latest visit to opth

[yoganut]

So, never really having been given a definitive diagnosis, I decided I would try visiting an opth again. It's been over 2 years since my last unsatisfactory visit.

This time, Dr's assistant stuck papers in my eyes (Schirmer's test?) and I saw her write down '8'. Doc came in and did the same thing, I asked him about my TBUT and he said 'you don't seem that bad'... he showed me the papers and said 'see?'...all Greek to me... The little white paper seemed to be wet 1/2 way down.

After describing my symptoms, some days ok, other days beeding awful, he said well you don't seem that bad and prescribed Fluro drops and doxyclyclene. I specfically asked him if he saw ocular rosacea ( I have little veins visible over my eyelid) and he pointed to my slight acne and said well I see these, so its possible...

I also commented that another md in his large practice had advised me to rub my eyes with a warm washcloth, as i didn't really see any improvement, should I continue to do that? Also should I do eyelid scrubs like Sterilid? To which he commented, no I don't think youre that bad for that (scrub).

Perhaps I should have pushed him more on a diagnosis, but believe me I was hard pressed to get that much out of him.

What is the significance of '8' from the paper in the eye test? Is that Tear Break up time or 8 mm?

[LasikRelatedDES]

What is the significance of '8' from the paper in the eye test? Is that Tear Break up time or 8 mm?

Sounds like 8mm on the Schirmers test... that's not very good and the doc should have been concerned.

He should have never said "you don't seem that bad". If you've been struggling for two years and are getting an 8mm Schirmers, it's bad. I'm sorry you've had that experience.

And to a larger point, I'm really starting to feel bitterness towards ophthalmologists. My first ophth didn't diagnose me or put me on any meds, just put in permanent plugs and sent me packing, collecting his couple hundred dollars from my insurance. Well, those plugs didn't help, in fact, they hurt me by holding my inflammatory tears in my eyes.

Second ophth wouldn't tell me any of my numbers and didn't help at all. Put me on restasis. No diagnosis.

Third opth gave me a diagnosis (MGD) and my first effective treatment but eventually concluded this was all in my head when I didn't get better after 3 months.

Fourth ophth confirmed diagnosis, told me I wasn't crazy, and tweaked my regimen. But rushed through the appointment and didn't answer any of my questions.

What is the deal? How can so many people be having such similar, terrible experiences? And how can it be allowed to continue? What happened to the patient-doctor relationship? What about customer service? Do they teach empathy at all in medical school?

Or have the realities of compensation and patient volumes just destroyed all that? (Recognizing they don't make much $$ from a chair visit, trying to treat a difficult to cure condition)

[odydnas]

yoganut, I'm sorry that your appt didn't go as well as you hoped for. I would try to seek another doctor...a doctor that relies on your described symptoms too, rather than simply clinical observations...since it is well known that symptoms and clinical findings dont always correlate when it comes to DE.

I don't understand why he prescribed doxy when he said your tbut isn't that bad....

I can understand the bitterness, LasikRelatedDES...I think that with managed care, opths really just have about 10 minutes per patient, and with DE, you need more than 10 minutes. Also, DE isn't really a "sexy" topic (unlike their other patients who may be struggling with sight-threatening diseases), so its easy for a doc to dismiss our complaints of pain and irritation. They are also trained to rely on clinical findings (schirmers, tbut, etc), and not basing their diagnosis on how we FEEL...DE is like going against the way a lot of docs are trained to think...its also a topic not discussed much in med school and training. I mean I have a hard enough time trying to convince friends and family who know me that I am in actual pain and that DE is completely interfering with my life....how can I expect to convince a stranger that spends his/her day dealing with sight threatening problems that my situation is a real problem?

Like how not every friend/family member you know can understand your situation, not every ophthalmologist will take an interest and understand too. But there are definitely a few out there. From what you wrote yoganut, I would not go back to that opth who seems to discount your pain. Keep searching.

[Newandconfused]

[QUOTE=yoganut;43542]So, never really having been given a definitive diagnosis, I decided I would try visiting an opth again. It's been over 2 years since my last unsatisfactory visit.

This time, Dr's assistant stuck papers in my eyes (Schirmer's test?) and I saw her write down '8'. Doc came in and did the same thing, I asked him about my TBUT and he said 'you don't seem that bad'... he showed me the papers and said 'see?'...all Greek to me... The little white paper seemed to be wet 1/2 way down.

After describing my symptoms, some days ok, other days beeding awful, he said well you don't seem that bad and prescribed Fluro drops and doxyclyclene. I specfically asked him if he saw ocular rosacea ( I have little veins visible over my eyelid) and he pointed to my slight acne and said well I see these, so its possible...

qUOTE]

I had the exact same experience with my 4th opthamologist appointment in many months. My main symptom is tearing in the lower left corner. The eye doctor diagnosed MGD without much explanation. Scrubs, massage and hot soaks all suggested.

I also commented that another md in his large practice had advised me to rub my eyes with a warm washcloth, as i didn't really see any improvement, should I continue to do that? Also should I do eyelid scrubs like Sterilid? To which he commented, no I don't think youre that bad for that (scrub).

Perhaps I should have pushed him more on a diagnosis, but believe me I was hard pressed to get that much out of him.

What is the significance of '8' from the paper in the eye test? Is that Tear Break up time or 8 mm?[/