Which specialist should I be trying to see for my vision issues?
July 10, 2016 9:24 PM
For the past two weeks, I have had a blurry spot in my left eye. Whenever I look up and to the left, it looks like there's an after-image there, as if I've been staring into a light or the sun. When it first started, there was a pressure verging on pain behind my left eye, and what felt like a muscle strain every time I moved my eyeball quickly, like when I was driving and needed to check my blindspot. The pain has gone away. On the advice of an Urgent Care doctor a few days ago, I got a CT scan, which was negative. Various doctors checked my peripheral vision when I was in the ER waiting for the scan, and they told me my vision was normal. My vision is not normal, though, because I do not normally have a blurry after-image spot in my left eye. What do I need to do to pursue this?
I am newly switched to my current insurance, which is an HMO, and my assigned PCP is apparently swamped. I have a phone call into his office, and they told me they would maybe get back to me within a week to schedule an appointment. I am planning on calling my insurance's member services and making a fuss about needing to see.. who?
Any other advice very much welcome.
I am newly switched to my current insurance, which is an HMO, and my assigned PCP is apparently swamped. I have a phone call into his office, and they told me they would maybe get back to me within a week to schedule an appointment. I am planning on calling my insurance's member services and making a fuss about needing to see.. who?
Any other advice very much welcome.
Seconding ophthalmologist. What I found in all my years of trying to get eye
posted by The Underpants Monster at 9:33 PM on July 10, 2016
posted by The Underpants Monster at 9:33 PM on July 10, 2016
There are no sparkles. The after-image/blurriness is pretty stable. The urgent care MD used the equipment I associate with opthamologists/optometrists (rest you chin on a shelf, look straight ahead, MD shines a light into your eyes) and said there was no corneal damage.
posted by lazuli at 9:36 PM on July 10, 2016
posted by lazuli at 9:36 PM on July 10, 2016
Sorry, finger slipped and hit the post button way to soon.
I was saying that I found in my experience of trying to get my eyes treated in a timely manner that it helped to stress to doctors and insurance reps that I couldn't work in my current condition. Sounds like your HMO requires your PCP's referral to get you into a specialist like an opthamologist? If that's the case, it can't hurt to ask if they'll give you the referral without seeing you just this once since it's an urgent situation. The worst they can do is say no.
posted by The Underpants Monster at 9:38 PM on July 10, 2016
I was saying that I found in my experience of trying to get my eyes treated in a timely manner that it helped to stress to doctors and insurance reps that I couldn't work in my current condition. Sounds like your HMO requires your PCP's referral to get you into a specialist like an opthamologist? If that's the case, it can't hurt to ask if they'll give you the referral without seeing you just this once since it's an urgent situation. The worst they can do is say no.
posted by The Underpants Monster at 9:38 PM on July 10, 2016
Sounds like your HMO requires your PCP's referral to get you into a specialist like an ophthalmologist?
Yes, that's the issue I'm facing. I'm going to try to argue that I can't wait for the PCP referral, so the better reasoning I have for seeing a specialist, the better.
posted by lazuli at 9:43 PM on July 10, 2016
Yes, that's the issue I'm facing. I'm going to try to argue that I can't wait for the PCP referral, so the better reasoning I have for seeing a specialist, the better.
posted by lazuli at 9:43 PM on July 10, 2016
Not an eye doctor, but I don't think you can reliably check for detached retinas by shining a light in someone's eye! If so, I am owed an awful lot to make up for years of unnecessary, uncomfortable eye dilations.
If you can't get an emergency referral, I would give serious thought to planning a visit to the ER. You'll have to sit around for hours and hours but, if it is a detached retina, it could go very bad at any moment. You really shouldn't be waiting weeks to see a specialist. The emergency co-pay (and the undeniable hassle) will be worth it.
posted by praemunire at 11:10 PM on July 10, 2016
If you can't get an emergency referral, I would give serious thought to planning a visit to the ER. You'll have to sit around for hours and hours but, if it is a detached retina, it could go very bad at any moment. You really shouldn't be waiting weeks to see a specialist. The emergency co-pay (and the undeniable hassle) will be worth it.
posted by praemunire at 11:10 PM on July 10, 2016
I could be wrong, but you may be able to switch PCPs completely. Maybe you can look into that and see if you can find someone with less of a wait.
posted by bookworm4125 at 2:18 AM on July 11, 2016
posted by bookworm4125 at 2:18 AM on July 11, 2016
I had some eye thing a couple of months ago that scared me. I called my PCP and asked for a referral to an ophthalmologist who saw me the next day. She did way more than shine a light in my eyes. And she told me the symptoms of detached retina: she said it could seem like a curtain coming down over the affected eye, like a a sheet of pouring rain, like sheets of aurora borealis.
