We strongly recommend that anyone with ocular inflammatory disease be treated by a physician who has completed a Fellowship in Uveitis or in Ocular Immunology. It can be difficult to find specialist resources for treatment of uveitis and, for this reason, we hope this information will be helpful to you. If you would like some help in researching specialist resources, please post a note on our support board, https://uveitis.org/patients/online-support-group/, and we will try to help you with your research.
All ophthalmologists receive some training in the diagnosis of uveitis as well as the diagnosis of many other eye diseases. The local ophthalmologist in general practice will often be the first physician to make the diagnosis of uveitis. General medical practitioners can suspect the presence of the disease, but special equipment and training in ophthalmology is required to confirm the diagnosis.
Uveitis is not, in most instances, a difficult illness to diagnose. The signs and symptoms of uveitis are obvious to the trained observer using special medical equipment (a slit lamp). While uveitis is not difficult to diagnosis, it can be very difficult to treat. Specialist resources should always be considered for ongoing care of uveitis lasting more than three months.
We strongly recommend that anyone with uveitis or other ocular inflammatory disease be treated by a physician who has completed advanced, specialized training in uveitis or in Ocular Immunology. This will most often require that you ask your local ophthalmologist to refer you to such a specialist. Finding specialist resources can be difficult and will take some persistence. The first step is to know what you are looking for.
Before going on to specialist training in ophthalmology, the physician will have successfully completed training to become a general ophthalmologist. To become an ophthalmologist, the physician must have graduated from medical school and have successfully completed a one year medical internship and a three year residency in ophthalmology at an accredited institution.
Some ophthalmologists continue their training after completing the requirements to become a general ophthalmologist. This advanced training is referred to as “Fellowship” level training, and lasts at least one year, often two. The most commonly encountered sub-specialties in ophthalmology are Glaucoma, Retina, Cornea, and Pediatric Ophthalmology. Most communities in the United States have access to glaucoma, cornea, and retina specialists. Ocular Immunology and Uveitis is another specialty area in ophthalmology. Such specialists are relatively rare, certainly as compared with the relatively wide availability of specialists in glaucoma and retina. There are about 100 physicians in the world who have been trained in Ocular Immunology.
Most people who want to consult with a true specialist in uveitis or ocular immunology will have to travel outside of their community. Because specialists with advanced, Fellowship level training in uveitis are in short supply in the United States, Retina Specialists often are called upon to treat patients with uveitis. This is because the complications of uveitis can cause symptoms on the retina. Cornea specialists also see a lot of uveitis patients when no specialist resources are available.
So, you may be under the care of a physician (ophthalmologist) who treats uveitis patients and who has considerable experience in this regard, but no formal training in Immunology or Uveitis. Some ophthalmologists without this advanced specialty training may even have a special interest in uveitis, and membership in professional societies such as the American Uveitis Society is an expression of this special interest.
There are three lists of uveitis specialists that are widely distributed on the web. These lists appear on the web sites of the American Uveitis Society, the American Association of Ophthalmologists, and the Ocular Immunology and Uveitis Foundation. All of these lists are made up of physicians who are self-designated as having an interest in uveitis. Many of the physicians on these lists have no formal, advanced training in the diagnosis or treatment of uveitis. There are some physicians on these lists who have completed advanced Fellowship level training in Uveitis or Ocular Immunology. Unfortunately, you will not be able to tell simply by looking at these lists who has had advanced training and who has “an interest.” You will have to ask the physician specifically about their specialist training. The OIUF list includes a link to the professional’s background and training.
If you would like some help in researching specialist resources, please post a note on our support board, Uveitis Online Support Group, and we will try to help you with your research.
So, you are looking for a “specialist” that has advanced training in uveitis or ocular immunology. What should you do. These definitions should be helpful.
A Uveitis Specialistis an ophthalmologist with a special, specific interest in uveitis, and who has become proficient in the diagnosis and management of patients with uveitis. The most straightforward way to do this is to complete at least one year of advanced training, a dedicated Uveitis Fellowship training program, aimed at development of expertise in the diagnosis and treatment of all forms off uveitis. Not all uveitis specialists have advanced training in uveitis. You will need to ask.
An Ocular Immunologist is an ophthalmologist who has, by virtue of advanced training in Ocular Immunology, developed highly specialized diagnostic and therapeutic skills in caring for patients with destructive inflammatory diseases of the eye mediated by abnormal immunoregulatory processes. Ocular Immunologists have advanced training and clinical experience with all inflammatory diseases of the eye, with systemic autoimmune disease, and with systemic immunomodulatory therapy.
If you are seeking a consultation regarding immunomodulatory therapy (IMT) for treatment of uveitis or other ocular inflammatory disease, it is worth knowing that physicians with advanced Fellowship-level training in Ocular Immunology are more likely to be equipped, by virtue of their training and experience, to render a balanced and expert opinion on the full range of treatment options that should be considered, and to be able to provide immunosuppression chemotherapy should it be recommended.
We strongly recommend that anyone with ocular inflammatory disease be treated by a physician who has completed a Fellowship in Uveitis or in Ocular Immunology. It is perfectly appropriate to ask any physician, whom you are considering having as part of your team, about their specific Fellowship training in Uveitis or Ocular Immunology.
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Uveitis and Steroid-Sparing Therapy
Presented by C. Stephen Foster, MD, FACS, FACR
Audio-Digest Ophthalmology Volume 56, Issue 15