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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8155
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am trying to determine the extent to which the ERs failure

Resolved Question:

I am trying to determine the extent to which the ER’s failure to properly examine me led to the amount of detachment of my retina, re-detachment of my retina, and the number and kind of procedures done to try and correct it.

I had an eye exam in the ER but they did not dilate my pupils or call an ophthalmologist to perform that exam. I was misdiagnosed as having benign ocular migraines. 6 weeks later, an ophthalmologist diagnosed the detached retina, which was treated with gas bubble and 2 rounds of laser surgery. It then redetached and I had a scleral buckle inserted.

I have been told by many doctors that the ER should have had an ophthalmologist examine my eye when I told them about my symptoms and the fact that I thought I was having a torn or detached retina (since my medical insurance nurse line had told me that)—and that if no ophthalmologist was on call, at minimum they should have dilated my pupils to be able to see into my eye during the exam. I have read that it is critical to immediately address a torn or detached retina, so it seems to follow that not immediately addressing it will lead to greater problems that would likely have been avoided had it been addressed sooner.

>>>To what degree is it a medical certainty that waiting 6 weeks between the wrong diagnosis and the right diagnosis affected the outcome in my case—and the long-term prognosis? Thank you!
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 :

Oops. You accepted too fast! I'm still here....let's work on your question -- now I owe YOU an fantastic answer :)

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8155
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.
I am confused about how this works. When do I receive the answer? I already selected "accept answer" . . . . .
Expert:  Dr. Rick replied 3 years ago.
Yup. That is OK....you just accepted to fast :)

I am a retina specialist and will help you with your question until you are happy with the answer.
Expert:  Dr. Rick replied 3 years ago.
Even if the doctors in the ER (non-ophthalmologists) had dilated your eye, they don't have the equipment or training to diagnose a retinal detachment in progress.
Expert:  Dr. Rick replied 3 years ago.
Can you remember what you told the ER docs about your symptoms and if your vision was noted to be decreased at that time in the affected eye?
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8155
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.
OMG this web site is driving me crazy! Did you receive my response to your question about what I told the ER docs?
Expert:  Dr. Rick replied 3 years ago.
Hi. My system shows you are still online and have reviewed my above posts.

Are you still there? If so, just type in the box and it will post to this thread and we can continue to work on your very interesting issue.

Yes! I got it :) Sorry about all the hassles with the system, but we are now on the same page....let's continue.
Expert:  Dr. Rick replied 3 years ago.
Actually, I don't see your response...what was your complaint when you went to the ER and how was your vision in the affected eye?

Don't get frustrated....we will get your question answered. I promise ;)
Customer: replied 3 years ago.
I told them that for several days I'd been seeing white lights flashing in the left side of my left eye--even with my eyes closed There was no pain, but the nureline had said it sounded like a detached or torn retina.

They gave me the eye exam and then a CAT scan. I told the nurse the latter seemed a little extreme, and she advised me that I was lucky to be there at that time because they were bored and looking for stuff to do (I only saw one other patient).

They sent me home with instructions to follow up with a neurologist. They didn't say anything about an ophthalmalogist, and I assumed no reason to go on my own since they'd already given me the eye exam.
Expert:  Dr. Rick replied 3 years ago.
Looks like they missed the mark on that one. Your symptoms are consistent with a vitreous detachment and traction on your retina. Your retina, at that moment, may not have been detaching.

Did they test your vision at all? If so, how was it? If not, did you notice any decreased vision in that eye at the time?

Next question:

When did you start to notice vision problems and/or a veil coming across your visual field?
Customer: replied 3 years ago.
I do not recall testing of my vision, but I am not confident they did not test it. What I remember was sitting in the chair and the Dr. looking into my eyes with a light. But I had no noticed any decreased vision at that time.

A little over a week after the gas bubble during which time I'd had 2 rounds of laser, I realized I had lost some of the field of vision in the top part of my left eye. I saw the on-call surgeon that night and the next morning he installed the partial buckle (not a full buckle, due in part to the fact that I'm on Coumadin for a DVT diagnosed a couple months earlier in the same ER that I went to for the eye issue)--and there was not time to discontinue the Coumadin before the surgery since I was starting to lose vision.

I didn't notice a change in quality of vision until a couple days after the buckle. I am really hoping that the horrible vision I have now will get better. My optomotrist said it looks like she may be able to correct it to 20/40 but not better than that.
Expert:  Dr. Rick replied 3 years ago.
Before you had the first retina surgery, were you able to read? Do you remember what you could see on the eye chart?

How long has it been since your last retina surgery?
Customer: replied 3 years ago.
Before the first retina surgery, I did notice any change in my eye sight in that eye. I had a prescription for -1.50 contacts.

The last retina surgery was the scleral buckle, which was almost 2 weeks ago.
Customer: replied 3 years ago.
I need to step away from my compute for a bit but will look forward to your response when I return. Thank you so much for helping me. I am really distraught about this situation, especially since I thought this kind of thing would only happen to me when I got much older. I am trying to understand and then come to peace with everything.
Expert:  Dr. Rick replied 3 years ago.
Ok. Well, I don't think that the ER is going to be found to be liable for not telling you that you have a vitreous detachment and suggesting you go to see an ophthalmologist. Did they miss the boat and give you an MRI that you didn't need? From what you have told me, yup.

Since you are 2 weeks out from an second retina surgery you still have a lot of healing left to do. If your optometrist believes, already, that he can get you to 20/40 vision, I bet you will end up with better vision then that. :)

Does this address your question and make sense to you? I am here, at your service, and awaiting your reply.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8155
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you

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Dr. Rick
Dr. Rick
Eye Doctor
8155 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest