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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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Have a question about my vitrectomy

Customer Question

Have a question about my vitrectomy
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 :

what would you like to know?

Dr. Rick :

I see that you are typing....I will standby

Customer:

I had vitrectomy around thanksgiving last year and was wondering if after this recovery if I can get a new lens in my glasses or is it too soon??

Dr. Rick :

Didn't you have a scleral buckle and endolaser too?

Customer:

Good memory!! I had another detached retina in my other eye

Dr. Rick :

Oh....sorry to hear that .

Dr. Rick :

To answer your question: You should be fine to get a new lens in your glasses at this point.

Customer:

the second one was easier....

Dr. Rick :

Of course, you understand that you will get a cataract in the next year or so in the eye that had the vitrectomy.

Customer:

So the eye should be stable and healed at this point??

Dr. Rick :

yes. It should be healed and stable enough at this point, if everything went a planned, to be worthwhile changing your glasses Rx now.

Dr. Rick :

How did the vision in the other eye turn out?

Customer:

Good thanks...Appreciate your help Dr. Rick

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 MD FACS

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.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 1 year ago.

I just noticed you said something about a cataract??

Expert:  Dr. Rick replied 1 year ago.
That is right. In the eye that had the vitrectomy there is a 99% chance that you will, eventually, get a cataract in that eye sometime in the near future.

This is just a known side effect of a vitrectomy/GFx.

I'm surprised that your retina doc didn't mention this fact to you.

Don't forget to mash the excellent feedback button for me :-)
Customer: replied 1 year ago.

OK am i correct to understand that it isnt until a certain point that the cataract is ready for surgery... I already gave you an excellent rating doc


 

Expert:  Dr. Rick replied 1 year ago.
Yes....I just noticed the rating...Thanks!

That is correct, the cataract does not need to be removed until such time as it is limiting your vision to the point that it affecting your ability to do the things you need to do.

Waiting to have cataract surgery doesn't make the surgery more difficult or the final visual outcome any different.

The cataract can be removed using the normal cataract surgery techniques and it should not affect the results of your previous retina surgery.

Let me know if you have any other questions :-)
Customer: replied 1 year ago.

Great Thanks Doctor Rick, you are the best. .wish you were local...

Expert:  Dr. Rick replied 1 year ago.
It sounds like you are in good hands but I am glad I can be of service in some small way.

Best of luck to you. Take care.
Customer: replied 1 year ago.

Dr. Rick,


 


It looks as though the system or you are looking for more money..I am happy to give you a tip.. How do i do that??

Expert:  Dr. Rick replied 1 year ago.
Thank you for the positive feedback.

I'm not sure what the tip screen looks like from your side, but there should be a box labeled "tip" or "bonus"

If you are having problems finding it, don't worry -- you can give me a tip next time I assist you :-)
Expert:  Dr. Rick replied 1 year ago.
Hi Mark,

I was good to hear from you the other day. I hope that your new glasses Rx allows you to see much better.

Take care and let me know if I can do anything else to help.
Customer: replied 1 year ago.

Got a question about sceral buckle removal


 

Expert:  Dr. Rick replied 1 year ago.
Sure. I'm happy to help. I am traveling right now and might take a bit to get back to you.....what is your question?

Customer: replied 1 year ago.

Need help with vitrectomy operation question

Expert:  Dr. Rick replied 1 year ago.
As a retina specialist vitrectomy surgery is my "bread and butter"

What would you like to know?
Customer: replied 1 year ago.

I was charged 5508.27 for surgery .. this seem reasonalbe or too much??

Expert:  Dr. Rick replied 1 year ago.
Did this bill include:

The retina surgeon's fee?

Anesthesiology doctor's fee?

Operating room charges?

Hospital charges?

Drug/misc charges?

Pre-op evaluation?

Post-op care by the retina surgeon for 90 days?

In other words, was this your entire fee or was this just your part of the bill after insurance had made a payment?

Customer: replied 1 year ago.

Looks like it was an insurance mix up .. i just got it resolved and down to 490.14 thanks to Blue cross..


 


oh boy what do "we" do now??


 

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

$490.14 is a lot better. Heck, you can't buy a computer for that :)

I really didn't do anything to help so don't worry about pressing the excellent feedback button if you don't want to (although it is fun to push lol!)..

Don't forget....you will get a cataract in that eye in the next year or so -- just part of the deal when you have a vitrectomy.

