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WHO GIVES THE BEST EYE CARE IN THE WORLD
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WHO GIVES THE BEST EYE CARE IN THE WORLD

There are many questions posted here by people with very complex eye problems or things that are very difficult to diagnose. I'm often asked WHERE IS THE BEST PLACE IN THE WORLD FOR THESE EYE PROBLEMS.

Each year academic eye surgeons are polled about their opinion of the best programs in the USA (which put them on a par with anywhere in the world). Here is the 2008 list as published in the October 15, 2008 Ophthalmology Times>

BEST OVERALL OPHTHALMOLOGY PROGRAMS:
1. Bascom Palmer Eye Institute of U of Miami
2. Wilmer Eye Institute of John Hopkins University
3. Wills Eye Hospital/Thomas Jefferson University
4. Duke University
5. Jules Stein Eye Institute/UCLA
6. (tie) Beckman Vision Center/U Cal San Francisco  AND WK Kellogg Eye Center U of Michigan
8. U of Iowa and Emory Eye Center/ Emory University
10. Massachusetts Eye and Ear Infirmary/Harvard

This does not mean that every complex or difficult problem needs to trek to these centers as there are literally hundreds of other fine centers, hospitals, clinics and outstanding ophthalmologists in private practice.

Nevertheless because this comes up so much I wanted to post this list. I'm pleased that the program that I trained in (Emory Eye Center) is listed in the top ten in all lists: Best overall Program, Best Research Programs, Best Ophthalmology Residency and Best Clinical-Patient Care Programs.

JCH MD
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Based on my personal experience (and I've had four eye surgeries), who you see is so much more important than where s/he practices.  All practioners at any institution (even the best ones) are not equally skilled.  I think that local ophthalmologists are the best source of information about which area doctors are the best.  I live in a city where Castle-Connolly does extensive ratings, and their data base (www castleconnolly com) has never let me down.
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I agree as I said:

This does not mean that every complex or difficult problem needs to trek to these centers as there are literally hundreds of other fine centers, hospitals, clinics and outstanding ophthalmologists in private practice.

JCH MD
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Emory is an exemplary university on all accounts. My favorite Yale-graduate professor moved there from UT, because being at UT made him the black sheep of his Yale-educated family.

He is the most brilliant person I have ever met, (in addition to looking like a blonde Jeremy Irons).

Seriously, he is very important and world in the world of English literature.

Emory has been well-respected for many, many years.

A great alma mater.
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I wholeheartedly agree with your comments on nlevels of expertise at any facility for the eyes.  I must say that I've had very little success here in the Chicago area getting a good referral from any eye doctor I've seen.  Most every time the referral is just to give a name, and not a qualified individual.  Perhaps a sign of the times, litigation issues, etc.  I also note from my nearly three years of experience that the top places for eye care listed by Doctor Hagan may be strapped to provide sufficient time to help the patient.  I've had exposure to one very high on that list, and was very disappointed in their herd like treatment of patients, and particularly new ones.  A fellowship doctor saw me first, and he dilated my pupils before I was to take a field test!  I didn't know he was dilating, thought he was getting ready to test my IOP's. When I told him of the impossibility of taking a field test with dilation, he said 'I'll just get you stronger glasses'!!!  A senior physician interceded later and needless to say, I did not take a field test.  Moral of this story-one must be very prepared when seeing the eye specialists, no matter their 'credentials' or you will get much less than what you expect.Russell903  
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I, too, have experienced less then ideal care at "top places" (and incurred additional expense in airfare and hotel stays).  A few lessons that I've learned along the way to get the most from your appointment.

1) Do not schedule a time on Mondays or close to lunchtime.

2) Make certain that an ophthalmologist makes the referral and provides a written summary of your case (seems that peer referral commands better attention than self referral)

3) Bring a typed list of most relevant symptoms and questions - make certain that they are succinct and focused.

4) You can request that no medical students, residents, or fellows examine your eyes or give you drops until you see the physician on your case.

5) Dress professionally, and act mannerly - be assertive when called for, but be friendly too.

In this day of assembly-line health care, a patient must prepare adequately for an appointment and be attentive to all details or bring an advocate who can.
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Good suggestions all.

