Saturday, December 8, 2007

4.1 Not-so-routine exams

Preventive care is a wonderful idea. This naturally applies to eyecare as well.

A routine eye exam is supposed to be yearly or biannually depending on what your insurance policy allows. It involves a physical exam of the eyes to make sure your eye sight is still 20/20. And any deviation from the previous exams is subject to additional testing and/or referral to a specialist. This specialist then also determines if any need for more treatments. What a system!

In reality, while many do enjoy routine care, others - young or middle-aged patients - show up in an eye doctor’s office often with a myriad of chief complaints, starting from blurred vision both far and near especially when driving at night, to diabetes and high blood pressure/cholesterol that are being treated, to frequent pain, tearing and photophobia, plus family history of glaucoma and AMD. And by the way: “I also need some new contacts.” In less affluent areas, even in a developed country such as the US, this is not an unusual scenario - yes, the all-inclusive not-so-routine exams. The cause? IMHO, the managed-care maze which both the patients and the doctors often must navigate together. It is a system so inflexible as to impede providing and receiving of proper care. As as result, the patients' health problems multiply.

So what do the doctors see in addition to changes in refraction, incipient cataracts, glaucoma suspects, and background diabetic retinopathy? Well, quite a bit. An interesting list, starting from the most common to somewhat rare, is shown below:

1. Dry eye and subconjunctival hemorrhage
2. Contact lens over-wear and keratoconjunctivitis
3. Medicine-induced mydriasis in children
4. Allergic conjunctivitis
5. Early arcus senilis
6. Pterygium and non-UV pinguecula
7. Undiagnosed keratoconus
8. Herpes simplex keratitis
9. Corneal dystrophy

In addition, patients who often self-refer because of alarming visual disturbances. A few common complaints are listed below:

1. Diplopia
2. Floaters/flashes/vitreous hemorrhage
3. Visual field loss/blood vessel occlusion
4. Retinal detachment
5. Macular hole/pucker

Interesting cases deserve serious comments which I will now start to post.

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