Can you get more aggressive next time you call your PCP's office? I didn't actually have to see my PCP to get a referral, in fact referrals is an option I can choose when I call her office.
posted by mareli at 3:53 AM on July 11, 2016
Can you get more aggressive next time you call your PCP's office? I didn't actually have to see my PCP to get a referral, in fact referrals is an option I can choose when I call her office.
posted by mareli at 3:53 AM on July 11, 2016
Ophthalmologist. Call your PCP this morning and talk to the nurse, not the receptionist. Tell the nurse you need a referral to [Opthamologist on your HMO] today. Do not mess about with your vision (I say this as a person with one working eye. Don't wait, be pushy.)
posted by PorcineWithMe at 3:57 AM on July 11, 2016
posted by PorcineWithMe at 3:57 AM on July 11, 2016
Ophthalmologist. When the ER is worried about my retina, they use an ultrasound and get an ophthalmology resident down. The cornea being undamaged is lovely but that's literally only the surface of your eye and its potential problems. Given that you've already been seen at urgent care, your PCP may well be comfortable providing the referral without a second appointment, so do call and ask about that as well. Or, if there's an in-network ER affiliated with a university's teaching hospital, hie there.
posted by teremala at 5:48 AM on July 11, 2016
posted by teremala at 5:48 AM on July 11, 2016
I had a similar issue and I was able to get a same day appointment with an optometrist (one in a shopping mall) who made sure it wasn't a detached retina (using dilation!) and was also able to refer me to an ophthalmologist the same week for further tests. Check to see if your insurance would accept that kind of referral.
posted by soelo at 7:07 AM on July 11, 2016
posted by soelo at 7:07 AM on July 11, 2016
There are other things that this could be besides a detached retina that are less scary but nonetheless need to be taken care of urgently. I am not trying to scare you, but you really need to go see an ophthalmologist as soon as you possibly can. Like, today or tomorrow if possible. If you call your PCP's office and ask to speak to the triage nurse, they can get you a referral to an ophthalmologist or retinologist.
posted by zoetrope at 7:45 AM on July 11, 2016
posted by zoetrope at 7:45 AM on July 11, 2016
There are arteries behind the eye that can swell and impinge on the retina, and the fact that you get this only in one eye, and then only after you move that eye in a certain way (as I am reading "Whenever I look up and to the left, it looks like there's an after-image there"), makes me think this might be happening to you.
I had this for a while, transiently, whenever I'd get a specific feeling of pressure in my head, generally triggered by exposure to solvents -- the first occurrence was in an antique store full of recently stripped furniture.
At one stage, I had trouble telling it apart from symptoms of the migraines I developed a little later; in fact, it was almost as if migraines replaced the swelling, and I've had them ever since.
My problems were much more likely to happen in the wake of hard exercise, so I think you might look at your blood pressure, but for me they were also the beginning of a long series of autoimmune disorders, and I think you should have a few standard blood tests for those too, such as a screen for anti-nuclear antibodies (ANA), and so forth.
posted by jamjam at 10:02 AM on July 11, 2016
I had this for a while, transiently, whenever I'd get a specific feeling of pressure in my head, generally triggered by exposure to solvents -- the first occurrence was in an antique store full of recently stripped furniture.
At one stage, I had trouble telling it apart from symptoms of the migraines I developed a little later; in fact, it was almost as if migraines replaced the swelling, and I've had them ever since.
