Anyone see 2 opths ongoing, 1 for Glaucoma and 1 for DES & everything else?

[MaryVa61]

Saw the new opth again yesterday. Should probably stop saying "new" since it's been a year now and several visits.

He's great with the Glaucoma, has very sophisticated imaging equipment, agrees to try alternative drops that are BAK-free if I do the research for him though otherwise he says he doesn't know of any BAK-free meds. And I think if I can find info on how to test my pressure accurately without flourescien (which I'm allergic to) he'll try it. So, I'm happy with him for the Glaucoma problem.

However, he has zero interest in discussing any of my other eye problems and cuts me off when I attempt it. I can tell he gets annoyed because I keep trying to steer conversation to those issues. My prior Opth was the same way. Problem may be that Glaucoma is so seriously vision-threatening, that he wants to focus only on that. Or problem may be that, because I've learned so much from you guys that my eyes have improved a lot with home techniques, that my eyes don't look irritated when he examines them.

I'm thinking the solution may be to have a seperate doc for the Glaucoma than for everything else. Then can get followed for the DES, filamentary keratitis (& hx SLK)possible MGD, allergies (type IV affecting inner lids), possible occular Rosacea and Blepharism (maybe Sebborheic).

I already use a different doc, an optometrist, for my glasses because so few docs seem able to do a prescription that allows me to drive safely and read. I've had major problems with new glasses I couldn't see well out of. This one optometrist does an amazing job with my glasses.

Not sure if that would be a smart move, having 2 opths. And not sure insurance wouldn't have a problem with it.

Anyone ever tried doing this? Thoughts?

[bunnyrabbit123]

Hi Mary,
I would think that as long as your doctors are submitting claims for different treatments, it wouldn't be a problem. It's when your insurer is being billed for the same services that they'll question what you're doing. I have not done this myself, so I can't say positively. Good luck with this- I know what you mean when you say doctors get annoyed and won't talk to you about something. It's maddening.

[littlemermaid]

Currently ongoing in 4 different hospitals: 1 anterior segment ophth/team + orthoptist + optometrist (all separate service appointments), 1 neurophth + team, 1 neurophth surgeon + orthoptics + emergency care, 1 paediatric neurologist, 3 neurosurgeons, 3 dermatologists (1 Prof), 1 GP. Private: 1 anterior segment dry eye ophth, 1 optometrist for refraction only (glasses), 1 dry eye optometrist good at surface and retinal photographs.

Been through and dumped a load more. I bet this isn't the record.

As you say, MaryVa61, they are good at different things and I honestly need them all. Once they get over the professional affront, some quite like working together. But we are NHS/private practice and have no insurance issues.

[MaryVa61]

Thanks for the reply mermaid. You keep busy with appts I see. Maybe the opth wouldn't mind sharing the work with another. I was afraid my Rheum and Neuro wouldn't like that I see them for the same undiagnosed disorder, but they seem to have no problem with it so maybe the same would be true with my eye docs.

[MaryVa61]

Update re: delayed allergic reaction to drops used at eye appt or new trial sample

I had a type 4 allergic reaction in my eyes starting yesterday afternoon, and still messed up this AM, from drops used Friday, probably during the eye exam . Probably the flourescien strips to check pressure, but could be the numbing drops they use and I don't know what the ingredients are in those.

Or could even be the new Glaucoma med sample I'm trying. It's Travatan-Z, which is preservative-free, but contains castor oil and Sodim hydroxide/hydrachloric acid, which I've suspected I have sensitivity with use those first two ingredients.

I hope it improves quickly. It was a really painful day yesterday. Right now they don't feel too bad, but they never do first thing in the AM because of the Refresh PM ointment I use at bedtime. Still feel moist. These eye reactions after appts used to cause a big flare up for 2 months after. I sure hope it's not true now because I have to have pressure checked again in one month.

I'm wondering if I can track down ingredients in the drops used Friday by the Opth, see an allergist that does custom allergy patch tests (my derm doesn't), get samples of the suspect ingredients from Leiter's to get those allergy tests to pinpoint the problem ingredient. Then maybe Leiter's can compound something to replace the bad drug or I could find out if there is a different dye that could be used if it's the flourescien. I'm so tired of the pain I have to go through after seeing opths for Glaucoma exams. And a doctor who doesn't care at all about the reactions.