JCH MD
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Not surprisingly the above list are ALL teaching hospitals. Afterall they have better facilities, resources and funding. But I would think the better doctors are the ones with their own private practices (generally apply to other professions as well). And many private doctors serve as expert consultants at the teaching hospitals.
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I concur w/the general sentiment that the quality of care given at the "best" hospitals in no way diminishes that of the care given at other institutions. :)
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I have had terrible luck both with 3 doctors in private practice and I at a teaching hospital.
Some of them had skills, maybe all of them. But many had poor judgement and ethics. One had severe mental problems. The 1 at the teaching hospital was overworked and told me so--county hospital. He was too busy to help me, and told me so. So I don't blame him.

The doctors in private practice often seem to be guided by money and politics. They believe patients are not smart enough to complain, so they are really responsible to no one. I saw 3 doctors in private practice who are maybe OK or good.
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I tend not to be at my professional best when  I have lost most of the vision in one of my eyes. I live in a casual university town, and when I am not working I wear perfectly coordinated expensive casual clothes. Take me or leave me. My doc used this to look down at me. My eye doc was intimidated by my typed list.He was also intimidated however, when I dressed up and wore good jewelry (because I had an appointment elsewhere, also.)

I agree with you. Not all of them are nuts like the doc I had.

I started to agree with you, but what are you saying? I am always excellently prepared and charming, too. Maybe that is my fault.I do not feel I have to dress up, because I know how capable and accomplished I am. I see.

What if we were indigent persons who had not facilities to type our notes? Are you saying that this is like a meeting with a lawyer or a banker? I think you are and that is what I have perceived. So sad.

I run educational programs for disadvantaged adults. I see no excuse for judging people by their clothes, etc. It is your perception, not your belief. Again, so sad.
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BTW, if I am shook up by my severe eye problems, I have no advocate. I could bring my lawyer, but I do not think that is the idea.
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My point is that there is assembly line retinology so that the doctors can make a lot of money. We should advocate against this. My doctors have not had competent assistants, for the same reason. This is just an example.
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just thought I'd bump this up!
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another way to use this list is to check the education and (if any) teaching backgrounds of prospective eye surgeons and see if they have been associated with any of these instututions. I think this info is in the profiles on the aao.org site.
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The world is not perfect.  Doctors are not perfect in their perception nor judgment.  Unfortunately bias exists and can affects behavior and treatment, at least unconsciously.  I still maintain it increases a patient's odds to dress well, come well prepared or bring an advocate who can.

It also helps to realize that many physicians are more interested in the disease - and not in the whole person.  They are not mental health professionals, and training in med school does not foster "compassion" in the usual sense.  Bedside skills are a bonus, but certainly not a given.  I think it also helps to separate clinical skills from bedside skills.  One can have a very personable but incompetent physician.  On the contraire, one can have a very unpersonable but extremely competent physician.

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Once I was told to not wear make up when I went to a doctor. Make up covers up and if we are sick they need to visualize it. Also look around the reception area of your opthamologist what do you see. I saw 75% white haired elderly and $$$ going to the pocketbook (Cataract surgery) that is.
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I feel for you and your difficulties in getting the proper considerations when visiting doctors.  I too have had all kinds of horrific experiences.  Dr. Hagan presents good answers where he has enough information and background, but there are few like him, from my years of experience.  I think that Dr. Hagan also having eye problems has helped him better understand our plight.  
The ophthalmology specialty still needs a lot of new ideas to help present day sufferers.  When I seek out research under way, little if any is geared towards looking for treatments and medications to help people now.  Most have characterization studies, to determine family traits, or genetic dispositions.  And, even if there were new ideas to be introduced, the FDA puts a stick in the spokes with their drawn out politicized three phase clinical trial process.  FDA does not allow for cross polination of research data frm foreign universities/teaching hospitals.  This means 10 years is a typical time frame for clinical studies to be completed and manufactuirng processes to be fine tuned, before the public may be able to utilize a new treatment.  And since eye problems do not show in a high percentage of the population, monies are not available to pursue new treatments, certainly not as available as for cancer, diabetes, and heart research.  I do not believe that eye problems are high on the list of priorities for research, from my searches.  russell903
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With the aging of us baby boomers, the incidence of age-related eye problems should increase significantly.  This will provide incentive for increased research.  (And consider all the money currently being spent on creating new and improved multifocal/accommodating IOLs for baby boomers who don't want to wear glasses.)
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I believe you are correct. However, the focus will be on age-related eye problems. That does little to help those with non-age related eye diseases/problems.
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Not sure what KG means by ‘dress well’. I think most people will not venture out of their house in pajamas! Anyway, I can’t comment or compare physicians behavior as I am always seen by the same doctor, a real cool fella. Once I overheard conversation of other patients that this doc is blessed with both IQ, AND EQ. I think all of us could use that, not just doctors.

