WHO GIVES THE BEST EYE CARE IN THE WORLD

[John C Hagan III, MD, FACS, FAAO]

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

[JohnHaganMD]

The rules of this website prevent "experts" from interpreting individual tests, scans as it is prohibited.  There is also no way I can answer your question. Only the eye surgeon looking in your father's eye can tell you what might be done, if anything to help. Pay extra care to his remaining eye to keep it healthy and avoid injury. he is at high risk for retinal detachment in the other eye.

[hashim043]

Respected Sir

My father has gone through 5 eye operations since his birth.He is 60 now.The last operation was about retina detachment.A renowned doctor in Lahore say that ask outside Pakistan if my father's case is curable
i am sending u his eye scan and doctors reports in attachment.kindly tell me is it curable if yes what should we do and what will be its operation cost in Pakistan and outside Pakistan?

waiting for your kind reply.
Thank you very much.

[John C Hagan III, MD, FACS, FAAO]

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[nishakumari]

My 22 year old brother's eye was wk by birth..... 5 years ago he hs gone through cataract surgery in his left eyes which turned white and his right eyes after checkup some doctors r saying ..... where images form in retina some optical nerves are shrinking or is damaging.... wat to do.... suggest the best hospital and doctor

[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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

[ace399]

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.

[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

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[John C Hagan III, MD, FACS, FAAO]

Rock on.

JCH MD

[JodieJ]

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!    

[2ndsight]

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.

[John C Hagan III, MD, FACS, FAAO]

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

[russell903]

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

[Lerbea]

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.

[John C Hagan III, MD, FACS, FAAO]

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

[walkietalkie]

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."

[John C Hagan III, MD, FACS, FAAO]

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[berrywoo]

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.

[JodieJ]

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.)

[russell903]

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

[Lerbea]

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.