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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11098
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am a 65 year old women with a diagnosis of glaucoma for over

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I am a 65 year old women with a diagnosis of glaucoma for over 12 years. I live in California. I had cataract surgery on my left eye in 2007. My eye sight has gotten worse since that surgery. A suture was left in my eye for over a year & I recently was told by a retina doctor that they put the lens in the front of the iris instead of the back. My glucoma doctor was insisting on doing a drainage device in my eye to lower the eye pressure about 2 mon ago. But I insisted on a second opinion, and consulted with another doctor. The consulting doctor told me that he thought there might be some swelling in the retina and that my eye loss could be due to the retina problem. I saw a retina doctor who did an "austin injection". Last Friday when I went to my follow-up check up. the optic/retina photo's showed my left eye was worse then the previous photo's. The diagnosis they gave me was invasive macular degeneration. This doctor insisted on doing another injection at that time. Again, I felt uncomfortable & since it was 5:30 PM & I had been waiting to see him since 2:30 PM, I was concerned that he might be to tired. The doctor looks like he is well into his 70's. I'm trying to see if my insurance would let me do an out of network second opinion. However, I have a HMO with Pacific Care & they want me to have an inhouse consult (UCSD). The doctor I want to see comes highly recommended & is out of my network. I need to get a second opinion from an experience person.
Unfortunately, my insurance is telling me that they will not pay for a doctor that is not in the network 3 program. I'm so scared, frustrated, and don't know what to do next. I am on 3 different eyedrops. They took me off Lumigan eyedrops on the right eye, because the doctor felt that that was the cause of the retina problem. After seeing the photo's that was not the problem. I'm worried that another injection will only make my eyes worse at this point. What would you suggest I do.? Please help me!
Submitted: 5 years ago.
Category: Eye
Expert:  Dr. Rick replied 5 years ago.

Dr. Rick :

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

Dr. Rick :

I am sorry to hear about all the difficulties you are having with your eye. From what you have told me it sounds like the primary problem that is damaging your vision is leakage/swelling in your retina, more specifically in an area of your retina called the macula.

Dr. Rick :

Your ophthalmologist was correct in thinking that your lumigan eye drops may have been contributing to the macular swelling and I agree with changing to another drop to see if things improved. From what you have posted, it seems that the problem continued to get worse off the drops, which is not uncommon, and that, after further testing, it was decided that you are suffering from wet macular degeneration.

Dr. Rick :

Avastin injections are the current state-of-the-art treatment for wet macular degeneration (wet armd) and, as you have already learned, multiple injections are needed to control the leakage and swelling in your retina. As a retina specialist myself I treat a large number of patients like yourself and, from what you have told me, you seem to be in excellent hands. In my opinion the retina doctors at UCSD are top-notch.....even the ones who are in their 70's :o)

Dr. Rick :

Avastin and Lucentis, along with a recently approved medicine called afibercept, are the current best treatment we have for your condition. At this point I strongly recommend that you continue with the injections in order to have the best chance to decrease the leakage and swelling in your macula and, hopefully, regain as much vision as possible. Delaying injections when indicated can greatly reduce your chances of regaining vision.

Dr. Rick :

If necessary for control of your eye pressure I think it would be OK to start back on your lumigan. While this may be contributing in some small way to your retinal swelling the risks of your eye pressure being poorly controlled outweigh, in my opinion, the possible retinal involvement the drops may be having.

Dr. Rick :

In regards XXXXX XXXXX glaucoma doc wanting to place a shunt in your eye to decrease your pressure....if your optic nerve is not working, it doesn't matter how well your retina is functioning. That being said, if your eye pressure will allow it, I would rather that you get the macular edema/leakage from your wet ARMD under control before having another glaucoma surgery.

Dr. Rick :

So. What is the botXXXXX XXXXXne here? I recommend you continue with the intraocular injections as recommend by the doc at UCSD without delay.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

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Dr. Rick :

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Expert:  Dr. Rick replied 5 years ago.
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