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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8327
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have just had a most unsatisfactory appointment with a hospital

Customer Question

I have just had a most unsatisfactory appointment with a hospital opthomologist. For 2 months I have noticed what appears to be a continuous migraine type problem with my right eye. Lines seem to flash and light colours appear more bright. When I look at a dark surface I see a central shadow, a bit like The sort of thing you see when you've been looking at bright light. My colour vision is 'washed out' My doctor referred me to the hospital - the doctor I saw asked nothing about the symptoms. He tested my colour vision, put drops in my eye and looked extensively at the back of my eye without comment. His only 'diagnosis' was that I have fewer capilaries at the back of right eye but he couldn't say why. I mentioned that I had an extremely overactive thyroid treated with radioactive tablet 6 years ago and, on hearing that, he promptly said that was the most likely cause! I have a strong diabetes history (mother and maternal grandfather) in fact my mother died from complications of the disease and had previously gone blind - he was not interested. I'm now waiting for a field vision test but I've no confidence in him. I couldn't understand his accent and he seemed reluctant to speak to me. Can you shed some light on this please?
Many thanks
Gill
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 I have to agree with you: The comment that your history of thyroid ablation with radioactive iodine as a cause of this vague "you have fewer capillaries" makes absolutely no sense to me either.

Dr. Rick :

If he wants to evaluate the statues of blood flow and capillary function in your retina then the test to do would be a fluorescein angiogram, not a visual field test.

Dr. Rick :

That being said, if you do not have diabetes yourself, your family history of diabetes would not have any impact on your current issues.

Dr. Rick :

Concerning your color vision changes I am not exactly clear on what is going on. You state that the colors are more bright but then also say they are washed out......

Dr. Rick :

Can you tell me if the doctor found any evidence of refractive change, relative afferent pupillary defect (RAPD), corneal abnormalities, lens changes/cataract, posterior vitreous detachment or macular abnormalities? If you could upload his notes, that would be great :)

Dr. Rick :

I see that you are offline. I will switch to Q&A format. This format 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..... :)

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.
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 I have to agree with you: The comment that your history of thyroid ablation with radioactive iodine as a cause of this vague "you have fewer capillaries" makes absolutely no sense to me either.
Dr. Rick : If he wants to evaluate the statues of blood flow and capillary function in your retina then the test to do would be a fluorescein angiogram, not a visual field test.
Dr. Rick : That being said, if you do not have diabetes yourself, your family history of diabetes would not have any impact on your current issues.
Dr. Rick : Concerning your color vision changes I am not exactly clear on what is going on. You state that the colors are more bright but then also say they are washed out......
Dr. Rick : Can you tell me if the doctor found any evidence of refractive change, relative afferent pupillary defect (RAPD), corneal abnormalities, lens changes/cataract, posterior vitreous detachment or macular abnormalities? If you could upload his notes, that would be great :)
Dr. Rick : I see that you are offline. I will switch to Q&A format. This format 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..... :)
Customer: replied 1 year ago.
Thanks for replying. The optician didnt find anything at all - he was very good and said my eyes appeared normal. I forgot to mention that my right eye is bigger than the left. It varies as to how much but neither the doctor or the hospital consultant seemed to think that was significant (it has only been like this since my thyroid problem)
My colour vision is washed out - plain white lines or lights appear very bright but not coloured images.
Customer: replied 1 year ago.
I had 2 types of drops in my eyes this morning - they made my vision very blurred. He also did a colour vision test - I couldnt identify many of the images.
Expert:  Dr. Rick replied 1 year ago.
Gill,

One of the most important things to closely test for, given what you have posted, is the possible presence of a RAPD (as discussed above)

Also your optic nerve should be evaluated with a 78 or 90 diopter hand-held lens or even a special contact lens.

A hertel exophthalmometer should be used to measure and document any differences in the protrusion of your eyeballs.

Also, an MRI of your orbits should be done if the clinical exam is suggestive of optic nerve compression, vision loss or globe protrusion with more then 2mm difference between your eyes.

So. What is the take home message? Sounds like you need to find a better ophthalmologist (Eye surgeon) to take care of you......

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

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. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 1 year ago.
Thank you - I'm going to keep a note of your suggestions for my next appointment. Just one last question - in your opinion, is this something to be concerned about? I'm thinking loss of sight or something more sinister brain-wise.I can cope with the way it is now if I have to, but since my mum went blind I always worry about stuff to do with eyes.
Thanks
Expert:  Dr. Rick replied 1 year ago.
Gill,

Everyone thinks of a brain tumor -- I do not think you have one :)

It may be from you thyroid issues, but not "less capillaries" as the doctor said...that makes no sense at all.

Let me know how things turn out. It is always a pleasure to help my friends on the other side of the Atlantic Ocean.


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: 8327
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 very much - I always get good advice from you!
Expert:  Dr. Rick replied 1 year ago.
My pleasure. Have a good day.

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Dr. Rick
Dr. Rick
Eye Doctor
8327 Satisfied Customers
Ophthalmology since 1994 with Retina sub-specialty interest