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Medical Forum / General / Vision / December 2005Finding a retinal surgeon
I was diagnosed with a macular pucker in my right eye, and my ophthalmologist referred me to a retinal specialist. Unfortunately, my initial consultation with this doctor was very unsatisfactory for me. I found him extremely uncommunicative, and his religious references made me very uncomfortable. I do not intend to see him again. As a medical "outsider" (with good insurance coverage but no primary care doctor), how can I locate the best retinal surgeon in my area? Are the listings of "best" doctors by Castle Connolly and Consumers Guide reliable? Is membership in professional groups (e.g., the Vitreous Society) important? If I were to schedule an appointment with a doctor at a teaching hospital, would residents also participate in my treatment? Any help/advice with this problem would be appreciated. If you are located near a teaching hospital, the care is first rate. Don't be fearful of residents being involved in your care. Their enthusiasm is contagious and they are practicing with direct supervision in a team approach. When you consider that a retinologist is the product of 12 years of education followed by 4 years of undergrad followed by 4 years of medical school followed by a two year ophthalmology residency followed by a two year retinology fellowship or residency..........Need I say more? These are the best and the brightest that most schools have to offer. go back to your ophthalmologist, tell them what you said here and ask for another referral to another retinal specialist. It is not just how good they are, it is how they treat you. When I write a referral, I do so to a doc who will treat my patient the way I would like to be treated. grant > I was diagnosed with a macular pucker in my right eye, and my > ophthalmologist referred me to a retinal specialist. Unfortunately, my [quoted text clipped - 8 lines] > at a teaching hospital, would residents also participate in my > treatment? Any help/advice with this problem would be appreciated. I also have an epiretinal membrane. I am waiting for FDA approval and distribution of the Glasser "rake" before undergoing the removal of the membrance. http://www.bmgnri.com/newsrake.htm If you live near Dallas, TX, the Texas Retina Associates have a very good reputation. > I also have an epiretinal membrane. > I am waiting for FDA approval and distribution of the Glasser "rake" > before undergoing the removal of the membrance. > http://www.bmgnri.com/newsrake.htm > If you live near Dallas, TX, the Texas Retina Associates have a very > good reputation. I really appreciate your input. My online research found no outcome studies of the Glaser "rake" vs. more traditional surgical instruments. (Do any exist?) I'd rather not be a surgeon's first experience with a new instrument. The biggest innovation in treatment that I found involves "nonvictrectomizing vitreous surgery" (i.e., peeling the epiretinal membrane without performing the vitrectomy). Post-surgery vision is reported to be excellent (average=20/25) with this method, with no increase in the rate of cataract development. http://www.revopth.com/index.asp?page=1_225.htm Unfortunately, the studies I found on pubmed indicated that the membrane grew back in about 33% of the patients (a much higher rate than with traditional surgery.) The rate of retinal detachment (the worst case scenario) from traditional macular pucker surgery varies from 2 percent to more than 10 percent, depending on the study. I suspect that the surgeon's skill has a lot to do with this. For lack of a better method, I ended up using Castle Connolly's guide (which relies exclusively on ratings from other doctors) in choosing a surgeon. Their guide yielded the names/education/training of ten retinal specialists in my area (Chicago) who are reported to be the "best." I have an appointment next month with a doctor at a major teaching hospital. His credentials seem awesome, but the participation of residents/interns in any future surgery would be a deal-breaker. I have been told that is is common place for the membrane to tear apart during the removal procedure. One doctor described it as trying to peel a wet tissue paper off a wall. One of the instruments currently used looks like a rake. I would rather try the Glasser rake than use current instruments which are not all that great (the membrane still tears using the current instruments). I talked with a friend who had detached retina sugery over 14 years ago. No problems with the removal of the vitreous except the cataract which occurred less than a year later. He is corrected to 20/20 and holds a Class 1 FAA physical. You might ask several "front eye" doctors who they would use for retina surgery on their own eye? I would be VERY specific about no one performing the surgery except the teaching doctor. No resident or fellow to touch any you or any of the intra-eye surgical instruments. Go to a reputable optometrist in your area and ask him (her) who they would go to. OPtometrists have the benefit of not being in "the system" and will refer to whoever is best, that's certainly my approach. Along with that, I also consider who is going to look after my patients, and that means emotionally as well as medically.\ dr grant |
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