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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3178
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I started having trouble with my right eye on April 21st, blurry

Customer Question

I started having trouble with my right eye on April 21st, blurry vision, like a dark tinge to everything, sometime grated over objects and when I look at letters or number there wavy and distorted, anyway I went to the optamologist and he told me it was dry eye, went back a week later and saw a diffrent optamologist but in the same office and said he saw fluid under my retina I think is what he said, then about a few weeks ago I went back and got an OCT and they think its CSR and the nurse told me to it was a classic case, I have an appointment with the retina specialist in one week from today, I have the OCT scan and I was wondering if I can email it to whoever I talk to on here for another opinion
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. Yes, I'd be happy to take a look at the scan though your need to attach it to your post in this chat session as we cannot receive emails through this site.
Customer : If we get out of chat then I can send it to you
Customer : ??
Customer : Can we get out of chat so I can send it to you
Customer : Are u there?
Customer : Hello?
Customer : I sent the scan
Doctor DanB : I can't see it. Did you use the tool to attach it to your post?
Customer : Can we get out of the chat
Doctor DanB : Yes, I will convert to Q&A mode and I'll wait for your picture there.
Customer : I sent it toXXX@XXXXXX.XXX and they will send it to you
Customer : Ok
Expert:  Dr. Dan B. 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.
Ok this is better for me
Expert:  Dr. Dan B. replied 1 year ago.
Okay. I'll wait for your picture.
Customer: replied 1 year ago.
I sent it toXXX@XXXXXX.XXX
Customer: replied 1 year ago.
Experts at justanswer.com
Expert:  Dr. Dan B. replied 1 year ago.
The website experts are not very responsive and so I do not know when or even if I will get that scan. Can you not send it or attach it to your next post in this question-and-answer window?
Customer: replied 1 year ago.
I don't know if I can send it through here or how to do it
Customer: replied 1 year ago.
Now it said it just went sorry
Expert:  Dr. Dan B. replied 1 year ago.
I still don't see the scan although I will give it some time to see if it shows up. In the meantime is there a specific question about the scan would like to ask me? If there is maybe you can relay some of the information on the scam to me.
Customer: replied 1 year ago.
I'm just worried that they missed something bad
Customer: replied 1 year ago.
Ok I just got a message that it was received
Expert:  Dr. Dan B. replied 1 year ago.
Okay, I have seen the scan and it looks very consistent with CSR.
Customer: replied 1 year ago.
This past Sunday it was seven weeks that I have had this, how long do you have it and should I be worried its something else bad?
Customer: replied 1 year ago.
???
Expert:  Dr. Dan B. replied 1 year ago.
Seven weeks is not uncommon at all. This can last several months sometimes. However, it can have a relaxing and remitting course as it improves and then returns months to years later. The best thing to do if you are worried about them missing a diagnosis is to get a second opinion from another retinal specialist. That will provide you the best security about whether they have missed something or not.
Customer: replied 1 year ago.
If you did an OCT on me and what I sent you was the exam what would you say it was from looking at it?
Expert:  Dr. Dan B. replied 1 year ago.
Well I would tell you that your OCT scan has subretinal fluid that could be consistent with CSR. However, the problem with me giving you a definitive diagnosis, is that I cannot examine you. Examination is a crucial component to giving a diagnosis. The OCT scan is only an auxiliary test.
Customer: replied 1 year ago.
I have an appointment in a week at the retina specialist for an angiogram and I'm worried that its going to be something bad or I will lose my vision
Expert:  Dr. Dan B. replied 1 year ago.
I Think you need to calm down, relax, and trust in medical professionals who have an exceeding amount of experience with this. I would also recommend that you seek care for your anxiety because it is clinically significant. Do you have any other questions about this?
Expert:  Dr. Dan B. replied 1 year ago.
Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3178
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Dr. Dan B. and other Eye Specialists are ready to help you
Customer: replied 1 year ago.
I am worried that if I go for the angiogram it will show something really bad
Customer: replied 1 year ago.
Will I need intraocular injections?
Customer: replied 1 year ago.
Would the optamologist that I saw about 3-4 weeks ago and who have me the OCT exam have missed anything really bad or something that I would lose my vision over or go blind in that eye from?
Customer: replied 1 year ago.
Would the optamologist have missed something like macular degeneration?
Expert:  Dr. Dan B. replied 1 year ago.
Could he have missed macular degeneration? Yes. Is it likely? No. Any ophthalmologist with his salt knows the difference between out between macular degeneration and CSR. Again, though, a second opinion eliminate any doubt. Well it is possible needed injection for this, most people with CSR have the fluid go away spontaneously.
Customer: replied 1 year ago.
Great so it could be macular degeneration? And what do you mean by salt
Customer: replied 1 year ago.
I dont want to lose my vision or go blind, I'm scared
Customer: replied 1 year ago.
Would they have gotton me in sooner or taken more action if they thought it was macular degeneration?
Expert:  Dr. Dan B. replied 1 year ago.
Buy salt I just meant that any ophthalmologist who is reputable at all knows the difference between macular degeneration and CSR. While it's technically possible it could be macular degeneration, again, if your ophthalmologist can't tell the difference then you need second opinion anyway. You need to try and stop worrying about this because there's only a make this worse. I was also serious about getting treated for anxiety.
Customer: replied 1 year ago.
So you think its CSR and my anxiety is crazy?
Expert:  Dr. Dan B. replied 1 year ago.
Yes, I suspect that it is likely CSR, but no I did not say your anxiety is crazy. I think your anxiety is clinically significant and affecting you in an unhealthy way.
Customer: replied 1 year ago.
So how long do you usually tell patients that CSR takes to go away and the last time I went to the optamologist when they did the OCT my vision was 20/30 which he told me that it stayed the same from about a month before that when I went the first time, also before I went last time I thought it was worse but turned out being the same so do you think now since it feels worse its most likely the same but all my worry and stress over it is causing it to be worse, and I am going to therapy but its a hypno therapist ( no medication)
Expert:  Dr. Dan B. replied 1 year ago.
It can take several months for it to go away in many patients. I suspect that your anxiety level may be contributing to this, yes.
Customer: replied 1 year ago.
I don't want this to be macular degeneration, whether it be dry or wet
Customer: replied 1 year ago.
Also what is ON?
Expert:  Dr. Dan B. replied 1 year ago.
Optic nerve?
Customer: replied 1 year ago.
Well I was told the optic nerve was ok according to the doctors notes, they would have been able to tell that right? And what if its macular degeneration either wet or dry or would they have been able to have seen that already with the exam and OCT exam
Expert:  Dr. Dan B. replied 1 year ago.
Yes and yes
Customer: replied 1 year ago.
So they would have been able to see that already even without the angiogram?
Expert:  Dr. Dan B. replied 1 year ago.
Yes
Customer: replied 1 year ago.
So if its not CSR could it be anything else that's bad or would they have seen that also?
Expert:  Dr. Dan B. replied 1 year ago.
There are several very uncommon things this could be but none are nearly as likely as CSR.
Customer: replied 1 year ago.
Would they have seen those uncommon things?
Expert:  Dr. Dan B. replied 1 year ago.
Sometimes yes, sometimes no. That's why a retinal specialist evaluation including a fluorescein angiogram are important.
Customer: replied 1 year ago.
Great so what are those uncommon things?
Expert:  Dr. Dan B. replied 1 year ago.
I actually think it would do you more harm than good to see a list of things that are quite unlikely for you to obsess about, most of which are even more unlikely in your case. Trying to introduce even more supposition into your case that will not solve anything but send you into an anxiety-ridden state is not helpful.

