ok, i've seen the doctor ...

[mel07green]

boy, was that FRUSTRATING. she would not allow me to ask a single question - cut me off point-blank. all i managed to get out of her was that she couldn't see anything to be concerned about "at this stage" and that I should go back in six months. i had a humphrey field test (negative), my IOP checked (13 both eyes), normal pupil response and she had a quick (30 seconds each eye) look at my retinas.
i know she is extremely busy, but i am annoyed she would not take two minutes to answer my questions.
when i asked her about pressure phosphenes, she made a scornful noise and said it had nothing to do with it. the thing is, she wouldn't even give me the opportunity to describe my symptom, which i believe would have at least allowed the problem to be located along the visual pathway.
she didn't ask a thing about my symptoms, just looked at what the technician had written on the chart.
grrrrrrrr
i am not questioning her proficiency, but her bedside manner stunk!

[Forum-OD-MP]

ah...ophthalmology.

[mrsjet]

Hi Mel. Sorry your experience was not so great.  But here's the good news.  EVERYTHING looks normal.  AND she's willing to double check you in six months...so she's not blowing you off, she's just telling you that right now EVERYTHING IS NORMAL.  There is just nothing else she can do for you right now.  No matter how many times or in how many different ways you try to tell her what you see, how you see it, when you see it, etc., she just simply cannot tell you WHY.  And yes, that is frustrating.  But answer this truthfully.  What is the biggest problem with seeing this grey spot when you squint....the spot itself, or the worry you have that someday this could turn into something debilitating?  It is hard but you MUST let go of that fear.  Because the bigger truth is, even if this were something horrible....there is nothing anyone can do for you.  There just really are no true treatments for retina diseases.  This obviously is not a symptom of something common.  But what IS VERY COMMON is unexplained visual phenomenon.  And you will be very sad if you spend years fixated on something that never amounted to anything.  

But again...the good news is that a RETINA SPECIALIST sees NOTHING wrong.  And don't get all caught up in the "at this stage" thing.  That's just her way of protecting herself from the unknown.  She can't predict the future, she can only diagnose and treat.  And she does not have a diagnosis for you, so there is no way to treat you.  SOOOO  you should not be worrying.  Unless something NEW develops.  So keep your promise to yourself and QUIT TRYING TO FIND ANSWERS.  THERE IS NO ANSWER.  It's summertime!  Enjoy all the wonderful gifts in your life and look around and treasure every sight you see.  If nothing else, the fear of losing your vision can help you realize that sight is a truly miraculous gift.

And if worry gets overwhelming, post here or on ************.  I'll be happy to help you keep a positive perspective - writing to you helps remind me, too.  

[mel07green]

it was almost comical, her total refusal to listen or engage in any kind of dialogue with me ... when i tried to ask something, she spoke over me ... i was incredulous, as was my husband ...
i know i have to trust her judgment, but she makes it hard ...
mrsjet, again, your words are most reassuring and wise ... thank you so much ..

[kylie02]

Hi, Mel, I know exactly how you feel. I have had so many eye symptoms and had so many appts over the years. It seems like when I go and find out everythings ok for now something new shows up and again leaves me wondering if I need to go again or seek another opinion. I think the reason,atleast for me, is that everything I've read talks about it being such an emergency , 24 hours can mean the difference between sight and no sight. It's so scary. It's hard to deal with and I feel sorry for myself that I could have this potential eye problem. I know alot of people have things so much worse and that just adds to the guilt and worry over the whole thing. Are you nearsighted? This whole eye thing started 11 years ago for me with a strange eye flash/ghosting thing whenever I turned my right eye.That's the first time I ever heard anything about rd and related problems. I have seen flashes, not repeated flashing, but occasional flashes for over 5 years. I've been seen by a retinal specialist probably atleast 7 times since then and numerous opthalmologists and optometrists . I don't think I'm crazy because it's true that you never know if there is a problem and with age, I'm 42 now, the chances for atleast a pvd increase. I would love to compare stories and symptoms with you, it helps to talk to someone who understands and doesn't think your'e too paranoid ( which I probably am).Take care!

[muppet]

Hi Mel
I have lots of serious issues with my eyes - very short sighted, retinal tears and scars and cataracts (the first one was removed just this week). I am only 38.  I have seen top surgeons and specialists in three countries.  The thing I learnt over time, is that they are all very matter-of-fact about what they see.  If I think something is wrong all of a sudden, I panic, lose sleep and when I have the retinal exam and they find nothing - I am out the door before I have had time to digest their words.

