my recent optometrist appointment

[poppy]

Justified neuro-ophth investigations (ultrasound, OCT, MRI) by papilloedema on optic nerve heads + persistent headache pain + confusion + transient visual disturbances (camera-shutter, peripheral wavering). They could see the optic nerve heads without dilation, esp with the handheld lens thingy that opens up more of the view of the retina (this is what they do paediatric sometimes). Maybe they're not keen to put dilation drops on your sore surface cos they normally bung 'em in first job without asking, preservatives and all.

Thanks for your reply LM.

Hmm, sounds like I might have to pull the final trick out of my hat and try to get ultrasound or OCT by mentioning my own bizzare visual disturbances. Haven't mentioned them to any eye doc up until now since I'm sure they are not an eye problem among other reasons, but if it gets the eye docs to investigate my problems might be worthwhile. I've had a brain MRI for visual disturbances (it was fine) but don't know if that would show up anything wrong in the eyes. OCT is something that I think can be done by an optom so might be easier to get. Optom just finally examined me with the hand held thingy you mention, this has never been done by anyone before. I like to think they are thinking of me by not using dilating drops, but somehow I don't think my comfort is a high priority for most of them

What were the visual fields like?

Optom was fully booked, have to wait a few weeks for this.

[littlemermaid]

And I hope you meet up with a decent corneal specialist who specializes in dry eye disease. I have just found a really good one in the U.S.

Just to get perspective on this for anyone medical tuning in. Mgshutterbug has been through 7 rings of hell to find this, and that's just for the eye surface. And that's in a part of the US with several regional eye hospitals. How many docs so far Mgshutterbug and how long's it been? Credit to Dr EA's drive to build service and knowledge and train staff.

I'm sure they are not an eye problem

Hmm, seek and ye shall find, Poppy. They can diagnose all sorts from the optic nerve, retina, blood vessels eg see a working artery pulsing away and a nerve head. If there's vision problems, you need an ophth to monitor to check it's not damaging even if you think it's migraine (some examples I know about to cheer you up: blocked artery behind retina, raised blood pressure and vascular conditions, cerebrospinal fluid hypertension). It's so cool. Like an early warning system.

So I'm thinking maybe get back in there and see if they've employed anyone decent recently like a bright young thing on rota from Sydney. I understand they expect us to re-present - my doctor-slang app tells me it's called 'bounce-back'.

pull the final trick out of my hat and try to get ultrasound or OCT by mentioning my own bizzare visual disturbances

Good plan.

brain MRI for visual disturbances (it was fine) but don't know if that would show up anything wrong in the eyes

Depends who's looking at it. If it's a radiologist thinking 'there's no unusual mass' and signing you off, then no. But if someone's measuring optic nerve swelling at retina and back, looking at fluids round back of eye, chiasm, cerebellum, then your neuro-ophthalmologist'd be wanting OCT or ultrasound as well (as if I have the first clue what I'm talking about).

If they're slacking in the optometrist part of the Eye Clinic, maybe try 'I've got vision problems and I'm here for scans to find out whether intervention is needed' and enjoy watching 'em jump (implies The Boss surgeon is waiting for imaging).

If it helps negotiate the Eye Clinic: if anyone says 'what's wrong with you?' or 'what are you here for?', these days I'm answering 'I don't know, I'm not medical' or 'oh, I'm hoping you'll tell me... don't you have my notes?' or 'there's something wrong with my eyes' (good GP tip). No preconceptions on diagnosis, they do the work, we ask useful questions.

Any chance of getting visual fields at the hospital Eye Clinic? Best place for CT as well. Even if an optom had it, would they know what they were looking at? In UK we occasionally go to high street 'dry eye' optoms for eg retinal photos + vision checks + surface exam - and they have not recognised eg MG bleph, optic nerve head papilloedema (quite marked), punctate keratitis.

Do you qualify for ongoing optometrist monitoring in the Eye Clinic or do you need GP re-referral? Maybe see what their 'referral pathway priority' criteria are for eg macular degeneration or glaucoma, and say you suspect that. http://www.allaboutvision.com/..amsler-grid Do you think you can get some kind hospital optometrists on your side with regular follow-up, some of them are good at supporting people ongoing.

[mgshutterbug]

Just to update: Poppy I do hope you keep trying to get an appt with a decent ophthalmologist. That's all we can do. The alternative is not so good for preservation of whatever eyesight we have at the moment. That being said, the doc whom I thought was an ophthalmologist - is not. Just found out. She's an OD. I found out because my bandage contact lens (BCL) fell out on Saturday, and I woke up w/erosion on Sunday despite having applied ointment twice during the night. I went in to Wilmer for an emergency appt. and was met by a corneal specialist, who really was one. He's the one who told me what kind of doctor my new one was. Upon examination, he also told me that I now have microcysts on cornea, and unless I got corneal debridement, I'd have nothing but endless erosions now. How's that for a shock? From reading literature (with eye w/macular hole, no small feat) available, I discovered that microcysts form from wearing BCL or soft lenses 24/7 for as little as 2 weeks due to corneal hypoxia (cornea not getting oxygenation). I've worn my BCL for 5 weeks 24/7. So now I don't know what to do. He did say that when a person has neuropathic pain, there is not always good progress in healing. He said most of the time, it succeeds. That doesn't sound very reassuring to me. I don't know what the heck to do at this point.

But I would say that you have to be vigilant to even make sure you know who is treating you. I feel like a fool right now. A hurting fool.