Your feedback is important to me and will help me improve my encounter with future customers.  Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated.  If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. 
 
My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry! 
Customer: replied 1 year ago.

I'm scared because the symptoms for CSR and macular degeneration are the same!!!!!

Expert:  Dr. Dan B. replied 1 year ago.
I truly am sorry that you are scared. I wish there was something that I could say or do to improve your anxiety, but that unfortunately, would be impossible for me. Good luck to you and make sure you get a second opinion if in doubt.

Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated.  If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. 
Customer: replied 1 year ago.
So your thought is that that with my three eye exams so far and the OCT scan they would be able to determine if it was macular degeneration?
Expert:  Dr. Dan B. replied 1 year ago.
Yes.
Customer: replied 1 year ago.
Even without having the angiogram? Last question
Expert:  Dr. Dan B. replied 1 year ago.
yes, most cases.
Customer: replied 1 year ago.
I was hoping you would just say yes.
Expert:  jbmd replied 1 year ago.
Ok--I'm going to take a stab at making you feel better about this. It's HIGHLY unlikely that an ophthalmologist would confuse CSR and macular degeneration. They look nothing alike on examination. Macular degeneration comes in two forms: dry, which had build up of cellular junk in patches called drusen, and wet, which has the development of new blood vessel on the retina, making a tangle that is hard to see through.

CSR is swelling in the center of the retina from fluid underneath the tissue there, not on top. This fluid pushes the cells that see the center of the field of vision out and distorts them, leading to you seeing things with distortion/halos/rays of refracted lights sometimes like in street lights.

It can be imaged from the side with optical coherence tomography, showing the fluid clearly but the look of it is characteristic, as is the history--usually of sudden central vision blurriness.

CSR usually goes away in 6 weeks to 6 months and is caused/worsened by stress. The fluid under the central area of the retina will be absorbed by the body over time.

So relax--in the beginning you will notice it all the time and then over time you'll forget and one day you'll realize it's gone.

Hope this helps--it's from stressful situations, so avoid them and be followed by your doctors who sound like they know what they're doing.

I can't examine you but just give advice here.
Customer: replied 1 year ago.
Can I send you a copy of my OCT scan?
Expert:  jbmd replied 1 year ago.
Was what I posted understandable to you? Did it begin to make you better?

Can you post it here or on photobucket or some other site? I am not an ophthalmologist bud I did have CSR myself and, believe me, looked into it very very carefully.
Customer: replied 1 year ago.
See I went a few weeks ago and had another exam and OCT and they think its CSR but I have to go have an angiogram on Tuesday and I'm scared they will see something bad, this started 7 and half weeks ago
Expert:  jbmd replied 1 year ago.
That's not very long ago. The angiogram will confirm what they think and then you'll feel better--without the test you'll never believe them.

Relax and wait it through. They're being VERY thorough. (it's usually men who get CSR and it's unusual for it to be anything else until you were a lot older than 34). You're lucky to have such conscientious doctors.

RELAX. It will all be done soon.
Customer: replied 1 year ago.
How long did you have it for?
Expert:  jbmd replied 1 year ago.
7 months. Right eye only. Gone now. But I was under continuous recurrent stress.
Customer: replied 1 year ago.
What were your symptoms, mine is when I look at number or letters things are wavy, distorted, blurry and when I look at a straight line it's like bent and I have darker tinged over things
Expert:  jbmd replied 1 year ago.
The bend is characteristic--like looking at letters with a bubble on top. If I looked at a tic-tac-toe grid, the center was wavy and when I looked at letters on the TV screen, they were kind of smeared with almost a 1/2 double beneath the letters but darker than the white letters.

Does that help?
Customer: replied 1 year ago.
Kind of, did you have an OCT and a angiogram?
Expert:  jbmd replied 1 year ago.
OCT no angiogram but other non-eye things intervened and I was also convinced my story was classic.
Expert:  jbmd replied 1 year ago.
Remember, doctors make the worst patients.
Customer: replied 1 year ago.
I don't understand why I have to have the angiogram and I sent you a copy if my OCT scan did you get it?
Expert:  jbmd replied 1 year ago.
It doesn't show up here--you'd see it as a link on the page. Also, I told you that I'm not an ophthalmologist so I'm not experienced with reading lots of scans.

