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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7846
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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just returned from eye dr., exam with dilation, discovered

Resolved Question:

just returned from eye dr., exam with dilation, discovered a retinal embolism with small cholesteral "bumps"...pressure good at 17/5/// age:66, female non smoker..how serious is this?
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I can help you today.

Dr. Rick :

Were you examined by an optometrist or an Ophthalmologist? Do you have any visual problems?

Customer :

sorry i missed you, kicked off.... back on, but I see you're offline...well, to ans. your questions: I was examined by an optometrist, with loads of experience, as for va. problems, not really, glasses for distance, drug store type, use sometimes, +1.25, same rx for 3 years, teach 6 fitness classes/wk, yoga, tai chi, stability ball, cardio....not bad for 66 y.o. cholesteral and tris slightly elevated 6 mos ago, due a gain this month....will u or anyone get this today?

Customer :

the glasses are for driving, tv, movies....these are rx, not drug store type, those are for reading

Dr. Rick :

Is difficult to know exactly what an optometrist is seeing when he looks in the back of the eye, even a very experienced one. As a retina doc, I am worried that what he is talking about is called an hollenhorst plaque.

Dr. Rick :

What did the optometrist suggest you do?

Customer :

would that be "small bubbles"...and what is that, please...due for my blood work next wk, checking lipids, etc

Dr. Rick :

A hollenhorst plaque is usually caused by a chunk of cholesterol breaking off from a plaque in the carotid artery in your neck and going to your eye instead of your brain.

Customer :

well, she mentioned a dopler for the carotid area....

Customer :

is that the only way to determine it, via dopler?

Dr. Rick :

I'm not sure what he means by small cholesterol bubbles.....time to dump the optometrist and see an ophthalmologist.

Customer :

yes, i can be referred, shall do that mon...i do, however take 81mg asa am and pm....should i continue?

Dr. Rick :

You will need a complete dilated exam to figure out exactly what the optometrist is seeing. If It is indeed a hollenhorst plaque the source will have to be located. Carotid doppler exams, cardiac exam, blood work etc are involved.

Dr. Rick :

The ASA is a good idea. Keep it up.

Customer :

oh, my......gee, and i thought i was doing well for my age....shall do with the asa....anything else i should be watching for...i live in a rural area, no dr in town on wkends...

Dr. Rick :

There is a high risk of brain strokes if this is not addressed. That being said, do not panic! Monday will be fine to see an ophthalmologist and get started on the workup. If there is significant ulcerated plaque in your neck it can be removed with surgery. In any event it needs to be taken care of.

Dr. Rick :

The optometrist did good to find it, even if it seems he really didn't know the differential diagnosis or importance of a complete workup.

Customer :

ok, as a widow, i'm handling this alone....i don't panic too easily, but i guess i should be concerned...

Customer :

yes, Dr.Tower did a good job, said to let her know bl work results,,,so the optometrist will order blood work, etc, right?

Dr. Rick :

I live in a rural area too so I know what you mean. No. Continue doing what you normally do, taking your normal meds and get in next week for the above workup. Things should be just fine with the right workup, diagnosis and treatments

Customer :

ok, but the surgery re the carotid artery is risky, right?

Dr. Rick :

no. It is time to move to an ophthalmologist and internal medicine physician. This is way, way beyond what an optometrist should even think about dealing with.

Dr. Rick :

yes, but it in the right hands it has less then a 2% serious complication rate. But. Let's not get the cart before the horse. We can discuss treatments, risks if you like after you have more information. I'd be very happy to assist you in every way I can.

Customer :

i'll get a referral to an ophthalmologist, i have a good family doc, but she'll probably send me out to MANY other docs....

Dr. Rick :

A good family doc and deal with most all of the non-ophthalmology, non-radiology and non vascular surgery parts of this issue. She would be a great person to coordinate everything.

Customer :

it seems like once you begin, a t my age, all sorts of things start happening, am a retired nurse, probably not too good,,,,, I really feel good communicating with you....how do we continue?

Customer :

as a nurse, i've seen too much

Dr. Rick :

you can get back on this site and request me.

Customer :

do i pay everytime we communicate?

Customer :

you'

Customer :

you're certainly worth it, if i do

Customer :

just ask for Dr. Rick?

Dr. Rick :

Ya, I know what you mean......It would be my pleasure to make sure you understand everything and feel comfortable with the issues....as we both know sometimes MDs don't answer questions very well

Customer :

oh, i know, i learned so much with my husband and, working as a hospice nurse...re the docs

Customer :

wish you were here in va

Dr. Rick :

You only pay again when we deal with a new topic. In any event, on this site, it totally up to you when you pay -- lots of folks read the advice and then "forget' to push the green button....it's becoming the American way, I'm afraid.

Customer :

well, i certainly WILL push the button!!!!!!! when we're finished this eve?

Dr. Rick :

I'm in Northern Wisconsin where it is snowing outside my office window as I type this....

Customer :

do you think I should tell my daughter, who lives a few blocks away?

Customer :

i'm north of richmond, cold here, possibly flurries tomorrow nite

Dr. Rick :

If you have all the info you need, we are. Remember. Better that the plaque went to your eye, you didn't loose sight and didn't have a stroke....

Customer :

well, i agree, the glass is 1/2 full of h2o.....but what about cindy?

Dr. Rick :

I think there was a little war in your area a few years ago -- something about The War of Northern Aggression, I believe :o)

Dr. Rick :

I think Cindy will be ok

Customer :

yep....this is an interesting area....so, i should tell her?

Dr. Rick :

yup

Customer :

i can't thank you enough, Dr. Rick......you have helped me so very much....and, i'll keep you posted, if you'd like...and, for sure, i'll push the green button....and, is there anything else i should do?

Customer :

besides have a glass of red wine!!!!!!!

Dr. Rick :

That should do it..Have a great Holiday season. I look forward to hearing from you again.

Dr. Rick :

Take care. It has been a pleasure chatting with you.

Customer :

will do, you, too, i also enjoyed our chat and will keep you posted....kind regards! mary

Dr. Rick :

:o)

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7846
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you

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