O D or M D?

[MDK]

I am going to see a specialist for scarring on my eye and hopefully dry eye, too. I noticed the doctor I am going to, is an O. D. and not an M. D. (My local eye doctor's office made the appointment) does that make a lot of difference? Or am I in good hands with the O. D.?

[Rebecca Petris]

Depends on the OD. Also depends on the MD alternative. You might want to check out my article on finding a good dry eye doctor here.

Here's an excerpt:

STEP 2. Consider both MDs and ODs

Your doctor type choice lies between an optometrist (OD) who happens to take a serious interest in dry eye and an ophthalmologist (MD) whose subspecialty training is in cornea/anterior segment (let’s call them cornea MDs for convenience’s sake) AND who also takes a serious interest in dry eye.

Many people with chronic severe dry eye tend to take it for granted that they must have an ophthalmologist – that an optometrist isn’t “good enough” in their situation. And understandably so, since many of you were referred to your first cornea MD by your OD.

But if you haven’t ever reconsidered a dry eye savvy OD as your dry eye “primary care” doctor, now is a good time to do so. Compared to the average cornea MD, ODs are considerably more likely to actually WANT you in their practice. As one cornea MD said to me a couple of years ago, most cornea MDs don’t actually like treating corneal disease. Some of you remember when I had the Dry Eye Yellow Pages, right? There were lots of MDs I wanted to list there because I knew they were really good at dry eye – but they did not want their names there because they were concerned it would bring too many dry eye patients through their doors. I’m quite serious. And I’m not saying it to be critical – I’m just describing the reality of our situation here. To the mainstream cornea MD, dry eye tends to be a sidebar professionally and something approaching negligible financially unless they are among the slim minority who truly specialize in it. To the mainstream optometrist, dry eye is a little closer to bread & butter. This does not mean you’ll get suboptimal care from the MD just because s/he’d rather be doing surgery. But with an OD may be more available and more interested and, overall, a better day-to-day resource.

So, to get a GOOD doctor, you are looking for either a gem of a cornea MD who likes ocular surface disease, or you are looking for a gem of an OD who is taking maximal advantage of the extensive continuing education dry eye courses available these days. Better yet, look for both. For some, the ideal situation is an OD who’s very serious and up-to-date about dry eye but who is either in a mixed practice with a cornea MD available to consult when needed or who has a good relationship with a good cornea MD at a nearby university.

One last note: Some of you could really benefit from drawing another specialist onto your team. This might be a really good dermatologist (for example if you have really stubborn lid margin disease) or a really good endocrinologist (if your dry eye onset is suspected to have coincided with hormonal changes).

[MDK]

Thank you, Rebecca! That is perfect! Just what I wanted to know!

[Blinks]

MDK, If you are considering laser surgery for corneal scarring as suggested in one of your other posts, my earnest vote / recommendation is for a corneal specialist --one who is an ophthalmologist (MD) and board certified -- with specialty in cornea and external eye disease, anterior segment and refractive surgery.

Then..... get a second opinion... Your dry eye may be secondary to the corneal scarring which needs a different level of care.
To the best of my understanding an OD, or optometrist is NOT qualified to do surgery.

Rebecca, would you agree?

Even if you ultimately decide not to have surgery, really give some thought to starting with a top notch board certified ophthalmologist (MD) for the corneal scarring issue for a diagnosis.

This is one of those stories from my own unhappy experience: I went to a great optometrist for years completely blissful, while the scars progressed, and now my options are limited.

Just my 2 cents. Wishing you all good outcomes.

[MDK]

Thanks, Blinks! I will. I am going to Vance Thompson Eyecare, they have both kinds of doctors, including the lady on the Restasis commercial! I am thinking that I first need a whole workup and then see where it goes.

[Rebecca Petris]

Great point, Blinks. I hadn't read the other posts yet so wasn't aware. Just goes to show how important it is to have the full picture before trying to answer a question I'm making a note to update that article too... There are a number of special requirements especially surgeries that could point to an MD being the better choice even setting other considerations aside. However also note that what ODs can do varies by state (and of course country).

[Blinks]

Oh, it sounds like you've found a practice with a team approach! How absolutely wonderful (and fortunate) to have access to this type of care! Best of success with your journey.

[MDK]

Well that's what it looks like on the website, LOL! We'll see what it's like in real life!

[Blinks]

There are a number of special requirements especially surgeries that could point to an MD being the better choice even setting other considerations aside. However also note that what ODs can do varies by state (and of course country).

Eyes are just so -um- complicated! It's really difficult to know which way to turn to sort out the issues; the chicken and the egg kind of thing. And the doctors (ophths, optometrists, specialists) seem to possess deep expertise / knowledge in one specialty, making a comprehensive coordinated care team the exception rather than the rule. Judging by the discussions on this forum, there's ample room in the market for a new model of providing coordinated eye care across specialties and unfortunately many of us who are desperate for comprehensive care. Finding the right diagnosis, the right doctor, the right treatment, at the right time is like finding the needle in the haystack. Thank you for all that you do for us, for this forum, and the opportunity for mutual support.