So Dr Hagan, it’s not true that "these forums are a magnet for unhappy people with persistent problems."
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When we systematically looked at 6 months of initial postings concerning any aspect of cataract/IOL surgery EVERY POSTING WAS UNHAPPY.  Now some of the responders were okay and not every question posted initially is unhappy but the overwhelming majority were. In fact if you look at the history of MedHelp.org as posted on the "about us" it says that Cindy Thompson and John de Sousa founded it because they were unhappy about the lack of information and support available to them with serious family illnesses.

JCH MD
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These forums are not a magnet for unhappy people they are a magnet for patients with problems in regards to their opthamology care. I am one of them and lucky I did find this forum.
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One area of research that I feel is very necessary, relates to floaters.  One of the retina specialists I saw indicated that floaters are not just an age related 'no serious problem'  concern, but an indicator of some retinal disorder, but as yet unknown.  Once the PVD/floaters become evident, certain other issues arise-eg, epiretinal membrane, created from cells that come off the PVD, as I understand.  However, as long as most ophthalmologists disregard floaters as a minor nuisance, the problem will remain on the neglect list.  Ask anyone with severe PVD/floaters if they think little of them in their daily routine, and I'd bet 90% or more would be moaning about the devastating life influence they have.  To be clear, I'm not talking about those small string like bodies in the eye, I'm talking about massive bodies likened to vaseline globs moving about in the eye, distorting the images constantly.  Retina specialists who check them and say 'no retinal tears, no detachments' cannot assuage the patient and their stress.  A call for more research on PVD/floaters!  More ways to reduce their impact on our sight!  Russll903
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You've brought this up and its the last time I will comment on it. There is a finite amount of money and research expertise in the world and a staggering array of diseases that will blind or almost blind people. Given these imperatives spending these precious resources on something that 99.9% of the time does not threaten vision no indicate serious eye disease and that almost everyone will eventually is not a high priority.

JCH MD
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what Dr Hagan says is true however I am sure if any research turned up a "cure" for floaters, even by accident, there would be a big market with medical companies and practitioners cashing in. Just think weight loss or plastic surgery.

On the subject of the unhappy patients posting here, especially about cataract surgery, I think there are a couple of purposes served. People need to know the risks of surgery which a lot of their surgeons are not disclosing to them. Also patients need to be able to communicate about the possible solutions to their problems. Eyesight is a sensitive issue which can provoke a lot of anxiety and sometimes it helps to know someone else has had a similar experience.
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Assuming that floaters are more prevalent in an aging population, it's possible that more research will be directed to this area in the coming years.  Berrywoo, I agree with the implications of your comment.  I hope that an aging population will focus more attention on retinal disease in general, which will benefit younger patients, too.

2ndsight, your points (above) are well-stated.  There isn't any place else except this forum where a respected, board-certified ophthalmologist will state directly that he wouldn't want a ReZoom IOL in his own eye and would not recommend one for his patients.  Since some cataract surgeons continue to push this IOL as their "top choice" (per recent posts on this forum), this information would be extremely valuable for patients who have already heard the manufacturer's hype.  This forum rocks!    
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Rock on.

JCH MD
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I just entered this forum discussion, even though it was started in October 2008.  It seems to me that the questions that are posted here are not necessarily just due to unhappiness or a problem, but also seeking an answer.....in advance of surgery.  And, besides a Dr. weighing in, a number of well informed patients too.

I agree with the previous writers that floaters are a real nuisance problem and if there was an easy fix, I'll bet tons of people would go for it.
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Since floaters affect one out of two people by age 50 and 3 out of 4 by age 70 no country could afford to remove floaters because they're bothersome. As I look at this screen I see my own floaters.

JCH MD
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