It's not personal.  They are just doing their job.  "At this stage" is just the way they protect their diagnosis because anything could happen in the future.

The great news for you is that NOTHING is wrong.  Don't dwell on the "what ifs" - I have learnt that I can't do that and I do have some serious future possible scenarios.  

Enjoy life !

[Belledonna]

I am confused.....is it okay for a doctor to put us on a conveyor belt and run us through the office  as if we are pieces of chocolate candy which needs to be dipped ,dried and wrapped and then dropped into a barrel to be distributed ???
If this doc doesnt have time to talk, go to another ( or two or three more if need be) and get your questions answered. You may be the one to answer them yourself eventially but keep talking and questioning until someone comes up with an answer that explains your unique situation to you...You can still enjoy the summer while being attentive to symptoms and questioning ---the answer is out there --keep a journal,record  symptoms -time of day etc ...attack your problem when you find it bugging you....

[who_is_this]

I agree; I'd NEVER go back to a doctor who talked over me or refused to answer questions.  Don't worry for now, MrsJet was quite right that nothing abnormal was seen, so you don't have to worry.  Anxiety often over maganifies common body sensations and observations.  

I have a good friend whose child has renal failure, and one of the doctors acts every bit as impersonal and arrogant as you described.  Yesterday, as this doctor was again dismissing her concerns, she stood up blocking the access to the door, looked directly at the doctor and said "Do you realize how rude you are?  How condescending?  How arrogant?  I want you to sit back down and ANSWER MY QUESTIONS"!  I had to chuckle listening to her describe the scene.  He was taken quite aback and did answer a few questions.  She then told him he was fired.  

You have a choice.  The doctor works for YOU.  Go to someone else for your next exam.  Write a letter to the doctor explaining clearly why.

[mel07green]

wow, i feel like i've hit a nerve with all these responses.
the more i replay the scene over in my mind, the angrier i get.
i want to make it clear that this was not just the exasperation of someone in a hurry or with a lot on their mind. and it wasn't as though i had been bombarding her with a whole bunch of question either. (I only managed to get one out in its entirety - all other attempts, she simple talked over me.) this was active and inappropriate rudeness.
i anticipated being hurried in and out, hence my questions on here prior to the appointment, but nothing as outrageous as that ... there was just no call for it. all i wanted was to feel like my symptoms had been heard and explain what could/could not be causing it. she did none of that.
i wasn't solely looking for reassurance. if she had no answers, that's fine too, but TALK ME THROUGH THAT. don't shove me out the door with a "come back in six months ..."
had she been more attentive to me as an individual, i doubt she would have been talking about tobacco amblyopia (I had ticked yes to having smoked in the past) when i have 20/20 accuity and fine color vision and the problem is only in one eye. or blamed migraine headaches (again from the ticked box - i haven't had one for years and this is NO WAY resembles a migraine).
arghhh - i want to trust this woman, but if she's that dismissive and disinterested, it makes it pretty bloody hard ...

[mel07green]

thanks everyone!

[mrsjet]

Of course that doctor should have taken more time to reassure you, Mel.  Of course that doctor should have appreciated the fact that you had your questions outlined and ready to go.  Of course that doctor should have made sure you understand your situation, even if all she could say was "I don't know what causes that, but lots of things go unexplained and never create any problems."  BUT I have to disagree with the idea that you should continue to see doctor after doctor until you get an answer that fits your particular situation.  There probably IS NO ANSWER!!  There is not always an answer in medicine.  There are limits to medical knowledge, and the eye and vision happen to be particularly difficult to understand.  

Most likely, that doctor is certain that you will never need her services.  I would guess that if you did have a problem, if she even suspected that it could develop into something concerning, her whole attitude would change.  She just knows that you are okay.  AND you get to go see her again in six months - just to make sure that everything still looks fine.  SO PLEASE relax, let it be for six months.  Don't get caught up in a search for the answer that is not going to come.  There is nothing ANY specialist can do beyond look to see if everything in the back part of your eye looks okay.  And unless you develop more serious symptoms (and you will know if that happens, you're not going to "miss" something)then you don't need to subject yourself to the merry go round of "is there one more person I can see".

