Seeing a private ophthalmologist in the UK

[jlg_uk]

My optometrist is now recommending I see a private ophthalmologist. I don't have medical cover, so I'll have to pay for this (£120??).

I figure paying for a consultation is worth it if only to confirm the diagnosis of the NHS ophthalmologist I saw last week (with it's try compresses and drops for 3 months treatment suggestion).

The private ophthalmologist has the following specialities according to http://www.bopss.org:

1 oculo / eye / ophth plastic surgery
2 oculoplastics, orbital and lacrimal
3 cosmetic / aesthetic / facial aesthetic surgery

I know in many cases you pay for seeing someone who also works for the NHS anyway, and that many of the above are more to do with plastic surgery (though it is from a plastic surgey website), but this guy has been recommended based on how he helped a different patient also in my optometrist's care who was having major inflammation issues etc.

I just kinda feel like I need to do something other than wait for 3 months to see the NHS guy again, though I know I need to have realistic expectations.

One major concerns I have is that I don't invalidate NHS care for my eyes by seeing someone private (whoo knows what will be available for DES in the future). Surely a private consultation wouldn't do that - but treatment might? Where is the line for this?

[irish eyes]

Hi

I can see your point - it is known as co-payments. At present, it is limited to cancer drugs, perhaps capable of extending life by a few months but at a cost of thousands of pounds, I think it is usually considered as a last resort.

By seeing someone private, you get another, different opinion (perhaps) but all you are really `buying' is time. AS you say, these people work with the NHS as well.

You could always see your GP - they will have a list of opthalmologists with details of their specialisms and expertise, They should also be able to answer your question.

[EllMitcho]

Hi - I went down the private route just to get seen quicker - to be honest my NHS consultant was better than the private and as Dry Eye is a long term issue waiting 3 months to get seen by the NHS could be used to try try a different regime- looking back going private was a waste of money imho - as my NHS consultant stated "we don't have any special treatments for private patients"

Hope this helps

EllMitcho

[IanJ]

Hi,

I have been back & forth to the NHS and a private ophthalmologist in regard to my dry eyes (including treatment). I always told both I was seeing the other and why!, i.e. "there is no cure for dry eyes, and it hurts, it bloody hurts...so don't blame me for seeking help elsewhere"
I always told both exactly where and what I was at in regard to treatment..........there was never any question about invalidating anything.

As far as the NHS went, I think it actually helped because it was always a different doctor and when they asked "are you still using the minims artificial tears" I was able to say "no, I'm taking something better" and to which they always looked on that positively.

For me, the main benefit for the private route was access to better eye drops, and a better more concise explanation of my problem. But not to say you won't get anything from the NHS approach. IMHO you need both.

Hope that helps!

Ian.

[jlg_uk]

Thanks all for your replies. I think now that I've been suffering for almost a year, it's worth a one off consultation - I think I'll just make it clear that I'm keen not to have any private treatment that could cause me to be discharged by the NHS (unless of course it's a cure </dream>).

[irish eyes]

Every year, thousands of people undergo surgery and pay for it themselves. This is often an option that GPs presents to patients if they want access to treatment more quickly. These people still use the NHS for other health conditions.

If you have the resources, then give it a go.

[jlg_uk]

I don't have huge resources here - and I'd still need to be able to engage the NHS about my DES problems (not just other things that go wrong). I have no idea how long my DES will last.

This is why I'm trying to be a little careful here so I don't shoot myself in the foot

But I do think if I have my diagnosis confirmed by somebody else, I'd at least feel I'd done all I could to understand what my condition is, and hopefully what the best way of treating it may be.

That said, if a consultation reveals that the diagnosis is wrong (and different treatment is recommended), then I'll have to raise that with the NHS. I really don't want to just spend the next 3 months doing more frequent compresses plus PVA drops if that's not what I should be doing.

