A marriage of specialties

A ground-breaking ophthalmologist-dermatologist pair practices together as colleagues and spouses.

The ultimate example of cooperation between the specialties of ophthalmology and dermatology may be the husband-and-wife team of ophthalmologist Jean Carruthers, MD, and dermatologist Alastair Carruthers, MD. The two physicians are known for their joint work in the development of Botox (botulinum toxin type A, Allergan) for use in ophthalmology and ophthalmic plastic surgery. Their successful collaboration is a result of their joint perspective on two medical-surgical specialties, a combination of Dr. Jean Carruthers’ work with strabismus and Dr. Alastair Carruthers’ work in dermatologic surgery.

Ocular Surgery News spoke with the two physicians about how their work together has bridged ophthalmology and dermatologic surgery and how they have maintained their fruitful working relationship.

Ocular Surgery News: How do the two specialties, ophthalmology and dermatology, complement each other?

Dr. Alastair Carruthers: They’re both visual specialties; that is, we have the ability to outwardly view the organs in which we specialize.

Dr. Jean Carruthers: But ophthalmology is also focused on the periorbital area and the whole visual system, including the brain, whereas in dermatology the outlook is much broader. But they complement each other extremely well. Both specialties cross over each other.

Dr. A. Carruthers: Historically, dermatologists have been trained in internal medicine, whereas ophthalmologists think of themselves as surgeons. But there are many dermatologists who perform surgery more than some ophthalmologists do. So in many ways the two specialties are medical specialties.

The husband-and-wife team of ophthalmologist Jean Carruthers, MD, (left) and dermatologist Alastair Carruthers, MD (right). Image: Carruthers J

OSN: How have ocular dermatologic procedures such as Moh’s aesthetic surgery evolved during your careers?

Dr. A. Carruthers: About 20 years ago, Alston Callahan, MD, from Birmingham, Ala., a famous oculoplastic surgeon, wrote an editorial in one the major ophthalmology journals saying that Moh’s surgery was the treatment of choice for basal cell carcinoma around the eyelid. It took time for that technique to catch on.

All the Moh’s surgeons I know have close relationships with oculoplastic surgeons, with the recognition that Moh’s surgeons are good at making certain the tumor is really gone, and oculoplastic surgeons are good at repairing the damage once it is gone. That is, I think, now firmly established.

The kind of cooperation that Jean and I had with Botox was just fortuitous. As a strabismologist, she used Botox, or Oculinum as it was then called, and I had patients with wrinkles. We put the two together and, because we were both looking at things with different expertise, it worked in the interest of our patients.

In other words, Jean knew how to draw this deadly poison up into a syringe, and I knew which patients would benefit from it. If you weren’t familiar with botulinum toxin, or if you didn’t understand the aesthetic sensibilities, then it just wouldn’t come together as it did for us.

There were a number of people who had the same idea at around the same time. But if you look at their publications, they weren’t as fortunate as Jean and I to have the complementary skills.

Dr. J. Carruthers: The important thing is the anatomy. That’s something that surgical dermatologists and surgical ophthalmologists are both familiar with, and that’s what makes for success with Botox – knowing what’s happening underneath the skin. If you understand the anatomy, when you’re injecting through the skin you’re going to create the aesthetic result that the patient desires.

OSN: What is the current status of the dermal fillers?

Dr. J. Carruthers: Fillers are outside the normal day of the average comprehensive ophthalmologist, but they could be an important part of their practices.

There are times, for example, that we do blepharoplasty on a young person’s lower eyelids to remove fat. Well, we now know that many times those young people just need an injection of a filler along the nasal fold and bony lateral lower orbital margin, and they get a fantastic result with minimal downtime. Surgery could be postponed until these individuals have skin that is more prolapsed with orbital fat.

With education on the safe use of intra- and subdermal fillers, these products could enhance the treatments oculoplastic surgeons offer to their patients.

Dr. A. Carruthers: When we look at one another, we look at the eyes. You can take a drop of fat out or reposition it close to the eyes, and it can make a difference. But when you’re addressing the abdomen, you have to remove a pound or more of fat to make a difference. So the closer you are to the eyes, the more important the difference cosmetically.

That’s within the area of expertise of ophthalmology. I absolutely agree with Jean. Dermatologists can do work on the lower eyelid and use fillers for other simple cosmetic procedures – simple, that is, in comparison to some of the oculoplastic procedures, such as rebuilding orbits.

Making adjustments

OSN: What obstacles did you have to overcome when you first started working together?

Dr. A. Carruthers: The biggest single hurdle was for Jean to give up pediatric ophthalmology, and the second biggest hurdle was for me to give up Moh’s surgery. The world that we had created together had taken over our practices. But being married to another professional is helpful.

Dr. J. Carruthers: Another helpful thing for me was going to dermatology meetings. Dermatologists are optimists and brilliant and full of energy – like ophthalmologists – but they deal with a different series of topics. There’s quite a lot to learn. If you want to be an ophthalmologist who works closely with dermatologists, you’ve got to learn their lingo. You’ve got to learn their subject matter.

It was a deep learning curve initially, but the more you involve yourself in a new language, the more it starts to be natural. When I keep up with the ophthalmology literature now, I feel that I’m looking down a more focused path than that of the cosmetic world.

Dr. A. Carruthers: The most important thing that one can bring to this kind of change in one’s practice is respect. You must treat the knowledge in the other specialty with respect and an open mind.

OSN: Do you think there will be overlap in the future between dermatologic surgery and ophthalmology?

Dr. A. Carruthers: In the areas of skin cancer and cosmetic surgery, we have, I believe, made huge advances in treatments. Dermatology is a very open specialty. We’re very inclusive. We’re keen to use the expertise of other specialties. We were keen to educate ophthalmologists because ophthalmologists gave us Botox.

Ophthalmologists, at times, can be more traditional, but I’m delighted to see that that’s changing and that they are becoming more open to other ideas. There is great potential for future collaboration.

Dr. J. Carruthers: The cosmetic world actually brings specialties together. You can come from a number of different paths and end up doing the same procedures.

When you become a specialist, whether a dermatologist or ophthalmologist, you choose a particular organ system and become an incredible expert in that system. But when you approach cosmetic surgery, you come back together to those procedures.

So I see cosmetic surgery as being a unifying force. Cooperation and interdisciplinary teaching are ways to give excellence and safety to our patients.

For Your Information:

• Jean Carruthers, MD, can be reached at 943 West Broadway, Suite 740, Vancouver, BC, V5Z 4E1, Canada; 604-730-6133; e-mail: christa@carruthers.net.
• Alastair Carruthers, MD, can be reached at 943 West Broadway, Suite 820, Vancouver, BC, V5Z 4E1, Canada; 604-714-0222; e-mail: reception@carruthers.net.

• Katrina Altersitz is an OSN Staff Writer, who covers all aspects of ophthalmology.