Sorry for rambling! Feeling slightly desperate.

[MaryVa61]

Thanks Bunny Rabbit. That was my theory when considering doing this, but I wasn't sure. I think I've also heard that the insurance won't pay for seeing 2 docs for the same problem twice within the same calender month, but I may have the details wrong on that.

[littlemermaid]

I'm so tired of the pain I have to go through after seeing opths for Glaucoma exams

MaryVa61 - So sorry to hear about this insensitive treatment.

As far as I know, there are different ways of checking eye pressure without anaethetising the surface, including an iCare Tonometer www.icaretonometer.com which is a lovely piece of reasonably-priced kit used by paediatric ophth in our hospital. It's not the only brand. They just shine a light in and measure the bounce-back.

With the tonometer mounted on the slit-lamp ophthalmoscope, the anaesthetic drop enables them to touch the eye surface to measure bounce-back. Anaesthetising the surface is a particularly bad idea for a dry eye because it knocks out reflex tearing for hours, and presumably soaks in even more without a tear film.

Another unnecessary drop which they whack in without asking while you're queueing is for pupil dilation so they can examine the fundus (back of the eye) for degeneration. While we appreciate the need for close exam in your case, they could do this with the right ophthalmoscope + handheld lens combo which opens up the field of view, like they do paediatric. We say 'bad reaction to dilation', and skip it. Also if your pupils do not return to normal within the afternoon if dilation is unavoidable, then report it because they need to use an alternative. If still dilated over 24h, go to hospital for treatment.

Why do they still use fluorescein knowing you have pain? - as far as I know there are at least 2 alternative dyes on the desk for surface exam - lissamine green and rose bengal (?). Why can't they buffer the dry surface 10 min previous if there's no alternative to staining for slit-lamp exam?

Maybe put in your tear substitute drop 10 mins before the test. They say this also improves accuracy of vision tests with an inflamed dry surface.

Here's a very good list of standard drops for different purposes in case it helps www.netdoctor.co.uk/medicines/effect/eye
For detailed ingredients and side effects www.fda.gov/Drugs

Irina we need you! Maybe post up on her thread. You're sure not the only suffering after unnecessary drops instilled in a dry reactive eye.http://www.dryeyezone.com/talk/..Irina-Ganelis.-M.D.-your-personal-dry-eye-doctor. She says

This is the reason I joined the dry eye forum. I am here to answer your questions.

[littlemermaid]

Re the galaxy of state-of-the-art docs, we are 'open door', they are supposed to be 'thinking about it' 'there if needed' so it's not as bad as it looks. Currently seeing 1 ophth + team regularly every 3m, no progress, that's it. She is still undiagnosed and managing the condition herself

[MaryVa61]

Thanks so much Mermaid, for the detailed reply and the link. I'd found the info on the accuracy of the dynamic contour tonometer this morning on PubMed and found a description of the Icare Tonometer that says there's no need for dyes or anesthetic drops with it. Problem will now be finding a doctor here who has it and is willing to use it. My prior opth was at the VA Eye Institute, which has a huge # of opths and is supposed to be a state of the art type of place, but I left that doc because he didn't listen to me at all. Acted like I hadn't spoken if I talked about pain or allergy to drops. Found out later (from someone who worked with him) that, over the 14 yrs I'd been seeing him, he'd become an expert in cataract surgery and had no interest in other patients. But the new doc, whose office is in a hospital, is almost as bad. Still insists he must use Fluorescein but not because he doesn't believe me, just because he says, "I don't know of anything else". He'd said he didn't know of any BAK-free Glaucoma drops either until I told him the name of one. Then he said, "If you'd like to try that, I have samples"!

So I'll start a search for an opth that has a tonometer and is willing to use it exclusively.

[littlemermaid]

So happy you're on the job again, so very sympathetic to that pit of despair feeling with recalcitrant docs <hug> I want to know what they know, and I want to know what they don't know, neither of which they are keen to divulge. I still love 'em all and can even tolerate a fair level of tetchiness and arrogance in pursuit of excellent treatment (except one, who was criminally negligent). It's just unbearable when they're off-hand because they're faking it. This is why I shop around to find docs who are professionally interested in this condition, and someone I can have a dialogue with. This is a very rare bird.