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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7835
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had my eyes dialted this afternoon and was told I have cotton

Resolved Question:

I had my eyes dialted this afternoon and was told I have "cotton wool spots". My doctor immediately scheduled an appointment wth a Retina Specialist and ordered blood work. What is this?
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.
Chat Conversation Started
Rick :

Hi I'll be happy to help you with your question. Are you still online?

Customer :

Yes, I am

Rick :

Cotton wool spots are an area of whitening in the superficial layer of your retina, called the nerve fiber layer. It is caused by a blockage of a very small arteriole (blood vessel) that makes the "juices" of the nerve fiber back up.

Rick :

good. Let's see if we can get your questions answered....

Customer :

As a lay person, I have no idea what you just said.

Customer :

I lost some vision in my right eye in June. I failed the perifial vision test. Today, my vision was stable until she dialted my eyes and found the "cotton wool." She mentioned a "mini stroke -- which has me freaked out.

Rick :

many things can cause cotton wool spots (CWS). The most common is diabetes, acute (really high) hypertension, and vein occlusion. I guess since your doctor (was it an ophthalmologist) sent you to a retina doc right away that you don't have diabetes

Rick :

it's not like a stroke in your brain, so don't get scared.....we'll get you the answers you need tonight to understand what's going on.

Rick :

did she mention anything about checking your neck with ultrasound? Or mention "giant cell arteritis" or vein occlusion?

Customer :

I do have diabetes. My medical history is this -- in April I had an abdonimal hernia repair. In June I went to Hawaii and back -- both on a airplane. I lost vision in Hawaii but my right leg also swelled up. Everyone thought I had a blood clot. I ended having evey scan known to man -- including a brain scain, the artery in my neck. I had a scope of my heart in July and knee surgery in August.

Rick :

OK then. Sounds like you have been through a lot lately. In the setting of diabetes I wouldn't get all concerned about a CWS all by itself. As you know microvascular disease is very common in diabetes. Was the doctor who told you about the CWS and rushed you off to a retina MD an ophthalmologist or an optometrist?

Customer :

She is an optometrist but had the ophtalmologist take a look at the chart. He was the one who ordered all the scans initially. I saw a Retina Specialist in July but the tests came back normal. The CWS is new today.

Rick :

OK, that's good. First thing. Don't worry about the CWS. An isolated CWS usually resolves by iteself in 4 - 6 weeks with no lasting damage to your vision. You did the right thing in being seen by an retina specialist in July. I believe that the optometrist who examined you works in a ophthalmology office, is this correct?

Customer :

Yes

Customer :

She conferred with my regular doctor, a cardioligist, a pulmenary person, and the othropedic surgeon. She is quite good.

Customer :

Today, there were 3 CWS in my right eye and one in the left eye.

Rick :

With your history I would recommend that you have all of your future eye examinations done by an ophthalmologist who you trust and get along with. There is no need, from what you've told me so far, for you to transfer your care to a Retina only practice but, even if the optometrist is good, and does an excellent job of coordinating with your other physicians I she is not as well trained as an MD.

Customer :

She realizes that and that's why she immediately left the room and talked to her boss, Dr. Bliss -- the ophtalmologist

Rick :

At this point you could be starting to have diabetic retinopathy which, at the beginning, can consist of CWS and subtle microvascular changes. These, truely, are best evaluated by an ophthalmologist.

Rick :

That shows good judgment on her part. But I'm concerned that the MD didn't come and look himself.

Customer :

Shall I keep my appointment with the Retina specialist?

Rick :

Yes. It will allow you to have the best trained eyes evaluating your retina, set a baseline (how can you tell if something is getting worse if you don't know where you started) for your eyes and allow you to feel confident that you are doing the best you can for you sight.

Rick :

There is one other thing I'd like you to do.......

Customer :

what is that

Rick :

Relax. Things will be ok.

Customer :

Ok, thanks.

Rick :

I hope this has been helpful. If I can answer any other questions please feel free to contact me again. It has been my pleasure to chat with you tonight.

Customer :

Ok, how do I accept your words of wisdom?

Rick :

just press accept on your screen. Just for grins and giggles, where in the world are you? I'm in Northern Wisconsin.

Customer :

I am in Carmichael, California

Customer :

Near Sacramento

Rick :

Nice Area. I went to UCD many moons ago....good luck with your eyes and hang in there. goodnight.

Customer :

My son graduated from Davis, as well.

Rick :

It's a small world and Davis is a wonder school. let me know if I can help again in the future. You just hit accept and I get credit for typing on this machine :)

Customer :

You got it...thanks.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7835
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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