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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Can ERGs be interpreted differently? I have symptoms of night

Customer Question

Can ERG's be interpreted differently? I have symptoms of night blindness, daytime glare, decreased contrast sensitivity, and decreasing visual fields. have had trouble for 10 years. I am 56 years old. I stopped driving. One doctor said that my ERG was lower end of normal. one doctor said it was "all normal". Made me feel like an idiot, and that I was making everything up, or exaggerating symptoms. One doctor says "suspect RP", but the other says "a mystery"---and looks at me like I'm nutso. I guess what I really want is reassurance that I'm not nuts! thanks!!
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today. I am retina specialist and very knowledgeable about ERG's and the pathology they are used to diagnose. Can you tell me more about why you have had so many of these exams done? Where did you have them completed? Was it at the institution you are teaching at?

Dr. Rick :

I'm sure that we can get to the bottom of what is going on with your eyes or, at least, get you over to someone who will give you the correct scoop on what really is happening. I'm always happy to help a fellow MD in need :-)

Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)


 

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
The more information you have the better I'll be able to figure out what is going on. If you have your ERG and report I'd be happy to review it for you. Talk to you soon.
Expert:  Dr. Rick replied 2 years ago.
Oops! You have accepted too soon :(

But,never fear, even though you have pressed the accept button I don't go up in a puff of smoke -- I'll still be right here to continue helping you at no additional charge :-)

Just post the information here and let's continue working on what is going on with your eyes.
Customer: replied 2 years ago.

Hi Dr. Rick! Thanks so much for your reply! I'm a pediatrician by training,(class of '81), and I did residency at U of Michigan. I now teach at U of Kentucky. I did peds for 26 years. Started having eye trouble in 2002. I've always been myopic, but it started feeling like my eyes (especially my left) weren't getting enough "juice"----in terms of energy to light things right. My vision in the dark was terrible----but at the same time, things were WAY too bright outside! It's dazzling!! In the clinic, even when I was wearing loupes, and looking through the oto-ophthalmoscope lense and light-----I just couldn't see right. I got frustrated and scared trying to see ears and throats and rashes in kids----so I just switched from pediatrics to teaching the first year students.

ANYway, I've had evals at UK and U of Michigan (I think in 2004 or there abouts). Fluoroscein angiography, MRI of my eyes (and I guess brain), OCT---all normal. My ERG's have been sometimes read as low normal, or normal. My pressures are normal. My central vision with correction is 20/20. So, that's all fabulous! I can read newspaper just fine with extra light. PE shows some pigment changes in the Right eye which have been there forever.

I think the reason that they repeat the ERG, is that I'm really not typical for anything. They got the new gold-foil machine here at UK, and I think they were trying to establish a base-line.

Family history is neg for RP. My paternal grandmother had MD, but she died in 1989, and was diagnosed probably 30 years before that. She didn't go to the doctor---so who knows.

I use brown fitovers outside, and I stopped driving because it was just too hard. I swim competitively, and I do ballroom dance.

My latest ERG was here at UK. They did the kind where they put the little gold foil in the lower eyelid (instead of the contact lense kind). I've had the gold foil thing the last two times. I've actually "done better" on the gold foil thing, but to ME---it seems like my eyes are getting a smidgeon worse yearly.

No big deal.

Sooo.....probably way more info than you asked for. I'm happy to send you my ERG---but that may be way outside of your job. BotXXXXX XXXXXne is that I've made some changes with my driving and work, based on what I feel like I'm seeing. Lots easier. But, when the doctor says "ERG all normal", "a mystery"----I sorta question if I'm nutso! Thanks!! Jani

Expert:  Dr. Rick replied 2 years ago.
I see we are both online at the moment....let me review your last post.
Expert:  Dr. Rick replied 2 years ago.
Hi Jani,

After 20 years of practicing Retina I would have to say that, given the history you have provided, you are absolutely correct -- you are what we have all learned to call "an interesting case". And, as you well know from your many years of practice and your personal experience, it is much better to be discussing such a case with colleagues then to be one :(

I actually know how to read ERGs but, as you know, each lab has their own baseline and "normals" and I've not done any work at all with the gold foil system that the folks at UK are using.....but the good news? You are in good hands with them...

First of all, you are not nuts.

As you probably already know there are huge variations on the clinical presentation of the cone/rod and rod/cone dystrophy's and, thankfully, it seems that you are afflicted with a variation that is on the very mild and slowly progressive (perhaps static) side of the spectrum.

If you wanted to "leave no stone unturned" I would consider talking to XXXXX who is the Chief of the Retina Service at Wills Eye Hospital. I consider him one of the best retina specialists in the county. He and his staff would be able to review your current data and subject you to all sorts of ocular torture and, in the end, give you confirmation of what you already know. Here is his contact info:

http://willsretinaservice.com/physician_brown.html

What is the take home message here? Even if you get the perfect, most "correct" diagnosis available, when it comes to the diseases we are talking about here, there is nothing that can be done to affect them anyway. All you will have is a better idea of what may or may not occur in the future.

At this point I believe you are in excellent hands and getting top notch diagnostic evaluations. Only time will tell at this point what will happen with your vision.

I wish I could paint a rosy picture for you but, at least I'm not telling you that it is all doom and gloom and I can confirm that you are, indeed, not nuts :-)

I'm here if there is anything else you would like to discuss. Take care and keep those First Year students in line.....
Customer: replied 2 years ago.

