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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I had a branch retinal vein occlusio, which was followed by

Customer Question

I had a branch retinal vein occlusio, which was followed by neo-vascularisation. I have had six laser treatments , but some abnormal bood vessels are still therare still there. Should I contact Moorfields hospitl to see if ther is any further treament I could have?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

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

Dr. Rick :

I am a retina specialist. How long ago was your last laser treatment?

Dr. Rick :

Is the doctor who noticed these persistent areas of neovascularization an ophthalmologist, on optometrist or something else?

Dr. Rick :

It is not true that having 6 treatments is either excessive or unsafe. You need the amount of laser treatment you need -- no more and no less. There is no magic number.

Customer:

The doctor I saw was part of the ophthalmologist's team. I won't see the consultant now until the end of January.Should I ask to see the ophthalmologist before the end of January?Does neovascularisation ever clear up --with laser treatment, that is?

Dr. Rick :

It sounds like you were examined by an optometrist. As a retina surgeon, and I don't mean to be cruel, but I don't think an optometrist would know a retina problem if it reached up and bit them.

Customer:

Is there any other treament that can be given for this condition?

Dr. Rick :

You didn't say how long it had been since your laser treatment but it is possible for neovascular vessels to still show up on photographs and be closed off with no evidence of edema or leakage. If an eye surgeon had told you that you still had NVE than I would be more concerned.

Dr. Rick :

Yes. If you still have more neovascularization then the treatment is more laser. That being said Moorfields Eye Hospital is, if not the best eye hospital in the World, than it is one of the top 5. You wouldn't even get better care right here in my own office :-)

Customer:

It was 4 months ago. The consultant subsequently thought that it was stabilisedd, and sent me for the photo to be taken. I returned to have the result.

Dr. Rick :

Ok. It is unlikely that, without another vascular event, you would have new areas of abnormal blood vessel formation (NVE). What I would do at this point is have a dilated eye exam by an ophthalmologist (MD) in the near future to confirm or refute this photographic finding.

Dr. Rick :

You might need to have another fluorescein angiogram to better evaluate your capillary function and any presence of active NVE. If this is found, then more laser should be done.

Dr. Rick :

Many times a general ophthalmologist can provide this type of diagnostic workup and evaluation without needing to travel to a retina surgeon like myself.

Customer:

By the time I see Dr Wardrop at the end of January, it will have been 6 months since I was told the above. A lot can happen in that time. Should I write to request an earlier appointment?

Dr. Rick :

Has it already been 4 months since the pictures you discussed in your post were obtained?

Customer:

Yes.

Dr. Rick :

I did not realize that the pictures were so old.


 


Did Dr. Wardrop see these pictures and/or comment on them?

Customer:

No--I was to see him, but he was off sick.

Dr. Rick :

Ok. Well, if the pictures were obtained shortly after your laser then is entirely possible that the vessels had not had time to go away and they were just taking the picture for something to compare to on your next visit.


 


Does it sound like that might be why the picture was taken?

Customer:

No--sorry--I had one appointment with Dr W. when nothing was done, as he thought it was stabilised, but sent me for the photo to be sure.

Dr. Rick :

Ok. Well, in that case, I'd see what the credentials of the doctor are who read the picture and said there was blood vessels present. If it was not an MD, then I would tend to not be as worried.....but, in any event, you need another dilate exam by an ophthalmologist.

Dr. Rick :

Should you try and move up your appointment with Dr. Wardrop or one of his associates? In my opinion, that would be the safest course of action.

Dr. Rick :

Does this answer your question to your satisfaction?

Customer:

Sooner than the end of January? Six months seems along time --as vessels can increase quite speedily.

Dr. Rick :

They sure can....If you were my patient I would see you sooner rather than later, probably this afternoon. But I know things move at a different pace in the UK.

Dr. Rick :

Do I think this is an emergency? Since the pictures are already 4 months old and you have not mentioned any decrease in your vision......probably not. But, yes, I would try to get in before your scheduled appointment at the end of January.

Customer:

I think I'll write to Dr. W. personally, or pay to see someone privately.

Dr. Rick :

That sounds like an excellent plan. I wish you the very best

Dr. Rick :

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


Customer:

Does laser treatment ever work for neovascularisation?

Dr. Rick :

It works 9.95 times out of ten, if my two decades of clinical experience are correct.

Customer:

That's somewhat reassuring--hope it works for me.Thank you.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.


Thank you--I asked an optician to look at my eye, and she rang the hopital and got me an appointment for next Wednesday. She had also noted some bleeding. What would the bleeding indicate?

Expert:  Dr. Rick replied 1 year ago.
Sarah,

I am glad to hear that you managed to give the "system" a kick and get in to see an ophthalmologist so soon. :-)

The abnormal blood vessels that form are very fragile and, in many cases, they can leak and bleed. I would bet that is where the blood is coming from.

I hope things turn out well for you. Have a good weekend.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Customer: replied 1 year ago.


What could be done about the bleeding blood vessels?

Expert:  Dr. Rick replied 1 year ago.
More laser should take care of them.

Once again, though, I am not really all that excited about the ability of an optician to accurately diagnose what is going on with your retina.

I'm sure that Dr. Wardrop will be able to take care of things. Let me know what he says.

Have a good weekend.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 1 year ago.
Hi Sarah,

I just finished a laser treatment on a patient with neovascularization and my thoughts turned toward you. What did the eye surgeon find yesterday? I hope everything is going OK and you are getting better.

Dr. Rick
Customer: replied 1 year ago.


Thank you for your interest. I saw another ophthalmologist--she said that the neovasvularisation was stable, but as for more laser treatment in future, she said that this was most unlikely, as Dr. Wardrop had more or less peppered the retina with blasts from the laser. I see Dr Wardrop at the end of January. I don't know if nv can lie d then become active again? I didn't ask. She said that I should have been told it appeared to be stable, instead of being told that he could see neovascularisation.Still worried, but not so much. Thanks for your help.

Expert:  Dr. Rick replied 1 year ago.
Sarah,

It it good to hear from you again. What this ophthalmologist told you sounds very reasonable. The other doctor probably just didn't know enough to be able to tell that things look stable and wanted to err on the side of being cautious.

Usually, well treated NV does not become active again but, that being said, in two decades of being a retina surgeon, I have seen it happen. In these cases, however, there was usually new areas of ischemia or the initial laser may not have been adequate.

I'm glad to hear that you are doing well. Have a good weekend.

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