I hope you have a good week.  Let go of your anger at that rude doctor and focus on the good news.  EVERYTHING LOOKS FINE!!!

[mel07green]

hey mrsjet
that is an interesting point you make about me perhaps not needing her services in the future, i hadn't looked at it that way.
i am DEFINITELY not going to start doctor shopping - it's too tiring and stressful. i agree that there is a limit to what any specialist can do and i believe i have reached that limit. there is nothing that can be seen and therefore nothing that can be done, so to doggedly pursue it is futile and counterproductive.
i am going to redirect my energies to my positive activities, not this endless speculation and worry. it's soooo boring!
i'm getting a puppy in a few days, so that should occupy my time is a fun way and i'm sure will be very therapeutic!
thanks so much for your time and advice. it's been invaluable.

[Belledonna]

Glad you worked it out and figured out how you need to preceive this. We each have different ways of reacting to things and you are right that positive energy is what any person needs to have to deal with problems and to overcome and or resolve them.
Time will allow you to get a more objective view.Too.
The only time I go doctor shopping is when I realze that the doctor is not up on the latest informantion about  the disorder I have . When I get the feeling that the  doctor's vagueness or abruptness is due to burn out, time mismanagement and/or a sense of non-curiosity(acceptance of disease) then I am too uncomfortable to stick around.
To be honest,I have never met a rude opthalmalogist or optometrist although my current opthalmalogist is tempermental.
But my experiences with rheumatologists and general practioners have been enough over the years to turn me into a questioner. And when I know more answers about my condition than my own doc, I'm outa there! Fortunately, after going doctor shopping over a period of months, I finally found a rheum and a GP who love their work and are each truely interested in theri patients.
A puppy is a wonderful addition to any household.Be sure to get lots of pictures of him /her when he's a baby.They are so cute and make wonderful subjects  although you have to snap the pictures quickly ,unless he is asleep!

[Lu An]

Mel, If you feel your concerns were not addressed then you should seek the advise of another retina specialist.  Her chair side manner leaves a lot to be desired.  But remember that Retina Doctors are just human beings that have had "some" training in medical, ophthalmic and retina diseases.  There are hundreds of medical schools, ophthalmology residency programs and retina fellowship programs in the country and others and they all follow their own teaching methods, based on the individual experience of the doctors doing the teaching.  You will never find the one that knows everything.  Sometimes they just don't know.  And if your doctor did not inform you that you can have an ocular migraine that is not accompanied by a headache then shame on her.

[Eagle eyes]

Hi Jodie J

You asked who is not a good candidate for aspheric IOL?
According to expert ophthalmologists those patients that have had previous "hyperopic refractive surgery" or corneal refractive surgery to correct far-sightedness. In addition, anyone who has an unusually steep cornea.
Approx 96% of the population is a good candidate for aspheric lenses.
As for your question about Chicago docs....I did some checking for you.....Depending on your area of the city : Greg Nelson in Arlington Heights, Mike Rosenberg downtown at NW, Walter Fried in the SW or David Lubeck in the South...hope this helps.

[Richard123]

Here is some information about the aspheric IOLs

http://www.medcompare.com/spotlight.asp?spotlightid=169
http://www.ophmanagement.com/article.aspx?article=86317
http://www.revophth.com/index.asp?page=1_891.htm

and a quote from the last one:

"Patients who have the most to gain from aspheric lenses are those who have undergone myopic refractive surgery, according to Asim Piracha, MD, who is in private practice at the John Kenyon Eye Center with offices in Jefferson, Ind., and Louisville, Ky. The patients who would do the worst with these lenses are those who have very steep cor­neas, such as keratoconus patients, or those who have had previous hyperopic re­fractive surgery."

[hud]

here's some more to choose from in Chicago:

                               Colman Kraff 312-444-1111
               South Suburbs   David Lubeck 708-798-6633
               North Suburbs   Randy Epstein 847-432-6010
               West Suburbs    Brian Smith 630-789-6700

[JodieJ]

Thank you very much for your Chicago doctor recommendations.  Both of the city docs you recommended are reputed to be among the very best in the metro area.

I've already consulted three excellent surgeons, all of whom use only Alcon lenses.  The last one I saw told me he would check with his surgicenter to see if he could implant a Tecnis lens.  (I have no idea why he needed to do this.)  Is it a bad idea to be a surgeon's first Tecnis patient?