Take care and let me know if I can help you again in the future.
Customer: replied 1 year ago.

Thanks Dr. Rick you are the best.. and thanks for understanding!! Have a great day!!

Expert:  Dr. Rick replied 1 year ago.
My pleasure.

Take care and try to stay out of trouble ;-)
Customer: replied 1 year ago.

LOL thanks I sent you a bonus for excellent customer service and soh .. sense of humor!! Thanks again

Expert:  Dr. Rick replied 1 year ago.
Thanks I got it -- you are too kind :)

Have a good day. TTYL
Customer: replied 1 year ago.

Glaucoma questions Dr. Rick??

Customer: replied 1 year ago.

Just checking... you there??

 

Expert:  Dr. Rick replied 1 year ago.
Hi. Sorry about the delay. I've been on a week long snowmobile trip...and my laptop was just too heavy to carry on my back :)

I'm here now. What can I tell you about glaucoma?
Customer: replied 1 year ago.

trying to figure something out... After my virectomy i had glaucoma... why would someone have glaucoma all of a suuden after a surgery when before the surgery there was none??

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

Glaucoma is not a common problem after a vitrectomy. If, however, you had steroids injected inside your vitreous cavity after the surgery, the -- yes -- this can cause your eye pressure to go up, leading to glaucoma.


But, in and of itself, vitrectomy surgery is not a risk factor for glaucoma.

Why do you have glaucoma now? It is possible that an underlying glaucoma, or risk of getting glaucoma, was "in your future" and, since you are getting frequent eye examinations it was discovered the minute the glaucoma showed up. This, in the scheme of things, is a good thing....not that you have glaucoma, but is has been caught and treatment started before any damage could be done.

Does this make sense to you?

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.

Other then the glaucoma, how are things going? I hope you're doing much better....

Dr. Rick
Customer: replied 1 year ago.

Snowmobiling?? Are you from Minnesota too?? Thanks for that explanation Dr. Rick ..No streoids injected as far as I know.. However iwas put on Azopt afterwards...

 

I want to explore another possibility... my doctor was very concerned twice at 2 of my followups regarding the pressure. He wouldnt let me leave the office until it was at a a safe pressure. Also i did have the gas bubble put into my eye for the operation??

 

Now .. is it POSSIBLE the doctor screwed up something??? Is it POSSIBLE???? According to my online research it seems possible...

 

If the IOP was too high then the central retina arrtery could have been occluded temporarily??

 

Dont worry Dr. Rick i wont use your name any where . I know doctors are hestiant to talk about the M word.. I just need some facts...

Expert:  Dr. Rick replied 1 year ago.
No. I'm way up North, near the U.P.

The gas bubble, while present, can raise your eye pressure.

I very much doubt that a complication (AKA: screw up) during the vitrectomy would be the cause of persistent elevated pressure in your eye. But, when it comes to medicine, anything is possible...but I'd not bet the farm on the surgeon having caused your glaucoma through some sort of error.

Customer: replied 1 year ago.

THe reason i am pursuing this is becuase at my last appt with a different doc she said I have optic nerve damage and PERMANENT vision loss in that eye. It is partial but it is permanent and it does affect my ability to make a living... so how would I go about eliminating the doctor error??


 


This is very important to me doc and you are my man.. hehe

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

Unfortunately, once your optic nerve is damaged there is nothing that can be done.

You are getting the pressure treated now so, hopefully, no more damage will occur.

I do not believe that past doctor error caused your glaucoma, nor will any future "error" on the retina surgeons part contribute to your glaucoma.

Like they say: "Stuff" happens.

From what you have posted, it sounds like your are getting the correct care.

Did you know that pressing the excellent feedback button is not only a lot of fun, but it is good for you too ;-)
Customer: replied 1 year ago.

OK doctor .. you have been very helpful in the past and I appreciate that... I will rate you favorably... I am not convinced that i was given proper care however..esp since i was perfectly fine before the operation and now I have all of these problems...I realize doctors dont like to talk bad about another doctor so I will move on... is the scenario mentioned earlier possible with the occlusion???

Expert:  Dr. Rick replied 1 year ago.
If you mean is it possible for the optic nerve to be damaged from vascular occlusion during the vitrectomy? Absolutely.

That being said, if the pressure in your eye was to have gotten that high enough to cause optic nerve damage during the surgery, gas bubble placement etc, I expect you to have catastrophic damage to your retina also....

