Ophthalmologists Show Highest Accuracy for Thyroid Eye Disease Referrals
September 14, 2026
A retrospective study presented at the Women in Ophthalmology Summer Symposium found that ophthalmologists had the highest accuracy among the major referring specialties for identifying patients with thyroid eye disease (TED). The findings suggest that ophthalmologists may have an important role in screening patients and directing them to specialized TED services, particularly in areas where multidisciplinary expertise is not readily available.
Study Findings
Emma Tsai, MD, and colleagues conducted a retrospective, cross-sectional analysis of referral patterns at a multispecialty academic TED clinic. The investigators reviewed 122 new patient referrals collected over a 1-year period and assessed the referring physicianโs specialty, the patientโs final diagnosis, and TED disease activity and severity.
Endocrinologists accounted for the largest proportion of referrals, followed by ophthalmologists and optometrists.
| Referring specialty | Proportion of referrals | Accuracy for TED referral | Patients with active TED |
|---|---|---|---|
| Endocrinologists | 33.6% | 85.4% | 57.1% |
| Ophthalmologists | 30.3% | 91.9% | 55.9% |
| Optometrists | 25.4% | 80.6% | 32.0% |
Key finding: Although endocrinologists generated the greatest proportion of referrals, ophthalmologists demonstrated the highest referral accuracy (91.9%) among the three specialties evaluated.
Ophthalmologists Had the Highest Referral Accuracy
The accuracy of referrals varied considerably among the specialties. Ophthalmologists correctly identified patients requiring evaluation for TED in 91.9% of referrals, compared with 85.4% for endocrinologists and 80.6% for optometrists.
The investigators also observed differences in the proportion of referred patients who had active disease. Active TED was identified in 55.9% of patients referred by ophthalmologists and 57.1% of those referred by endocrinologists, compared with 32.0% of patients referred by optometrists.
These findings indicate that referrals from ophthalmologists and endocrinologists were more frequently associated with active TED than referrals from optometrists in this cohort.
Importance of Multidisciplinary Care
TED can produce a broad range of ocular and systemic manifestations, making coordination among multiple medical specialties important. Tsai and colleagues emphasized that:
โThese symptoms often require multidisciplinary care including oculoplastic surgery, neuro-ophthalmology, strabismus surgery and endocrinology.โ
The investigators further noted that appropriate referral is important not only for ensuring patients receive appropriate treatment but also for making efficient use of specialized medical resources.
Implications for Clinical Practice
The findings may have particular relevance in regions where dedicated TED centers or multidisciplinary teams are difficult to access. In such settings, ophthalmologists may serve as an effective initial screening point for patients suspected of having thyroid eye disease.
The authors concluded:
โReferral to appropriate providers is crucial for optimal outcomes and resource allocation.โ
They further suggested that, when specialized TED services are unavailable, assessment by a local ophthalmologist could potentially reduce unnecessary referrals and improve access to appropriate specialist care.
โIn settings where multidisciplinary or expert TED care is hard to access, screening from a local ophthalmologist may provide more efficient utilization and avoidance of unnecessary referrals that are costly and inconvenient to the patient.โ
Clinical Interpretation
The study supports several practical observations:
- Ophthalmologists demonstrated the highest referral accuracy among the three referring specialties examined.
- Endocrinologists were the largest referral source, accounting for approximately one-third of referrals.
- Ophthalmologists and endocrinologists referred substantially more patients with active TED than optometrists.
- A local ophthalmologist may be particularly useful as an initial screening clinician when access to a specialized TED center is limited.
- Because TED can involve orbital, ocular-motility, eyelid, and endocrine manifestations, multidisciplinary management remains important.
Study at a Glance
| Characteristic | Finding |
|---|---|
| Study design | Retrospective, cross-sectional study |
| Study setting | Multispecialty academic TED clinic |
| Number of new patients | 122 |
| Observation period | 1 year |
| Most common referral source | Endocrinologists (33.6%) |
| Highest referral accuracy | Ophthalmologists (91.9%) |
| Endocrinologist referral accuracy | 85.4% |
| Optometrist referral accuracy | 80.6% |
| Active disease among endocrinology referrals | 57.1% |
| Active disease among ophthalmology referrals | 55.9% |
| Active disease among optometry referrals | 32.0% |
Limitations and Context
Because the findings came from a single retrospective analysis of 122 patients at an academic TED clinic, they should be interpreted within the context of the study population and referral system. Referral patterns and diagnostic accuracy may differ among institutions, geographic regions, and health care systems. The study was presented as a poster at the Women in Ophthalmology Summer Symposium, rather than as a full peer-reviewed journal publication in the material provided.
Bottom Line
In this cohort of patients referred to an academic thyroid eye disease clinic, ophthalmologists had the highest accuracy for referring patients with TED, while endocrinologists were the most frequent source of referrals. The findings highlight the potential role of ophthalmologists as an important screening and referral point, particularly where access to specialized multidisciplinary TED care is limited.
Source: Tsai E, et al. Referral source and accuracy of thyroid eye disease diagnosis. Presented at the Women in Ophthalmology Summer Symposium, August 20-23, 2026, Monterey, California.
