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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7746
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am a 67-year-old female in otherwise excellent health. Thirteen

Resolved Question:

I am a 67-year-old female in otherwise excellent health. Thirteen days ago, an opthamologist performed surgery to remove a cataract from the left eye. Medicare and a supplemental plan will cover the costs.

I did some research today.  What I learned is troubling.  

The U.S. National Library of Medicine National Institutes of Health says:   
"Acute angle-closure attack is a medical emergency. Blindness will occur in a few days if it is not treated.
?The Mayo Clinic website calls angle-closure glaucoma "a serious medical condition."
?Wikipedia says:  "Acute angle closure is an ocular emergency, "where intra-ocular pressure is above 30 mmHg. 

I called my doctor's office 5 hours after surgery about pain and loss of sight in the left eye.  Also, whether I should be concerned about a rather large red blotch. 
The office staff assured me not to be concerned. I was reminded I'd see the doctor the following morning. I already knew about the next morning's appointment. The assurance reduced neither my concern nor the pain.

Before surgery, my doctor assured me I'd be able to drive myself to his office for the first post-op appointment following surgery. 
The left eye had no sight 12 hours after surgery and pain was intense.  A kind friend drove me to that first post-op appointment.  Combining pain and blindness with driving would have been a very dangerous situation.  

According to the medical literature online, sudden and very high intra-ocular pressure (above 30 mmHg) can be painful and dangerous.
The intra-ocular pressure in my left high measured 40 mmHg -- a medical emergency.

Both eyes were watering from the pain of the left eye. Keeping the left eye closed helped.  
My doctor scolded me for keeping my left eye shut. Because of pain it was difficult to open the left eye. After measuring the pressure, the doctor should have understood.  My right eye wanted to shut also. I think it was sympathizing with the left eye.

I believe I had acute angle-closure glaucoma. When asked, the doctor said the pressure of 40 mmHg would take 6 months to cause permanent eye damage.
I learn today that medical literature disagrees.

I asked the doctor what caused the red blotch in the left eye.

The doctor said, "I don't know."  The evening of the day after surgery, a Surgical Center nurse called to follow up.  In answer to my question, the nurse said the red blotch was "heme" or blood.  (I had already seen the doctor at my first post-op visit earlier that day, when the doctor had said, "I don't know.")

Why write you: Everything about my post-op experience scares me:  

1. From what I understand, high intra-ocular pressure causes optic nerve damage. Optic nerve damage is permanent and causes blindness. Permanent blindness can occur within days (not six months).  

2. The doctor's advice about being able to drive 12 hours after surgery seems to have been careless advice. Careless about my safety and the safety of others on the road.  

3. During pre-op, the doctor provided general information about complications common to all surgical procedures.  Information about complications of the eye such as what I went through was not provided.  Even after having gone through what I've gone through, I still don't get much specific or relevant information or instruction about what I should be concerned about or what I should do. Even when I ask. 

4. Until this evening, I had no idea the medical literature would have considered my condition a medical emergency. The doctor doesn't seem to be overly concerned. Yesterday, eye pressure measured 24 mmHg (normal is 10 - 20 mmHg).  The doctor prescribed or advised nothing to reduce the pressure even though I expressed  concern.  My father suffered blindness from glaucoma in his old age.  I told the doctor "I don't want to go through that." I don't know if the doctor cared.

But I care and I'm scared. 

I might have relied on my doctor's competence and good-will when maybe I should not have.

I don't know if I can trust him to prevent optic nerve damage and blindness.  Any amount of optic nerve damage or blindness is unacceptable.  I sought treatment from this doctor to improve my eyesight, not make it worse.

What should I do? Would another ophthamologist be willing to treat me? Would he/she be afraid to get involved under such circumstances? Where can I go for help?

Thank you.

LD
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Hi. Thanks for the very detailed question. I'm sorry that your doctor didn't seem to be concerned about your condition. Let's go through your issues one at a time.

Dr. Rick :

You do not have angle closure glaucoma. It is not uncommon for the pressure in the eye to be elevated after cataract surgery. This might be caused by one of the fluids placed in your eye during surgery to protect the inner lining of your cornea. This fluid can temporarily block the outflow of aqueous out of your eye and cause elevated eye pressure. A reading of 40 is high but not high enough to panic about in an eye with a otherwise healthy optic nerve.

Dr. Rick :

As you noted the eye pressure had come down to almost normal, 24, when retested. I assure you that the short time your pressure was elevated did no appreciable damage to your vision or your optic nerve.

Dr. Rick :

You pain and discomfort may have been related to a couple of things. You might have had a corneal abrasion (scratch on the eye), which happens during cataract surgery sometimes, and the pressure may have been causing some discomfort/nausea. If there was an abrasion it usually heals within 24 hours, and as you already noted, your eye pressure came down nicely toward normal in a short time, which was to be expected.

Dr. Rick :

Now. The red blotch. That is most likely a subconjuctival hemorrhage. This is like a bruise on the eye. During surgery there is some bleeding, sometimes even with "no shot, no stitch, clear cornea" cataract surgery. This will, like a bruise elsewhere, resolve without problem. It's nothing to be concerned about.

Dr. Rick :

Your doctor is correct about the driving to the post op day #1 visit. 99.5% of patients can drive themselves. Of course, with your post op difficulties, that was not true in your case.

Dr. Rick :

I am sorry that your doctor or his staff have been unable to communicate with you affectively. It sound that they were very busy or something. Your post op experience, while not the "routine" is by no means outside of the expected for cataract surgery. When everything is said and done I am willing to bet that you will have an excellent visual outcome.

Dr. Rick :

I applaud your initiative to research your condition when your "trusted source" was not forthcoming. However, you need not worry as you do not have angle closure glaucoma, your pressure did not require treatment, as you can see by it coming down on its own, and you are not at any greater risk of having glaucoma like your father due to this brief, commonly occurring, spike in eye pressure after your cataract surgery.

Dr. Rick :

I am sure that any ophthalmologist would be willing to take over your care with no concerns about getting in the middle of your post op experience. You will be fine and, really, have nothing to be concerned about other then your disappointment at how your surgeon and his staff handled your questions.

Dr. Rick :

So. What is the take home message? You will be fine and, truly, have nothing to be worried about. Continue to use your post op drops as directed and enjoy how white white things look and how bright colors are now that your cataract is gone :o)

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)



 

Dr. Rick :

Also, the Combigan is a drop to lower your pressure. The Post op visits number 2,3 &4 were just to make sure your pressure and other issues were getting better. They are extra visits that you doctor does not get paid to do by your insurance company or medicare -- I bet there are no lawyers who would do that :) Based on the timing and number of post op visits and your eye drops you were getting excellent medical care by your ophthalmologist, even if he didn't communicate what he was doing very well to you.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)



 

Expert:  Dr. Rick replied 3 years ago.
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Expert:  Dr. Rick replied 3 years ago.
I hope I've covered everything. Let me know if I can add give you any additional information. Have a great day.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7746
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 3 years ago.
THANK YOU FOR DETAILED ANSWERS TO MY CONCERNS!!!!

LOIS
Expert:  Dr. Rick replied 3 years ago.
My pleasure....that is what they pay me the "big bucks" for ;o)

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