Here on JA (and actually in my professional life) I have no problems with calling a doctor out who has done poor work....I guess that was why I got stuck as Chief of Staff at our local hospital for a few years. :-)

I call 'em like I see 'em.....

Plus, I like being your "go to guy" ;)
Customer: replied 1 year ago.

OK i appreciate your candid response.. Here another avenue I was pondering...The doc was definitely very concerned with my IOP on the follow ups however the follow ups 2 weeks and a month apart..what happens between the appt when the pressure is too high?? Esp since Azopt is a SUSPENSION and I was never told to shake that bottle by that doctor. My optomestrist told me that and was very surprised that i wasnt told by my retinologist. .what happens when you combine the high pressure between appts with the eye drops problem???

Expert:  Dr. Rick replied 1 year ago.
It depends on how high your pressure was between the appointments. Usually, a few months of elevated IOP is not a big problems. Glaucoma is a slowly progressive issue that usually takes years to do damage.

As far as shaking the bottle goes, even without shaking it I'm sure you eye pressure was lowered some. It is entirely possible that you could have got more medicine instead of less....it depends where the stuff settled in the bottle. That being said, make sure to give it a couple of good shakes in the future.

Also, don't go to an optometrist for your glaucoma care...no matter what he may tell you he has been "trained" to do....
Customer: replied 1 year ago.

I like your first sentence here...a slow progressive issue.. so how did I get it so fast??? The optometrist was for glasses not for glaucoma but THanks anyway doc.. I was thinking more along the lines of not enuff medicine with the drops..


 


So now that you know my situation and my mindset what would you suggest I do from a consumer standpoint??

Expert:  Dr. Rick replied 1 year ago.
Hard to tell where you "got" glaucoma. You might have already had elevated eye pressure for years before it was "discovered"

Glaucoma, in the vast majority of cases has no symptoms as it slowly takes you along the path to irreversible blindness.....a path that is changed with treatment.

I suggest you continue to followup with your ophthalmologist and realize you will be, most likely, be using eye drops for the rest of your life.

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.
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.

THanks Dr.Rick.. didnt get all the answers I wanted but I sense you dont want push the malpractice line of questions...


 


Stay warm up there..and thanks for all of the other eye info..

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

I'm happy to get into malpractice issues for you....but to give a valid opinion, I would have to review your entire medical record, operative notes and post op care....and possibly examine you (which is very difficult to do online ;)

I must say however, that from what you have posted so far, I do not get the feeling that you have been exposed to medical malpractice but, perhaps, if I was to review your entire medical history and current care I might feel different......

Have a good weekend, keep using your drops and try to stay out of trouble :)

Dr. Rick

PS: Thanks for the positive feedback -- you are too kind.
Customer: replied 1 year ago.

You are welcome Dr. Rick.. I guess I need to find someone as thorough as you down here in FLA>> to proceed.

Expert:  Dr. Rick replied 1 year ago.
That sounds like an excellent plan. Let me know if I can do anything to help.

If you are near Miami, you could consult with one of the retina specialists at Bascom Palmer:

311 Tamiami Trail N #100, Naples, FL 34102
Phone:(239) 659-3937
Customer: replied 1 year ago.

THanks Doc I am near Miami Boca Raton area .. Naples is about 3 hours away.. Bascom main campus is in Miami I used to work at UM across campus.. :)


 


I guess the first step is to get the records from the doc... because of HPPA laws I am entitled to them correct??

Expert:  Dr. Rick replied 1 year ago.
I have relatives who live in Boca :)

You will get excellent care and an unbiased second opinion from the ophthalmologists at Bascom Palmer....they are top notch.
Customer: replied 1 year ago.

OH really??? Please let me know when you are in Boca.. I'd be happy to buy you a beer or whatever else you drink.. I need a break from the wife occassionally hehe .you have my email???


 


XXXXX@XXXXXX.XXX


 

Expert:  Dr. Rick replied 1 year ago.
the email was blocked by our ever vigilant fire wall :(

As far as wives go, I'm in the process of trying to get mine a second job....but I'm meeting a lot of resistance lol!
Customer: replied 1 year ago.

Darn!!! oh well... offer still stands if you figure out a way to contact me.. us northerners gotta stick together MArk Royer at Florioda atlantic University

Expert:  Dr. Rick replied 1 year ago.
got it :)
Customer: replied 1 year ago.

THanks for all of the info DR. Rick , see ya ( hehe) next time

Expert:  Dr. Rick replied 1 year ago.
:)

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