My problems were much more likely to happen in the wake of hard exercise, so I think you might look at your blood pressure, but for me they were also the beginning of a long series of autoimmune disorders, and I think you should have a few standard blood tests for those too, such as a screen for anti-nuclear antibodies (ANA), and so forth.
posted by jamjam at 10:02 AM on July 11, 2016
This sounds a lot like optic neuritis, which I've experienced personally in my left eye. My peripheral vision was totally unaffected, but my central field of vision looked as though someone had smeared a bit of dirt onto it.
I also had the same sensation of pressure followed by a couple of days of pain when moving my eye. The pain got better long before my vision returned to normal (which it did, completely).
You definitely need to be seen by an ophthalmologist. If you call your HMO's customer service number, ask to be assigned to the primary care provider with the soonest available appointment, and get an appointment with that provider as soon as possible. You can always change later if you don't like them. Really, all you need from them is a referral to an ophthalmologist.
In the meantime, a quick test you can do at home is to look at something bright red with your good eye while covering up your affected eye, then do the reverse--cover up your good eye and look at it just with your affected eye. If the red looks much less brightly red to your affected eye, use the words "red desaturation" when talking to the primary care provider. Red desaturation is a common feature of ON.
The good news is that ON usually goes away on its own without treatment, so even if you'd been seen sooner, there's really nothing to be done for it except wait. The bad news is that ON is closely associated with a number of autoimmune diseases, most commonly MS, so if it does turn out to be ON, you'll likely be sent for an MRI.
posted by jesourie at 12:42 PM on July 11, 2016
I also had the same sensation of pressure followed by a couple of days of pain when moving my eye. The pain got better long before my vision returned to normal (which it did, completely).
You definitely need to be seen by an ophthalmologist. If you call your HMO's customer service number, ask to be assigned to the primary care provider with the soonest available appointment, and get an appointment with that provider as soon as possible. You can always change later if you don't like them. Really, all you need from them is a referral to an ophthalmologist.
In the meantime, a quick test you can do at home is to look at something bright red with your good eye while covering up your affected eye, then do the reverse--cover up your good eye and look at it just with your affected eye. If the red looks much less brightly red to your affected eye, use the words "red desaturation" when talking to the primary care provider. Red desaturation is a common feature of ON.
The good news is that ON usually goes away on its own without treatment, so even if you'd been seen sooner, there's really nothing to be done for it except wait. The bad news is that ON is closely associated with a number of autoimmune diseases, most commonly MS, so if it does turn out to be ON, you'll likely be sent for an MRI.
posted by jesourie at 12:42 PM on July 11, 2016
The Brigham & Women's Hospital neuro-ophthalmology page on optic neuritis has a picture that does a pretty good job of demonstrating what the vision in my left eye was like when I had ON.
posted by jesourie at 12:49 PM on July 11, 2016
posted by jesourie at 12:49 PM on July 11, 2016
Waiting at the opthamologist now. The PCP's referral coordinator was able to make the referral (though she also claimed I didn't need it for an emergency appointment, which doesn't seem likely to be true, but whatever). Thanks, all.
posted by lazuli at 1:08 PM on July 11, 2016
posted by lazuli at 1:08 PM on July 11, 2016
So glad you got what you needed. Your HMO may be different but a lot of plans do have exception for emergency appointments - however, you really don't want to be getting into an argument with the insurance company about whether something was actually an emergency if you can safely avoid it. Hope it was good news.
posted by metahawk at 3:57 PM on July 11, 2016
posted by metahawk at 3:57 PM on July 11, 2016
Optic neuritis, being sent for an MRI to rule out MS, freaking out about the possibility of MS.
posted by lazuli at 4:28 PM on July 11, 2016
posted by lazuli at 4:28 PM on July 11, 2016
So glad you pushed through and got the appointment. I will keep you in my thoughts- hoping for the best.
posted by PorcineWithMe at 7:41 PM on July 11, 2016
posted by PorcineWithMe at 7:41 PM on July 11, 2016
Best wishes to you. Hope for a negative MRI.