I wanted to reassure you that what you are dealing with sounds classic for CSR so you wouldn't stress and would wait for it to get better after the angiogram being done to be super conscientious by your doctors.
Customer: replied 1 year ago.
I don't understand why you didn't have to have an angiogram, it makes me think the reason why I do is they think it could be something else bad
Expert:  jbmd replied 1 year ago.

Nope--I didn't have an angiogram because I REFUSED to.

 

You are going to because you need it to convince you.

Customer: replied 1 year ago.
So you had an OCT?
Expert:  jbmd replied 1 year ago.
Yup--was equivocal but the diagnosis was CSR and now it's gone.

See, you're making yourself stress. Quit it.
Customer: replied 1 year ago.
Yeah but my doctor said he thinks its CSR, when I went back the next day the nurse gave me a copy of the scan and said it was a classic case of CSR
Customer: replied 1 year ago.
Also I thought an angiogram is the only thing that would tell you if you have CSR
Expert:  jbmd replied 1 year ago.
Wow, that's great the nurse said that. The story is classic, the scan was classic, you could discuss with the doctor waiting and being followed if you wish or have the angiogram to rule out wet macular degeneration and other vascular problems--which is what it rules in or out. CSR to me is a diagnosis of scan and history.

Customer: replied 1 year ago.
I have been told by a retina specialist on here that they would be able to tell if its macular generation already and that they would know the diffrence
Customer: replied 1 year ago.
See this is what I'm so worried about
Expert:  jbmd replied 1 year ago.
See, I'm trying to hard to reassure you that I let my battery go to 7% and had to reboot my computer.

STRESS gives you CSR and you have to de-stress. Stop fretting here, rate my answer, and come back if you need more help in a few days--after the angiogram to help you know what's going on.
Customer: replied 1 year ago.
I just don't want this to be macular degeneration, that's my fear
Expert:  jbmd replied 1 year ago.
IT'S NOT. AND THE ANGIO WILL PROVE It.

Do go watch something diverting or go for a nice walk. Calm down. You'll be fine.
Expert:  jbmd replied 1 year ago.
When you return from relaxing, please rate the response. I like to help people but I rarely relate personal information. I want to keep helping you when you need it but want to know you appreciate this with a positive rating.

Honest, you'll be fine.
Customer: replied 1 year ago.
Does this feel worse this last week because of so much stressing out about it
Customer: replied 1 year ago.
I feels like I'm looking through like a gel
Customer: replied 1 year ago.
So stressing over this is making it get worse?
Expert:  jbmd replied 1 year ago.

Classically, CSR comes from stress--the stress hormones cause the fluid buildup. And you are, temporarily, looking through a gel. The fluid under your retina is not exactly H2O--it's thicker, serum. Hence the "serous." If you could feel it with your fingers, which you cannot, it would be thickish and a little sticky. But it's part of the body fluid and given a chance the body will absorb it.

 

Stress does all kinds of things to one's body: raises blood pressure and heart rate, gives truncal (abdominal) obesity, causes CSR.

 

How about using this time to work on your stress: meditate, do yoga, exercise aerobically and, if needed, seek counseling. Avoid stress if you can.

Customer: replied 1 year ago.
It's so frustrating!!!
Expert:  jbmd replied 1 year ago.
Why are you surprised at blurry vision being frustrating?

And frustrated is just another way of being stressed. Get off the computer and do something relaxing, even if it's just getting your work done. Go for a rapid lunchtime walk. Do a mid-day yoga class. Something.
Customer: replied 1 year ago.
I'm not but I don't know how long I can deal with it
Customer: replied 1 year ago.
Did it ever seem like the good eye was getting bad too, my last visit thats what I thought but the vision was the same, I wonder if the good eye seems bad because it overcompensating for the bad
Expert:  jbmd replied 1 year ago.
Keep stressing and there is a chance your good eye will react like your bad. Please do what I said.
Customer: replied 1 year ago.
Did the other doctor online here tell you about my problem? I forgot to ask
Expert:  jbmd replied 1 year ago.
I read all the responses of the previous doctor--to what are your referring specifically?
Customer: replied 1 year ago.
Well after going to the optamologist and having the OCT scan they told me they thought it was CSR, then I sent the scan to a retina specialist and a optamologist here online and both think that that's what is
Expert:  jbmd replied 1 year ago.
AND so do I--it's classic. Now you need to deal with your stress and worry as I said. Really. You have a stress-induced eye problem and stressing makes it worse.