Hud, are you knowledgeable about Alcon's blue-blocking lenses?  I've been reluctant to go with Alcon's aspheric IOL because of this property.  From what I've read, it decreases light perception of the rods, which might be a problem at night for older people or those with retinal disease.  (I'm 54, and my Snellen acuity was 20/15 post-vitrectomy/epiretinal peel, but my contrast sensitivity will probably never be normal due to increased macular thickness.)  When I've tried to explain this to the docs, they roll their eyes. I think there was a post on this forum from someone with a blue-blocking IOL complaining of impaired night vision.  Any opinions about this?

[hud]

according to the manufacturer, there is not enough blue-filter in the acrysof natural IOL to adversly affect the contrast sensitivity or the color perception of the patient. At 54 years of age, you are already looking through more yellow tint than any implant on the market. The average Alcon "Natural" lens contains as much blue filter as a 25 year old human lens. When a cataract is removed, your natural retina protection from harmful UV and blue light radiation is removed also. To put in an implant that filters up to 400nm only, may leave the patient vulnerable to retina damage. The jury is still out on whether this added chromophore will save eyes, but the general consensus is that it does no harm, and it might be beneficial in the long run. I have them in both of my eyes and, although I don't have the history of retina issues that you do, I cannot tell what I have other than clear, crisp vision at most activities. Also, on a business note, more patients in the US are implanted with the Alcon "Natural" blue filter than all other implants combined. I study marketshare data for my job.

[JodieJ]

Thanks for your response, hud.  I hadn't realized that ReStor also utilizes blue blocking.  Alcon appears to be betting their economic future on this technology, so there must be some scientific basis for it.  I tried typing "blue blocking IOL" into a search engine and got hundreds of hits, which generally led to opposing conclusions (depending on who sponsored the research?)  Some studies found that it has no adverse impact on quality of vision; others reported impaired vision in dim light situations.  I wonder if the effect is anything like blue-blocker glasses, which are great in sunlight but maybe not so good for night driving.  Since I'm hoping to use my IOL for at least 25 years, this seems to be an important factor which I had managed to overlook.

[hud]

Alcon says that their product filters, not block blue light. Blue blocker sunglasses are generally not a good idea because your human lens already filters blue light. Adding a blue filter/blocker would double the filtration, adversely affecting your vision. Like I've said I have them in my eyes and cannot tell any trade-off in any light condition, but I also know that the incidence of macuklar degeneration after cataract surgery increases dramatically, before this innovation came from Alcon. We won't know for years if the blue filter will decrease the incidence of maculopathy. Yes, Alcon is betting the farm on this. They sell more implants in the world than all competitors combined, and have stated that they will no longer offer a clear UV-only implant on any models in the future. The only exeption would be phakic implants where the patient retains their human lens. Other companies are scrambling to keep up. While we are discussing designs, I was impressed with the elegant one-piece acrylic design that is Alcon's exclusive. They introduced the winning Acrysof material on the 40 year-old platform of an optic with 2 separate haptics staked in. This comes from the days when the procedure was less refined, and the implant might not stay in the capsular bag as intended, and wouls wedge itself into the sulcus under the iris. the one-piece AcrySof is designed for todays' skilled surgeons who almost always have perfect capsular integrity, and this design fixates the lens with gentle adhesive contact, rather than radial tension, which can lead to other issues. While most surgeons are very comfortable with the old-fashined 3-piece design, they prefer the mechanical elegance of the one-piece and consider a 3-piece as a back-up for complications.

[JodieJ]

Blue-blocking filtration really is a perplexing issue.  I've read more about it, which raises a couple of questions in my mind:  Why would Alcon "bet the farm" on a theoretical premise with such flimsy empirical support?  If blue-blocking IOLs really do decrease functional vision in dim environments (as claimed), then why don't Alcon's competitors prove it in a well-designed study?

You're right, hud, there was a study that found that the risk of age-related macular degeneration increased after cataract surgery.  However, larger, better-designed research subsequently found no relationship between cataract surgery and AMD.  (So why conclude that it's the removal of the crystalline lens--with its blue-blocking properties--that causes AMD?  That just doesn't make sense to me.)