To add for completeness, the exam that we do in the emergency department or in an urgent care is very limited compared to an ophthalmologist's exam. Even if we use a slit lamp. Basically we can check for corneal abrasion/laceration, see any major defects in the pupil or anterior chamber exam, and and major defects in the funduscopic exam (looking through to see the inside of your eye). But without a dilated exam by an ophthalmologist there are plenty of more subtle things that won't be detected (but aren't as emergent in nature). "Your vision is normal" by emergency department standards can mean that it is 20/20 and that you have no giant visual field deficits (we usually only check for ability to see a finger or two in each of four quadrants of vision), but as you experienced there is more to a full evaluation of vision. And it is true that we use ultrasound to detect retinal detachment.
posted by treehorn+bunny at 12:30 PM on July 12, 2016
To add for completeness, the exam that we do in the emergency department or in an urgent care is very limited compared to an ophthalmologist's exam. Even if we use a slit lamp. Basically we can check for corneal abrasion/laceration, see any major defects in the pupil or anterior chamber exam, and and major defects in the funduscopic exam (looking through to see the inside of your eye). But without a dilated exam by an ophthalmologist there are plenty of more subtle things that won't be detected (but aren't as emergent in nature). "Your vision is normal" by emergency department standards can mean that it is 20/20 and that you have no giant visual field deficits (we usually only check for ability to see a finger or two in each of four quadrants of vision), but as you experienced there is more to a full evaluation of vision. And it is true that we use ultrasound to detect retinal detachment.
posted by treehorn+bunny at 12:30 PM on July 12, 2016
So, just to follow up, and in case anyone stumbles on this in the future trying to explain their own symptoms: The MRI (along with a follow-up MRI) did show that I have MS, so I've been coming to terms with that for the last few weeks.
The optic neuritis has almost completely resolved on its own. When jesourie described it as like having a smear of dirt on her central vision, that was really close to what I was experiencing, except mine looked more like a smear of vaseline, in that I could see through it, it was just blurry and doing weird things to reflections. (But I wasn't able to articulate that very well until I read her description!) And I hadn't noticed my color vision was so bad in that eye until the ophthalmology assistant showed me the tiles with which you test color-blindness, and I couldn't make out half of them with my left eye.
I met with a neurologist yesterday and she seems fairly optimistic (as much as one can be) about the MS symptoms, in that the MRI indicated that I've had it for a while but haven't really experienced symptoms, which she said means it may be fairly mild for me. She and I will discuss treatment options once she gets some lab work back.
Thank you all for pushing me to pursue this. Because they did the first MRI while I was experiencing active symptoms, it apparently made the MS diagnosis easier than it often is, which means I can start treatment right away (and avoid a spinal tap!). So, obviously not the outcome I would have wanted, but a better outcome than continuing to have weird symptoms and not having a diagnosis or treatment plan for them.
posted by lazuli at 8:53 PM on August 6, 2016
The optic neuritis has almost completely resolved on its own. When jesourie described it as like having a smear of dirt on her central vision, that was really close to what I was experiencing, except mine looked more like a smear of vaseline, in that I could see through it, it was just blurry and doing weird things to reflections. (But I wasn't able to articulate that very well until I read her description!) And I hadn't noticed my color vision was so bad in that eye until the ophthalmology assistant showed me the tiles with which you test color-blindness, and I couldn't make out half of them with my left eye.
I met with a neurologist yesterday and she seems fairly optimistic (as much as one can be) about the MS symptoms, in that the MRI indicated that I've had it for a while but haven't really experienced symptoms, which she said means it may be fairly mild for me. She and I will discuss treatment options once she gets some lab work back.
Thank you all for pushing me to pursue this. Because they did the first MRI while I was experiencing active symptoms, it apparently made the MS diagnosis easier than it often is, which means I can start treatment right away (and avoid a spinal tap!). So, obviously not the outcome I would have wanted, but a better outcome than continuing to have weird symptoms and not having a diagnosis or treatment plan for them.
posted by lazuli at 8:53 PM on August 6, 2016
Oh, lazuli, I have been wondering and thinking of you. Thank you so much for posting your (very personal) update. I'm glad you were able to reach a diagnosis quickly and I hope your journey with this illness is as easy as it can be. Best wishes.
posted by PorcineWithMe at 5:37 AM on August 7, 2016
posted by PorcineWithMe at 5:37 AM on August 7, 2016
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posted by Johnny Wallflower at 9:28 PM on July 10, 2016