saw my retina specialist today-I need input

[LoveMyHusband2010]

I went in to see my retina specialist as suggested by Dr. O, for seeing floaters.  My retina specialist didn't dilate my eyes to check for any tear but he was very concern about my pupil size.  He noticed the right one is slightly more dilating than the left one.  He called the neuro-opthalmologist for a brief consultation.  

I went in to check with my opthalmologist for the uneven pupils a few days ago already and she didn't notice anything uneven, even though we all (my husband, myself, the assistant and now the retina specialist) notice it, therefore, she didn't refer me to see a neuro-opthalmologist.  Anyways, the retina specialist wants me to see a neuro-opthalmologist ASAP to get the diagnosis and bring it back to my opthalmologist so she HAS to refer me out.  I have HMO.

I showed my retina specialist the picture I took 2-3 years ago and he noticed my right pupil is slightly more dilating than the left pupil in the picture.  He thought the difference in size hasn't change.

Anyways, at the end, I asked him to dilate my eyes to check why I saw floaters yesterday but he's more caught up with my uneven pupils.  He told me that he checked my eyes a month ago already and there was nothing, the few floaters I saw yesterday could be the partial gel detaching.  When I see the shower of dust particles falling with light flashes then it's a sign of retinal tear.

I'm caught in the middle.  What should I do next.  My opthalmologist wont' refer me to see a neuro-opthalmologist because she didn't see anything uneven (it's obviously there).  My retina specialist is very concern and gave me an appt. to see the neuro-opthalmologist that he knows next week, ASAP.  I hate to pay cash for all the eye specialists I'm seeing because my opthalmologist is not referring me.   I don't know who's right who's wrong, but I'm caught in the middle.  

I didn't even get my eyes dilated today for the floaters problem "sigh"

Any input is appreciated

[LoveMyHusband2010]

Thank you so much for a quick response.

I've just checked all the pictures 2-3 years ago, it's hard for me to see the pupil size to judge because I'm asian and my eyes are small and dark brown.  The only picture large enough for me/my husband/retina specialist to see is the one taken 2 years ago.  I don't know if one picture is enough to prove that's it's been there before; I've looked at other pictures and can't tell, only that picture I can tell.

One thing I know for sure is my right eye has always been bigger and the bad one since birth.  My mom told me I can't even close my eyes when sleeping. I've always have strain in that eye

However, my vision is normal, 20/20 on the left eye, 20/30 the right but with pin hole, it's 20/20.  Vision field test normal, no double vision.  No neurological problems on the body beside tension headache.  If indeed there is something wrong with my brain like the retina specialist so concerned about, I would be in the hospital by now right? it would show more symptoms than just the eyes right doctor?

I just don't want to do a lot of test on my body unnecessarily until I have severe symptoms.  

By the way, my prolactin level was high few years ago, at 51 but then was back to normal at 29 two years later so I'm not too concern.  

I'm just lost, different doctors tell me different thing while my main concern now is the floaters.  I have HMO so what else can I do.

Thank you doctor, I'm watching my eyes very closely for the floaters

[Ray T Oyakawa, MD]

I would not be concerned about the asymmetrical pupil size since it has been present for a few years.  This could be an Adie's pupil which is nothing to worry about.  Acute unequal pupils are a sign of a problem in your brain (or often dilating drops).  Since you are not having any other neurological signs I would not be concerned.

I would watch for any changes in the eye with the floaters. Unfortunately,  HMO care is different than private care.  Private patients can just go see another retinal specialist.

Dr. O.