[stella]

Go for it jlg - the NHS doc wont even know you have seen anyone privately (even assuming they were the least bit nterested- they have thousands of patients)
It will speed things up for you and get a second opinion by a consultant of your choice (or recommendation) and maybe he will have different ideas, also ,if you are paying he should give you plenty of time to address your concerns.Also with the NHS you seldom get the consultant - its usually one of his juniors
Its a good idea to make a list of questions you want to ask so you dont go away thinking - I should have mentioned this or that
Good luck

[jlg_uk]

Thanks Stella

The take questions thing is a good tip - the first time I didn't and did wish I'd asked things. I now always go armed with a folder containing questions and even pictures of my eyes.

[irish eyes]

Stella is correct - the NHS people need not know that you had seen someone privately. They are busy people - that's why they cannot afford to give everyone the time they need. Remember though that private or NHS, they all trained in the same way.

I have a number of eye conditions and see people privately some some and the NHS deals with the others. You will know that when you pay to go privately, you get a rather nice letter with the heading `Fees for Professional Services' etc etc and you would normally pay the person direct.

By all means go with some questions but do remember that you are paying them for their expertise and knowledge. There should be no need for you to go armed with pictures and other people's opinions. You want a fresh insight. Otherwise why go?

[jlg_uk]

There should be no need for you to go armed with pictures and other people's opinions. You want a fresh insight. Otherwise why go?

That's a good point irish eyes. I'll go with my pics really to use after they've had a look at me and told me what they think. If it's not the same as what the NHS Ophthalmologist said, nor what seems to fit my symptoms, then at least I can show them and ask questions (hopefully not to the point of becoming overly annoying).

But yes - do agree I'm looking for an independent perspective here, though they will be armed with what my optomtrist has seen and they are referring me (not the NHS system though).

[eva b]

I agree with all the others...go for it.

Seeing someone privately in no way invalidates your NHS treatment, or disqualifies you from it. In fact, when I had a chalazion one time, I actually asked at the eye hospital dept whether they could recommend a specialist who would do it privately (and, obviously, much sooner than the 3 months they were forecasting) - which is precisely what I did, and it was done within a week.

This is quite common practice, and perfectly ethical, and doesn't compromise you in any way.

As one or two others have said, though, you won't necessarily get more satisfaction from your private chap - though if it's a personally known doc who has helped another patient of your optometrist then you've a better chance.

I've had one or two NHS docs tell me things that the private ones (and I've seen plenty of both, believe me!) had missed. It really is a matter of getting lucky. One thing is for sure, though, is you WILL get their full attention and time!

[jlg_uk]

Thanks Eva

I agree it's pretty much a matter of luck. I've found out it's £140 for a consultation - ouch

I'm still thinking about it - the guy has alot of lid surgery type specialism, which doesn't necessarily make help a DES expert. But then, I think my problems are firmly routed in the lid region, and he has apparently helped someone with inflammation problems before etc so I think I will go for it (a consultation that is, not endless hugely expensive appointments).

Thanks for all the feedback on this.

[jlg_uk]

Actually I've spoken with the private ophth's secretary, and they've been good at answering my questions. So I think I'm going to go for it. I was asked to email them with my status, and I got a reply and a potential recommendation for short term steroids (though this won't really help beyond a short term period right?).

I thought I'd include my email and reply here (sadly no photos though), with names removed (I haven't asked their permission to post this). As always, any thoughts welcome.

Hello <Ophth>

As discussed with <Ophth Secretary> earlier, I'll do my best to provide a description of my ocular history in addition to a brief overview of my recent visit to <NHS Ophth>, at Kettering Hospital Ophthalmology dept.

I am a 32 year old white male who works in IT. In Dec 2007 I've started having serious problems with my eyes - primarily soreness (burning), light sensitivity, aching (top corner of eyes next to nose) and occasional front head ache. The soreness occurs most of the time to varying degrees heavily influenced by environment, and moisture goggle type glasses do help. After seeing a number of people regarding this, these problems appear to stem from a tear film instability. My left eye is worse than my right although both are affected.

