneal aberrations before, during, and after treatment. This will also enable me to experiment with wavefront generated contact lenses.

Sorry I don't have anything new to report about dry eyes, at least at this time, except that there are lots of them.