Thanks Dr. Rick!

Aren't you kind! "Not nuts,...In good hands" Sweet! That's what I needed to hear!

I am totally cool with not knowing precisely a diagnosis or prognosis. I get checked yearly for anything that should be/could be treated like glaucoma, CME, or cataracts. If those things are negative (which they have been :-)), then I count my blessings, and I am out the door quick like a bunny!

I will certainly keep the link to Dr. Brown if needed for me or a friend in the future.

When I started noticing trouble with vision, I've really tried to "roll with it", and make wise choices for me and my patients----not based on fear or pride.

I started second guessing myself when told my latest ERG was normal. I really don't wanna be a wimp or a faker. I'll chat with my regular Retina Doctor, and he'll review my ERG and VF in a couple of weeks.

And Yes! I'll do my best with the first year students. I've been teaching for 6 years, and teach the interviewing/physical exam course. What a blast!! We set up practice labs (based on swim practice) where the students move from room to room and get one-on-one feed back from the simulated patients. I get to write the cases. Really fun!!

Thanks again!!! You've done a great kindness for me. Jani Kregor

Expert:  Dr. Rick replied 2 years ago.
Thanks for your very kind words :-)

It sounds like a blast teaching the first year med students!

I was on Faculty in Texas for a few years and taught retina to ophthalmology residents but, alas, I entered private practice and joined the rat race. Many is the time I think back to those days and wonder if I made the best choice....

If you every have any other questions or would just like to bounce things off a retina doc I'd love to hear from you again. Take care and have a wonderful summer.
Customer: replied 2 years ago.
Thanks! I certainly will log-on again prn. You've been VERY helpful. Have a great summer! jk
Expert:  Dr. Rick replied 2 years ago.
My pleasure. Take care.
Customer: replied 2 years ago.

Hi Dr. Rick, It's Jani Kregor again, with more questions. First question: should I have further evaluation, and if so--where?


The end of the story is that I am fine now, and my eye pressures bilaterally both before and after dilation, were 16. My vision hasn't changed much. (I think the light sensitivity, and peripheral vision are worse compared to this time last year. It's harder to walk around as a pedestrian.)


 


The beginning of the story is that I had two episodes, one day apart when I had REALLY bad pain in my right eyeball. It didn't lead into a headache. The episodes only lasted for a couple of minutes (less than ten). I didn't notice any vision troubles. One time, I was walking to swim practice, and I had just gotten off the bus. One time, I was doing ball room dance practice (International Foxtrot to be specific! :-)), and OH MY my eyeball hurt.


 


The pain went away both times. Later that weekend, I googled it, and that lead me to glaucoma. (So I went to the eye clinic, they checked my eyes and pressures--all good).


BUT, in reading about glaucoma----it seemed that the symptoms of decreasing peripheral vision, decreased contrast sensitivity, increased light sensitivity----are the very things that I've been complaining (that's the polite word) about for the past 10 years. I'm wondering if my symptoms aren't more related to optic nerve trouble (probably not from glaucoma---although when I read about glaucoma "it's complicated"), instead of disease of the retina per se.


 


I emailed my regular retina doctor (because I saw an optometrist in the urgent eye clinic), and asked if I should see him again--or somebody else. But, it's been 2 and 1/2 weeks, and no reply.


(He's emailed me in the past with results of tests----about once a year).


I think he either didn't get the email, got it and forgot it, or thinks I'm a bit nutso.


 


When I go to the clinic, they check my central acuity with the Snellen chart----and when I test near 20/20---I'm afraid they sort of give me the fish-eye. Really the light/dark/glare/peripheral vision trouble are what makes it the hardest for me to get about.


 


So, that's Waaaay more than you wanted to know. If I don't need any further eval----that's fine. I can read fine. But, if I should have someone evaluate my optic nerve to see if there is some treatment that should be considered----I will do it.


 


Thanks for listening!! Jani Kregor

Expert:  Dr. Rick replied 2 years ago.
Hi Jani,

Good to hear back from you. While your symptoms may sound like they could be related to glaucoma and/or optic nerve problems I can assure you that if your case was that easy it would have been solved already.

Glaucoma, with the exception of an angle closure glaucoma attack (which is rare and has many other signs/symptoms then just pain), is painless. As such there is no need to worry that your eye pain was from that.

After the workup you have already had I do not see any need for you to undergo further evaluation.

I am glad, however, to hear that you are doing better. And, if and when you get to the bottom of your eye issue -- I want to hear from you :-)

Have a good day.

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8506
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

THANKS!! That's exactly what I needed to hear. I'm super happy not having more evaluation. I just didn't wanna ignore something----if I should do something about it. I'm very aware of the dangers of goggling, and I know that I'm wrapped pretty tight! Smile


On another subject, I'm having a blast teaching the students this semester, and I just swam a 3000y swim for a postal competition in 45:36. Thanks again!!

Expert:  Dr. Rick replied 2 years ago.
Ya. You should put a parental block on your computer for Google LOL!

My pleasure. Keep up the swimming...I'm waiting for the snowmobile trails to open....
Customer: replied 2 years ago.

Hahaha! will do the parental block thing! But, I think I'll stick with water instead of ice. Just got my Yaktrax in the mail. thanks again. jk

Expert:  Dr. Rick replied 2 years ago.
My pleasure. Take care and have a good evening.

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
5453 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest