Growing Challenges in a Shrinking Field

Jan 22, 2019 at 11:30 am by admin

Dr. Lauren Ditta examines a patient's eyes.

Memphis' Dr. Lauren Ditta Is One of Nation's Few Neuro-ophthalmologists

As one of only a very small number of pediatric neuro-ophthalmologists in the nation, in a field that medical experts say is in rapid decline, Lauren Ditta, MD, says versatility is key in her profession.

A subspecialist in neurology and ophthalmology, Dr. Ditta believes her job brings with it a series of challenges that include:

  • A rising shortage in the profession.
  • The sizable amount of time required to determine the cause of a vast range of vision problems.
  • And the inability to prevent permanent blindness.

In contrast, she said there are significant advantages that bring a high level of job satisfaction, including treating, and sometimes curing, patients with complex and uncommon vision issues and collaborating with a variety of specialists to treat patients.

Even though her specialty is in pediatrics, she also treats adults. Her patients go to her from across the nation with conditions ranging from double vision to brain tumors. She sees them at Le Bonheur Children's Hospital and the Hamilton Eye Institute, a nationally renowned ophthalmology institute through the University of Tennessee Health Science Center's Department of Ophthalmology.

Fellowship-trained in both pediatric ophthalmology and neuro-ophthalmology, she assists the departments of ophthalmology and pediatrics at UTHSC as an associate professor.

Neuro-ophthalmologists require specialized training in problems of the eye, brain, nervous system and muscles. According to the North American Neuro-Ophthalmology Society (NANOS), a professional organization consisting of 600 ophthalmologists or neurologists, neuro-ophthalmologists complete at least five years of clinical training after medical school and are board-certified in neurology, ophthalmology or both disciplines.

"We see with our eyes, but we process our vision with our brain," Dr. Ditta said. "Neuro-ophthalmologists have an understanding of how the eye and brain work together."

Despite the need for the subspecialty in both adults and children, Dr. Ditta said there is a local and national shortage of neuro-ophthalmologists due to the historical lack of lucrative surgical procedures in the discipline, the extra fellowship training required to practice in the field and the extensive time and effort it takes to diagnosis and treat a patient.

"I am one of about 25 pediatric neuro-ophthalmologists in the country," Dr. Ditta said. "The profession is extremely underserved in this region. There just aren't many of us."

A recent national survey of ophthalmology residents conducted by NANOS produced results that basically confirm Dr. Ditta's assessment. Thirty-one percent of residents were not interested in neuro-ophthalmology because of a lack of surgery and surgical reimbursements, the difficult nature of the specialty and the time required to practice the discipline.

"The process to determine what causes a patient discomfort is extensive," Dr. Ditta said. "We don't usually figure out what the cause of the problem is on the first visit. I don't see a lot of patients in one day. By the time patients see me, they are extremely frustrated because they may have already seen several specialists."

Dr. Ditta performs various surgeries, including eye muscle surgery, but she said this is a recent development in the field.

She treats patients with all kinds of acute issues through referrals from specialists all over the country, typically from neurologists and ophthalmologists. Some patients travel from as far as Florida, Missouri and Kentucky to see her at the Hamilton Eye Institute, which provides comprehensive eye exams and specialty eye care for patients.

"I see patients with acute issues every day," Dr. Ditta said. "Fifty percent may have a disease of some kind and 50 percent may have something else. It can be hard for me to easily determine what condition a patient has. I must do extensive testing, review records from several specialists and order scans to figure out if the problem is in the eye or brain. The first visit can take three or four hours. The earlier I'm referred the patient, the better."

Dr. Ditta said the key to treating patients is for physicians to refer them before the patient goes permanently blind.

"Sometimes, I get patients too late, " she said. "I can't do much for the patient if he or she has gone blind. I stress to all clinicians that if they see something that looks suspicious to refer their patients as soon as possible. I don't want to see a patient become permanently blind, especially if I could have prevented it."

According to Dr. Penny Asbell, chair of the Department of Ophthalmology at UTHSC and director of the Hamilton Eye Institute, the Memphis area benefits from Dr. Ditta's expertise.

"We are able to treat more unusual and less common eye disorders in the Memphis area," Dr. Asbell said. "We are fortunate to be able to provide an extra source of care for those patients at the Hamilton Eye Institute."

Dr. Ditta said that mostly she treats adult and pediatric patients with double vision and crossed eyes.

"There are many reasons a patient may have crossed eyes or double vision," she said. "The patient could have a brain tumor, a stroke, multiple sclerosis or an inflammation in the brain."

Over the past several years, she has seen a rise in adult women with idiopathic intracranial hypertension, which is a condition that occurs when pressure in the skull increases and the optic nerve becomes swollen. The symptoms mimic a brain tumor, but a brain tumor isn't present. Patients experience a headache behind the eyes, ringing in the ears and brief episodes of blindness.

According to Dr. Ditta, researchers aren't exactly sure why this condition typically occurs in overweight women of child bearing age, but they suspect it may correlate to progestin-containing contraceptives that are found in contraceptive implants and birth control injections.

"I am seeing a massive rise in 28- to 30-year-old women with this disease who are experiencing vision loss, and it's worrisome," she said. "There is a change in hormonal regulation which causes a swelling in the optic nerve. I've seen patients with 20/20 vision slowly lose their vision."

In addition to the Hamilton Eye Institute, Dr. Ditta is in charge of the neuro-ophthalmology program inside the Le Bonheur Neuroscience Institute at Le Bonheur Children's Hospital. Named one of the nation's top neuroscience programs by U.S. News & World Report, the institute treats pediatric patients with various neurological conditions. Surgeons performed 200 brain surgeries there in 2016. In 2017, the institute treated pediatric patients from 32 states.

Dr. Ditta sees pediatric patients with common neuro-ophthalmologic conditions and eye-related issues related to neurologic conditions on an inpatient and outpatient basis at Le Bonheur. She said one of the most rewarding aspects of her job is collaborating with other specialists. She works closely with a variety of medical specialists, including pediatricians, genetists, nephrologists, neurosurgeons and occupational therapists.

Despite her busy schedule and the amount of research and testing it takes to treat each patient, she said she achieves high job satisfaction through her profession.

"This is not a glamorous subspecialty; it's definitely a labor of love," Dr. Ditta said. "It's gratifying to help a patient who has double vision to be able to have normal vision again. I have adult patients tell me, 'I have a life again.' It's highly satisfying to get them functioning again."


Hamilton Eye Institute

Le Bonheur Children's Hospital

University of Tennessee Health Science Center

North American Neuro-Ophthalmology Society

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