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Medical Forum / Diseases and Disorders / Glaucoma / April 2005Dr. Cohn ... Seeking best opthalmologists in Dayton. Ohio area?
Dr. Cohn, I live in southwestern Ohio, near Dayton. I have been seeing an opthalmologist, but have no idea if he is really all that good. I am trying to figure out if I should I get a second Dx or just trust this guy. Obviously, this is a seriuos matter. He Dx'ed my eyes as having glaucoma. He seems to have a well equipped office. With a couple of differenct computer based Dx devices, he has mapped my eye inside and found nerve impairment and/or damaged areas. He measured my pressures as varying quite a bit from day to day, ranging from 20 to 27. His tools sseem impressive, but I wonder how reliable the results are and how can I know if an opthalmologist is a good one or not? My next appointment is Wed, 30 March. I was already taken off of travoprost (after 2 days) because of the excessive redness it caused in my eyes. I have rather bad hay fever too. How many patients end up needing some kind of surgery because the drops/drugs have too many adverse side-effects? Axel Hi Axel, Unfortunately, hard to say if your doc is a "good one" or not...to me the tools are not as important as the communication and your level of comfort. It does sound, based on your description, that you probably do have glaucoma, but without seeing your optic nerve I can't know for sure. I'm sorry I don't know anyone in Dayton, but if you are concerned, a second opinion certainly couldn't hurt. I seldom start Travatan as a first line agent because of the redness. I almost always start with its cousin, Xalatan, first as it is much better tolerated. Well fewer than 1/2 of a percent of my patients require surgery because they can't tolerate ANY of the drops out there. Even if they are allergic to the preservatives in them, there are preservative-free versions of several available. Good luck to you, Rick Cohn, MD Thanks Dr Cohn, Here is more info to go on... My opthalmologist is a DO, not an MD. He was chosen because my insurance plan at work pays for glasses through his office and other vision care companies are too far away and/or have no evening or Saturday office hours. The medical part of this is being paid for by my major med insurance plan (separate from glasses plan). Initially, a *Optomap* device made a scan which seemed to show some "cupping" of the rim of the optic nerve around the blood vessels at the back of the eye. The doc admitted that may be a birth defect since he had no previous scans to compare to. However, a visual field map showed loss of vision in some regions. After 2 doses of the Travatan the redness of the sclera was very severe, but the IOP went down. Also, Travatan seems to have had a carry-over effect even 5 days out. My IOP was back down to 18 or a bit less. My opthalmologist wants to get the numbers down more. He gave me a sample af ALPHAGAN-P (Brimonidine Tartrate Ophthalmic Solution, 0.15%; Alpha-agonist ) to use once per day for a week and then 2x daily for 3 weeks if I can tolerate it. After one dose, I am not seeing redness with the ALPHAGAN-P drops, but it does "itch" for a while after I put them in, just prior to going to sleep. Axel > Hi Axel, > Unfortunately, hard to say if your doc is a "good one" or not...to [quoted text clipped - 11 lines] > to you, > Rick Cohn, MD > Thanks Dr Cohn, > Here is more info to go on... [quoted text clipped - 5 lines] > > Axel Normally, regular medical insurance will pay for eye conditions other than routine eye exams and glasses for refractive problems. Check with your insurance - bet they'll cover a ophthalmologist or glaucoma specialist for glaucoma. Because of the glaucoma diagnosis when I get a refraction, my medical insurance will cover that - however, not glasses. No way would I see an optometrist to treat glaucoma! Sorry if I offend any optometrists monitoring the list with my comment, but that's just the way it is - glaucoma is a *medical* condition that needs a *medical* doctor and preferably a specialist, at least for proper diagnosis and to get treatment started. I'm being followed by my ophthalmologist but he refers me back to the glauc doc when necessary. I really don't think optometrists keep on top of medical conditions of eyes - some even still think glaucoma is diagnosed by elevated IOP - wrong! If I had no major problems with my eyes and only needed glasses, I'd go to an optometrist - went to one for years - and my glauc doc has an optometrist in his office for refractions after surgery. Sherry Sherry, If elevated IOP is not the criteria, then what tests should I be looking for? I need to know because there seems to be a shortage of glaucoma specialist MDs around here. I want the right tests and the right Doc. I also tested as having some loss of visual field. I noticed what seems to be progressive night blindness starting about a year or more ago,b ut thought it was just "age". My eyes hurt frequently, but I also have allergies and horrid sinus trouble. I've only had one sinus headache in my lfe. It started in 1953 and it is still going. Axel > No way would I see an optometrist to treat glaucoma! <snip> > I really don't think optometrists keep on top of medical conditions of > eyes - some even still think glaucoma is diagnosed by elevated IOP - [quoted text clipped - 5 lines] > > Sherry > Sherry, > If elevated IOP is not the criteria, then what tests should I be [quoted text clipped - 9 lines] > one sinus headache in my lfe. It started in 1953 and it is still > going. Axel Glaucoma is diagnosed based on damage to the optic nerve. Visual fields, HRT, gDX and a good dilated visual exam of the optic nerve by a glaucoma specialist are good ways of determining the presence of glaucoma. Some people have ocular hypertension - elevated IOP - and never develop glaucoma. Others have normal pressures and have glaucoma. According to http://www.retina-international.org/nightbld.htm, loss of peripheral vision can result in night blindness, however night blindness has to do with the rods and not everyone who has night blindness has glaucoma. Sherry Sherry, I do thank you for that clarification. Now, perhaps I can procede on a more reliabel track. Axel >> Sherry, >> If elevated IOP is not the criteria, then what tests should I be [quoted text clipped - 24 lines] > > Sherry |
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