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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7759
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Is a retinal exam supposed to hurt? I know they are looking

Resolved Question:

Is a retinal exam supposed to hurt? I know they are looking for detachment or tears after the sudden occurrence of a bunch of floaters, but the exam when the doctor (an intern at a medical center who will be going into opthamology, but let me know she was pretty much of a beginner) pushed the eyeball to make the retina more clear in the "keyhole"? all around my eye socket--leaving bruises--it made me wonder if her technique was faulty or i should expect similar awful queasy painful exams in the future. they want to re-examine me in two weeks. thanks for your time.
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 and what this young doctor did to your eye is called a "scleral depression" retina evaluation.

Dr. Rick :

Even after two-plus decades of clinical practice when I do a scleral depression it is uncomfortable.

Dr. Rick :

The reason it hurt is that the young doctor was pressing too hard, and probably in the wrong area. Unfortunately, other then helping the young doctor practice her skills, you didn't benefit much from her "expert" exam :(

Dr. Rick :

I hope that one of the more senior residents and/or Attending Physician (professor) had a look at you too.....

Dr. Rick :

But, the good news? I am sure that no permanent damage was done to your eye.....

Dr. Rick :

In two weeks I would suggest that you kindly ask the young doctor to take only a brief look and then have he senior doctor (resident or Atttending) do your scleral depression if it is needed.

Customer:

thanks for answering. is it really necessary to repeat it in two weeks time? i got the intern yesterday because it was urgent on a sunday, but the follow up is definitely with the specialist. meanwhile, i am really feeling debilitated by all the interference with normal vision (not that i had that to begin with...i am very nearsighted but this is happening to my "better" eye...

Dr. Rick :

I taught young ophthalmologists for many years so I know how these things work and, at least, how they are done in my clinic :-) Retina is a very hard specialty for the young doctors to get good at early on in their training.

Dr. Rick :

It is necessary for you to have an ophthalmologist examine you in the future. Since I don't put any value on the exam the young doctor gave you, I would feel better if you were seen in two weeks....by a ophthalmologist with experience.

Dr. Rick :

Let me take a moment to attach my information sheet on floaters/retinal tears for your review:

Dr. Rick :

You have a thick gel material in the middle of your eyes called the vitreous. Over time as it liquefies, this gel material collapses on itself, forms little clumps that you can see as dots, lines or bugs. As these clumps form the vitreous pulls away from the wall of the eye. In the process it can stimulate the retina -- causing the flashes that you may see.

It is recommended that you see your ophthalmologist to look at the retina to make sure there are no problems such as a retinal hole or tear. In most cases, there are no problems, but this exam is precautionary and allows for preventative treatment of any lesions that are found.

If you notice a sudden increase in floaters, flashes of light (like a lightning storm), or a shadow/veil in the periphery of your vision, this can be worrisome for a retinal detachment. You would need to contact your ophthalmologist promptly in that case.


 

Dr. Rick :

The chance of you having a retinal detachment is low, but if you are one of the unlucky few who has one, the sooner it is found and fixed the better.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Are you still there?

Dr. Rick :

I can assure you that the exam by an experienced ophthalmologist will not be painful. Uncomfortable? Possibly. But not painful.

Customer:

yes, just had a phone call. the doc also said that these floaters would not likely ever go away. is that your experience as well?

Dr. Rick :

Yes.

Dr. Rick :

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.


 


Here is a video of the actual surgery to remove floaters:


http://www.retinavitreous.com/video%20files/intro_floaters.html

Dr. Rick :

I actually did a vitrectomy to remove severe floaters last week....so the surgery can be done but I am very slow to rush into it....

Customer:

yeah, i wouldn't want that surgery unless i just can't adjust to what has happened. it's just that i'm practically blind in the other eye, so having my "good" eye so affected is really disrupting right now.

Dr. Rick :

I can understand how you feel and have to commend you for letting the young doctor torture you.......I remember a time, sometime back in the 80's, when I was in the same place in my training.....

Customer:

well, i work at this medical center and teach the med students so i know a bit about what it's like in the apprentice system...still, i am glad you made the distinction between discomfort and pain...

Customer:

thanks again for your time and thoughts

Dr. Rick :

My pleasure. Have a good day.

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

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7759
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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Expert:  Dr. Rick replied 1 year ago.
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Expert:  Dr. Rick replied 1 year ago.
Hi Denah,

I was just thinking about you and wondering what the ophthalmologist found on her exam. I hope it didn't get past the "uncomfortable" stage :-)

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