My Optometrist <Opto> has shown that there is a problem with the lipid layer of my tear film, and I have been doing hot compresses + massage + lid scrubs daily since late June 08 (lid margin & particles in tear film pics from June attached). My vision has not been affected, although I do now see halos around lights at night.

I have tried a number of preservative free artificial tears (approx 8), and although these help a little, their effectiveness is limited and short lived (<10 minutes?).
At my suggestion, my GP agreed to prescribe me Doxycycline 100mg for 2 weeks, 50mg for 4 weeks. I'm not aware of any benefit, though I only have subjective observations on this, and it may have perhaps not been long enough.

I have seen 2 ophthalmologists through the NHS:

- The first was in May, found no problems, prescribed Viscotears and indicated migraines (this has been ruled out).
- The second, last month with <NHS Ophth>. I took pictures along with me this time. I'm still trying to get a copy of the exact diagnosis, but the essential thrust was excessive meibum secretions. Treatment to consist of lid hygiene 4 times per day, and the use of PVA drops. Follow up appointment in 3-4 months.

I have felt that I have not been fully successful in impressing upon those I have seen the impact this condition has had not only on my quality of life, but more importantly it is becoming close to being job threatening. This is likely partly due to a lack of obvious significant clinical signs.

I'm currently of a mind to arrange for a private initial consultation, and as I have no medical insurance, perhaps any subsequent appointments perhaps arranged via the NHS if at all possible. I'm happy for my GP to be approached, though I am concerned that a referral to a different ophthalmologist via the NHS may be problematic as I have recently seen one and am currently "undergoing treatment". I am however keen not to spend additional months and months with no effective treatment if it can be avoided. My GP is:

<GP>

Currently, other contributory or causal factors (both occular and dermatological) such as aqueous deficiency, occular rosacea, demodex, lid apposition, Lid Wiper Epitheliopathy (LWE) etc have not been given consideration. It's my current feeling that a specialist may be able to rule some of these in or out reasonably easily.

In terms of my expectations, I appreciate infinite resources are not available to be dedicated to me, and that long term lid hygiene may be the only treatment available. I do not expect perfect health indefinitely nor I am currently concerned that my sight is at risk. However, I do seek to try to determine the root cause of my problems to a reasonable degree in order to improve my quality of life and employability, and would like to feel confident that the treatment given is the most appropriate.

I'd welcome any view you would have regarding my situation, and would like to thank you for reading my summary.

Regards

<Me>

PS Additional photos attached

Reply:

Hi <Me>,

<Ophth> says he thinks he can help you, certainly in the short term, although it sounds as if it is a chronic condition. He will probably suggest topical steroids but wouldn't be able to do this over the phone as would need to rule out herpetic eye disease (unlikely). He is more than happy to see you, unless you would like to see someone else. This sort of problem falls between eyelids (<Ophth>) and anterior segment, the local specialist in which is <specialist> who has a practice at <removed>.

<Ophth> could see you, if you wish, <appointment details>

Please could you call me on <removed> to let me know either way.

I will forward this email to <specialist> in case you wish to contact her.

Many thanks,
<Ophth Secretary>

I don't think my problems are anterior segment related (front part of eye), though I think it's good that it's been clearly stated the problem could fall between 2 specialists. The mention of herpetic eye disease is interesting - does anyone have a view on that and DES?

Not sure if a short term steroid recommendation is suitable to mention in the reply (I haven't been seen yet) - or what actual use that would really be unless I'm having flare ups that need to be controlled on a short term basis (I don't think so).

Still, I felt this was promising. If I'm boring everybody with this level of detail - just tell me, I won't take it personally

[irish eyes]

Steroids can cause problems if used long term - so yes, you do need to be careful on that one. BUT - if you can get the condition under control and get some respite from all this, then that seems OK to me.

I have had to use steroids for iritis - so now I have a cataract in my right eye. The steroids certainly addressed the iritis but didn't make any difference at all to the blepharitis. The steroids can have a high potency so you need to withdraw them gradually.


Hope this helps.