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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3194
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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About 45 days ago, I noticed that the vision in my right eye

Customer Question

About 45 days ago, I noticed that the vision in my right eye was not up to par. Since it had been over a year since my last exam, i scheduled an appointment with a new Optomestrist ( which is by the way, a M.D, F.A.C.S, and a Board Certified Ophthalmoligist.) I am near sighted (about -5.25) and have been for about 30 years. I am 50 years old.

The Dr, briefly examined me ( there was no dialation or the little puff of air test) and, as I recall, he didn't even look my eyes with the little hand held light that I've seen in the past. He did look through some large device as I put my chin in the appropriate place. He proceeded to ask me " which is better, A or B, etc for a about 5 minutes until he was satisfied that my new prescription should be -6.5 and -6.0. He told me my right eye looked irratated ( I had been wearing a -4.5 to assist with reading) and that it would take a few days to adjust to the new lens.

About 2 weeks later, I returned, explaining that the vision in my right eye was poor, and no matter what lens I used I couldn't see properly. He again went through the same drill and finally said " as far as contacts go, your shit out of luck, you can correct for distance or reading, but not both. Maybe you should just give up and go to glasses"

I wasn't happy with this answer, because just a few weeks prior, I manged to do just fine most of the time without readers, but usually had then handy just in case. He got rid of my by saying, "I can't help you" And wrote me a prescription for the previous lenses I had been using.

2 weeks later, when the new lenses were also failing, I went to another optometrist. Within 2 minutes, he suggested that I may have a detached retina in my right eye and should seek medical treatment immediately. 3 days later, I had emergency surgery for a giant retinal tear.

My question is this: Should the original doctor have detected this problem rather than just send me away? My vision declined after my last visit to his office and the visit to the next optometrist but I tried to tell him that nothing seemed to be working.

The way I look at it is that I had a small tear which worsened because it was not properly diagnosed and that the first optometrist was negligent in not recognizing the symptoms.

Your feedback is appreciated.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Dr. Dan B. : Hello and thanks for your question. Are you available to chat?
Customer:

yes

Dr. Dan B. : First of all, I'm sorry to hear that happened to you. Without knowing exactly what your eyes looked like on that day, it's difficult to say that, for sure, he should've caught this. However, I can tell you that if someone who previously had good vision came back to my office and their vision in one eye was significantly worse and I couldn't correct it with glasses, then I would look in the microscope both in the front and the back (retina) of the eye to see if there was a physical reason or diagnosis causing the decreased vision. It really isn't hard to detect a retinal detachment but it does require looking.
Customer:

is it within the realm of expectation that a prudent practionier would look for this during a routine exam after hearing my concerns?

Dr. Dan B. : Absolutely it is. If the vision were only slightly different and there were no symptoms such as floaters, flashes of lights, curtains/veils/ or shadows complained of then it's conceivable that he might not have felt the need to look.
Customer:

I admit that I could see but not very well when I left his office. By the time I had surgery I was very nearly blind in the affected eye.

Customer:

i did not have any of the above mentioned symptoms

Dr. Dan B. : I can imagine. If the tear and retinal detachment were quite peripheral and early, you would still be seeing pretty good, very likely, in the central, normal, useful vision.
Dr. Dan B. : Do you remember what line on the eye chart you were able to read with the prescription they found for you that day?
Customer:

no, but I could read decently. Maybe 3 or 4 lines lower than my left eye, which was almost 20/20 corrected. The main problem was that distance was poor and reading was also poor. In the past, it was easy to correct for one or the other.

Dr. Dan B. : If the vision in this eye was 3 to 4 lines different than the other, most importantly, 3 to 4 lines worse than it normally is for you, I would have been compelled to look in the eye in the microscope, specifically at the retina if there was nothing unusual in the front. That's a pretty large discrepancy between the two eyes not to have it explained by something.
Dr. Dan B. : Do you have any other questions about this?
Customer:

So.. just to clarify, I may have had a minor tear early on still been able to see. I suspect this to have been the case. Could such a minor tear be detect with a routine exam? And, would the surgery to correct such a minor tear be considerably easier than to repair a major tear with ( I think my dr called it a macular detachment)

Dr. Dan B. : If by routine you mean a non-dilated eye examination, and a tear in the periphery of the retina would not have been routinely expected to be detected. However, if the eyes were dilated and they were examined under a microscope in a complete, dilated eye exam, then I would've expected a retinal tear to be detected. And yes, it's much easier to treat a small retinal tear than a significant retinal detachment.
Dr. Dan B. : I hope this has been helpful. I'm sorry but I have to step away from my computer for now. If you have further questions, please let me know what they are and I will be happy to address them when I return. If you are satisfied with your answers then...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:

Thank you. I may have follow up question later, but I am satisfied with your responses.

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3194
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
Dr. Dan B. and 2 other Eye Specialists are ready to help you
Customer: replied 1 year ago.


Just a follow up question regarding recovery from this surgery. I had a 20% detachement and the macula was involved, The dr used a buckle and a gas bubble. I'm now 10 days post op and I'm seeing about 20/30 minus 2 with my eye still significanty dilated. No double vision or anything unusual. The bubble is disapating and I can see it floating around as I move.


My question is to the amount of physical activity that is appropriate. I've been cleared to walk all I want but to avoid head jostling. Are there any specific risk factors from excercise that I should avoid such as elevated heart rate or general weight lifting at this stage?


 


I realize that I am currently under a doctors and will defer to her on these questions, but I was just hoping for an additional perspective.


 


Thank you

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Dr. Dan B.
Dr. Dan B.
Eye Doctor
3194 Satisfied Customers
Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology