Retinal Problems in MS1, an update

[fishmoon]

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Hi, on suggestion of azzarah, I wanted to post this thread, once again, in this ophthalmology section so that I could get better advice.

In short, in the beginning of August, I was diagnosed with bilateral lattice degeneration. The retinal specialist said that I had many atrophic holes but did not require surgery at this moment. He wanted me to follow up in 6 months. This retinal specialist finished his residency from a prestigious school in 2002.

I was not satisfied and yesterday went to another eye specialist who finished his residency in 1978 from another prestigious school. As you can see, this guy studied long time ago but I wanted to see him because I thought he has a 30+ year experience and might be better than the retinal specialist I saw earlier. Anyways, after my eye examination, he said my eyes are just fine! Till he said that I have developed posterior vitreous detachment though which explains the floaters in my eyes. So I asked him further questions about PVD. He asked me if I know about it. At this point, I told him that well Ive seen a retinal specialist before and he has diagnosed me with bilateral lattice degeneration with atrophic holes. He was shocked that he did not see any such abnormality. He further added eye drops to dilate my eyes and re-do a more close up exam.

This time he said that of course he sees very little lattice in both eyes. He said he sees something which is only 1 hole in right eye but even that is questionable if its really a hole. He however denied the previous specialists statement that I have 'multiple' atrophical holes in my right eye. He just said that he sees none except one which is also questionable.

Now of course this is good news for me. But now I am wondering that did this old specialist really miss these holes because of his age and because he studied long time ago compared to the young specialist who is fresh out of school and well-aware of how to use modern equipment?

Secondly, do I still need to tell my school of this?

 

[MstaKing10]

Why would you need to tell your school? Just curious. Not sure how to answer your other question without handing out medical advice, which this sight prohibits. Maybe someone else can. Best of luck.

 

[orbitsurgMD]

Hi, on suggestion of azzarah, I wanted to post this thread, once again, in this ophthalmology section so that I could get better advice.

In short, in the beginning of August, I was diagnosed with bilateral lattice degeneration. The retinal specialist said that I had many atrophic holes but did not require surgery at this moment. He wanted me to follow up in 6 months. This retinal specialist finished his residency from a prestigious school in 2002.

I was not satisfied and yesterday went to another eye specialist who finished his residency in 1978 from another prestigious school. As you can see, this guy studied long time ago but I wanted to see him because I thought he has a 30+ year experience and might be better than the retinal specialist I saw earlier. Anyways, after my eye examination, he said my eyes are just fine! Till he said that I have developed posterior vitreous detachment though which explains the floaters in my eyes. So I asked him further questions about PVD. He asked me if I know about it. At this point, I told him that well Ive seen a retinal specialist before and he has diagnosed me with bilateral lattice degeneration with atrophic holes. He was shocked that he did not see any such abnormality. He further added eye drops to dilate my eyes and re-do a more close up exam.

This time he said that of course he sees very little lattice in both eyes. He said he sees something which is only 1 hole in right eye but even that is questionable if its really a hole. He however denied the previous specialists statement that I have 'multiple' atrophical holes in my right eye. He just said that he sees none except one which is also questionable.

Now of course this is good news for me. But now I am wondering that did this old specialist really miss these holes because of his age and because he studied long time ago compared to the young specialist who is fresh out of school and well-aware of how to use modern equipment?

Secondly, do I still need to tell my school of this?

You got a second opinion from someone who examined your eyes and had a differing opinion than the first.

You are wondering why the first examiner claimed to see something that the second examiner did not see.

Is this a bias of succession? Are you assuming the second examiner is correct and the first one is not merely because the second examiner saw you more recently? And what was it about the first examination that led you to be not satisfied?

It seems you have a bias based on your perception of the relative prestige of a training program lending value to a medical opinion which to me seems to be irrelevant to your needs.

As the poster above said, this is not a place to get a third opinion, or any medical advice for that matter.

Why would you need to tell anything to your school? What would you tell them?

 

[fishmoon]

You got a second opinion from someone who examined your eyes and had a differing opinion than the first.

You are wondering why the first examiner claimed to see something that the second examiner did not see.

Is this a bias of succession? Are you assuming the second examiner is correct and the first one is not merely because the second examiner saw you more recently? And what was it about the first examination that led you to be not satisfied?

It seems you have a bias based on your perception of the relative prestige of a training program lending value to a medical opinion which to me seems to be irrelevant to your needs.

As the poster above said, this is not a place to get a third opinion, or any medical advice for that matter.

Why would you need to tell anything to your school? What would you tell them?

Of course no, I am not assuming that the second specialist is more correct or correct for that matter. I actually still believe that the first examiner was more accurate (its just a belief due to my paranoia) in telling me that I am doomed (because I have more than one atrophical holes).

I got the second opinion because the first examiner did not answer my questions properly, he seemed to be in a haste and I concluded that his judgment could have been made in haste as well.

Dont I have to disclose to school any health condition which might inhibit me from providing competent medical care? At least I will be taking that oath on white coat ceremony. Not that lattice inhibits me from doing anything but lattice can lead to retinal detachment and that would decrease my vision and has the potential to blind me. I have not seen any blind physicians providing care in this country on equal levels as non-blind physicians.

 

[Visionary]

Of course no, I am not assuming that the second specialist is more correct or correct for that matter. I actually still believe that the first examiner was more accurate (its just a belief due to my paranoia) in telling me that I am doomed (because I have more than one atrophical holes).

I got the second opinion because the first examiner did not answer my questions properly, he seemed to be in a haste and I concluded that his judgment could have been made in haste as well.

Dont I have to disclose to school any health condition which might inhibit me from providing competent medical care? At least I will be taking that oath on white coat ceremony. Not that lattice inhibits me from doing anything but lattice can lead to retinal detachment and that would decrease my vision and has the potential to blind me. I have not seen any blind physicians providing care in this country on equal levels as non-blind physicians.

This is by no means medical advice. It's just the facts. Risk of retinal detachment in the general population is about 1 in 10,000. Yours is slightly higher, though still low (even with round holes). You have a greater chance of dying in a car accident on the way to school. This is not a medical condition that needs to be revealed to any school or potential employer. It's not currently affecting you and may never do so.

 

[Mirror Form]

In short, in the beginning of August, I was diagnosed with bilateral lattice degeneration. The retinal specialist said that I had many atrophic holes but did not require surgery at this moment. He wanted me to follow up in 6 months. This retinal specialist finished his residency from a prestigious school in 2002.

Lattice, OMG, that's pretty rare! I think only like 10% of the population has it! Scary! Did you have seasonal allergies or dry eye syndrome too? You should probably see several cornea specialists to make sure you don't have dry eye syndrome! It's a good idea to make sure they went to prestigious schools, otherwise they might not have heard of it.

At this point, I told him that well Ive seen a retinal specialist before and he has diagnosed me with bilateral lattice degeneration with atrophic holes. He was shocked that he did not see any such abnormality. He further added eye drops to dilate my eyes and re-do a more close up exam.

LOL, this is classic. Something tells me that if he had yet to dilate your eyes, then he was not actually all that shocked he hadn't seen it

Now stop being such a hypochondriac and just follow the directions that the first physician you saw gave you.

 

[Eyefixer]

Lattice, OMG, that's pretty rare! I think only like 10% of the population has it! Scary! Did you have seasonal allergies or dry eye syndrome too? You should probably see several cornea specialists to make sure you don't have dry eye syndrome! It's a good idea to make sure they went to prestigious schools, otherwise they might not have heard of it.

LMFAO

If he gets diagnosed with blepharitis, he may need to quit!

 

[eyes44]

I think we're forgetting what it's like to be an MS1.

To the OP, don't worry about it, just be regular with your follow up exams. No need to disclose this to anyone.

 

[fishmoon]

Lattice, OMG, that's pretty rare! I think only like 10% of the population has it! Scary! Did you have seasonal allergies or dry eye syndrome too? You should probably see several cornea specialists to make sure you don't have dry eye syndrome! It's a good idea to make sure they went to prestigious schools, otherwise they might not have heard of it.



LOL, this is classic. Something tells me that if he had yet to dilate your eyes, then he was not actually all that shocked he hadn't seen it

Now stop being such a hypochondriac and just follow the directions that the first physician you saw gave you.

Well I do appreciate your humorous take on it as you see how I am taking things but it does not feel funny to be in this position.

Yes, he dilated my eyes when he did the first exam. But he only added 1 drop to each eye. I think it was 1% solution from the number I could see on the bottle? For the second exam when I told him about previous diagnosis, he added 3-4 drops. I hope its not "classic" anymore?

 

[Meibomian SxN]

Well I do appreciate your humorous take on it as you see how I am taking things but it does not feel funny to be in this position.

Yes, he dilated my eyes when he did the first exam. But he only added 1 drop to each eye. I think it was 1% solution from the number I could see on the bottle? For the second exam when I told him about previous diagnosis, he added 3-4 drops. I hope its not "classic" anymore?

Sometimes even on a dilated exam it is difficult to get clear views of the far periphery of the eye. In school we used to have competitions as to who could see all the way out to the ora serrata portion of the retina, even glimpses of the ciliary body on rare occasions!

It seems neither retina doctor declared your pathology as an emergency, so as was already stated its best you follow their advice with a DFE every 6 months.

My question to you is:

1) How was the PVD in your eyes diagnosed? Were scans performed on your eye or was it through observation through the slit lamp?

 

[FutureCTDoc]

Most RDs can be prepared and if the floaters are an issue that affects daily life there are options to deal with it. Get another consult. If I knew where you were I could probably suggest a surgeon.

 

[fishmoon]

Sometimes even on a dilated exam it is difficult to get clear views of the far periphery of the eye. In school we used to have competitions as to who could see all the way out to the ora serrata portion of the retina, even glimpses of the ciliary body on rare occasions!

It seems neither retina doctor declared your pathology as an emergency, so as was already stated its best you follow their advice with a DFE every 6 months.

My question to you is:

1) How was the PVD in your eyes diagnosed? Were scans performed on your eye or was it through observation through the slit lamp?

He first only used indirect ophthalmoscope to look into my eyes. After that he told me my eyes are fine and that my floaters are due to PVD. I asked him if my eyes have already undergone PVD or they are in the process. He said they have undergone it. Now I dont know if he can use indirect ophthalmoscope to diagnose PVD.

At this point I told him of lattice to which he was shocked. He then decided to add few more drops to my eye and then used slit lamp on my right eye. The one where you put your chin and forehead into the instrument.

In slit lamp he saw my lattice and the "questionable" hole.

 

[odieoh]

He first only used indirect ophthalmoscope to look into my eyes. After that he told me my eyes are fine and that my floaters are due to PVD. I asked him if my eyes have already undergone PVD or they are in the process. He said they have undergone it. Now I dont know if he can use indirect ophthalmoscope to diagnose PVD.

At this point I told him of lattice to which he was shocked. He then decided to add few more drops to my eye and then used slit lamp on my right eye. The one where you put your chin and forehead into the instrument.

In slit lamp he saw my lattice and the "questionable" hole.

You can see a PVD with the indirect, I think its a lot easier at the slit lamp however.

I think you have yourself very worked up over something which, yes, has potential to cause impairment, but is still very common and usually does not, especially if you are educated about the signs/symptoms of detachment.

Definitely don't need to "disclose" anything to the school, doing so would be akin to disclosing that you sometimes eat cheeseburgers which could lead to heart disease and stroke which then could affect your patient care.

 

[azzarah]

Honey, go back and read my original advice.