It's agreed by all that virtually everybody's night vision/contrast sensitivity improves after cataract surgery.  What's disputed is the premise (as yet unproven) that people with blue-blocking IOLs realize a little less visual improvement in dim environments than people with conventional IOLs.  If there really is a meaningful difference in functional vision between the two groups, it shouldn't be that hard to prove in a well-designed study.

Hud, you're certainly on target about the docs' preference for Alcon lenses here in Chicago.  I've already consulted three excellent surgeons, and Alcon IOLs are all they use.  My attempts to find out which lenses a doctor uses BEFORE setting up a consultation have not been successful.  However, I did manage to get an appointment with one of the surgeons recommended by Eagle Eyes (and without the required referral from another ophthalmologist), so I'll see what he says about the Tecnis lens.  At this point, I don't think that a blue-blocking IOL would offer any extra benefit, but I doubt that it would cause any problems.  Do you think it would change a brown eye to amber?              

[hud]

you are obviously very thorough in your research. Radiational damage is thought to be one of many possible factors related to maculopathy. Without a cataract, a 30 year-old human lens has more blue-filtering yellow filter than an Alcon implant. I am fairly biased, as you can tell, due to my personal experience, and my professional research I do for a living. If you feel strongly against this new feature, you can opt out. But keep this other bit of breaking news in mind. Earlier this year, the aspheric Tecnis lens from AMO was granted NTIOL status from Medicare, which nets a higher reimbursement for surgery centers. This "New Technology Intraocular Lens" designation recognises that in the data submitted to medicare, Tecnis patients showed improved contrast sensitivity and night driving capabilities compared to standard spherical implants. Since Tecnis established this category, any other lens wanting to be included in this exclusive category has to MEET OR EXCEED the criteria established by Tecnis.
Alcon's aspheric lens, AcrySof IQ, was recently granted inclusion into this group, and now is the most used NTIOL in the US. The crucial point is that this model #SN60WF, has the yellow chromophore that filters high-energy blue light, whereas the Tecnis does not. So how can a yellow lens MEET OR EXCEED nighttime driving performance and contrast criteria of a clear (Tecnis) lens if it allegedly hinders low-light vision? I am sure that there will be studies forthcoming to document the differences. Ask your doctor about AcrySof IQ. Chances are he is already using it on most patients.

[JodieJ]

Funny, but I just asked my doctor (from my third surgical consultation) about the AcrySof IQ during a phone followup a couple of hours ago.  His preference was the conventional AcrySof lens.  He didn't consider the wavefront technology used in aspheric lens design to be legitimate; his notion of correcting wavefront aberrations involves the individualized process used in Lasik.  He was willing to use Alcon's aspheric lens if I insisted, although he had never implanted one.  (This doctor is reputed to be among the very best cataract/refractive surgeons in Chicago.)  The first two surgeons I consulted also preferred the conventional AcrySof model.  Maybe you need to make a trip to the Windy City to educate your docs about technological advances.

Or maybe they know something that we don't.  A recent study in Review of Ophthalmology (www.revophth.com/index.asp?page=1_940.htm) compared the AcrySof IQ with the conventional AcrySof (SA60AT) in 69 eyes.  The conventional lens provided better near and intermediate BCVA.  No difference between the two IOLs was found in terms of distance vision, reading speed, contrast sensitivity, accomodation or unwanted visual images.  Comments?

I'm aware of the NTIOL status of the two aspheric lens.  I suspect that the hypothesized loss of functional vision due to blue-blocking in not meaningful/measurable.  The absence of findings to support such a premise says a lot.  This doesn't mean that blue-blocking provides any benefit whatsoever, but this would also be impossible to prove.

[hud]

Thanks for the link. I'll let the Chicago docs study on their own. I'm just an interested lay person and patient.
I will comment though, that this illustrates the problem with weblogs and chatrooms, and that is generalizations and anecdotes aren't a good thing when it comes to healthcare. It is generally agreed that 80% of cataract patients have positive spherical aberrations (young people, in general have negative). So your doc would have to go to the expense and trouble to do a wavefront analysis on every candidate to see who would benefit or not. I assuming that he chooses not, until he is convinced, or reimbursed, to do otherwise. Also, I haven't heard that there are any definitive studies that show UV blocking prevents any pathology. But all manufacturers offer this feature. And Alcon doesn't claim to "block" blue -light with the chromophore, just filter the higher wavelengths-otherwise I would never see the blue sky, or a gas flame, etc.