Like 4-5 doctors AGREE: nothing bad, will go away.
Customer: replied 1 year ago.
So do I really need to go for the angiogram, I also have been seeing a hypno therapist for like 8 months now and he works with sub concious and tells me if for two weeks I don't talk to anyone about my health issues it will go away but I have been like this my whole life so I don't know what to do anymore to get rid of this, I only have health anxiety and its bad, every time an ailment goes away I get something else
Expert:  jbmd replied 1 year ago.
I think your doctors are the best to decide if the angiogram will really help physical diagnosis and your therapist the best to help with anxiety about this health problem.

If it were me I wouldn't have it and I would forget about the eye and do therapy more frequently. and one day it would be gone.
Customer: replied 1 year ago.
So last question I guess, when you had your OCT exam they wanted you to get an angiogram but you refused? Also did they say they tought you had CSR like they told me?
Expert:  jbmd replied 1 year ago.
Yes--they were being super complete, as with you.
Customer: replied 1 year ago.
Just wondering what your recurrent stress was? Mine is my anxiety and my job
Expert:  jbmd replied 1 year ago.
That's something I cannot discuss here, sorry.
Customer: replied 1 year ago.
Sorry for asking
Expert:  jbmd replied 1 year ago.
That's okay! I can understand you wanting to ask--remember, you're a lot more anonymous here than I am.
Customer: replied 1 year ago.
What if its starting a little in my other eye now, what if I go tomorrow and its that's macular degeneration or something that's bad, yesterday was 8 weeks since this all started, I'm so worried about tomorrow
Customer: replied 1 year ago.
You said that when looking at a straight line and its bent or wavy is a classic sign if CSR? Why does it feel like the other eye is that way but not as bad as my right one? Is that my anxiety or is it the stressing that causing it, I read CSR occurs in one at a time, what if its in both my eyes now?
Expert:  jbmd replied 1 year ago.
Please have the other eye tested--it is classically only one eye at a time and it may be your stress making you think the vision is off. I cannot test you online but your doctors can and reassure you.

Customer: replied 1 year ago.
I think when I go tomorrow they will tell me I have something awful, I can't relax and be reasonable and say if it was something awful they would have already found it and not make me wait a month to go back
Expert:  jbmd replied 1 year ago.
There will be nothing awful. I think you need to get some help with stress--you're using up your life with worry.
Customer: replied 1 year ago.
What can I do to not be scared for tomorrow's appointment?
Customer: replied 1 year ago.
I'm scared to go tomorrow
Expert:  jbmd replied 1 year ago.
They'll take good care of you.
Customer: replied 1 year ago.
Ok then
Customer: replied 1 year ago.
What if this is something bad and I have to quit my job over it?
Customer: replied 1 year ago.
If blockage or leakage is present, the pictures will map the location for possible treatment.

An abnormal value on a fluorescein angiography may be due to:

Blood flow (circulatory) problems, such as blockage of the arteries
Cancer
Diabetic or other retinopathy
High blood pressure
Inflammation or edema
Macular degeneration
Microaneurysms -- enlargement of capillaries in the retina
Tumors
Swelling of the optic disc ( this is what I'm worried about)
Customer: replied 1 year ago.
Can I ask you one more questions and its a non related eye question?
Expert:  jbmd replied 1 year ago.
Swelling of the optic disc is characteristic looking and nothing like CSR--it's not in the same place. Since I doubt that all the doctors you saw were incompetent enough to confuse the two. The other things mentioned in your list also don't seem to fit

As far as another question, please close this one and ask another and ask for me--that makes things more clear so please do that. We have been discussing this for a while.

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