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#1
Old 02-01-2013, 02:15 AM
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Optometrist vs Opthamologist for a specific issue

I have no medical insurance and not much money at the moment. The county here lets you use their medical system to a limited degree at a heavy discount - so basically I can see a GP, get some basic prescriptions, and get basic labwork done. Anything that requires a specialist is on my own.

I've been having an issue with my right eye. You know how when you rub your eyes, it can take a few seconds to clear again? Well, my right eye now takes upwards of 30-60 seconds to clear after that. And in general, it seems that the acuity is down - my right eye used to be my better eye, and now it isn't.

Anyway, I mentioned this to my GP, and he asked me when the last time I had an eye pressure test was. It was about a year and a half ago, during a thorough optometry exam/prescription update. Then he asked me if I'd experienced any bright spots in my vision - and I do have a dark circle with a bright spot in the center in the outside corner of both eyes in certain circumstances like if I'm leaning forward or if you apply even very light pressure of the eye.

So we talked about my inability to get a specialist referral, and financial situation, and he told me just to go see an optometrist at walmart for cheap. But we got sidetracked in a conversation about something and I moved onto the next item on my list of concerns for the visit. It seemed like he knew what he thought my condition was, but I somehow managed not to ask him what he was thinking.

So two questions. Does anyone know what it was that he was getting at with his questions? He seemed to clearly suspect something. I'm 31, by the way, so from what I understand glacoma isn't terribly likely.

And two - could I trust an optometrist to diagnose whatever it is he was getting at? He seemed to think so, but I wonder if it's a serious condition if I'd just be referred by the optometrist for an opthamologist anyway. The obvious advantage to the optometrist of course is cost - I can get a detailed exam at my regular guy for about $100. I don't know what an opthamologist would cost. Of course, this is for just the exam - if it turns out I have some serious condition, I may just be fucked.

What does a new patient exam for an opthamologist cost? Any chance they might have some sort of low income/no insurance patience some sort of sliding scale fee?

Actually, 3 questions - are we at the stage of the ACA where if I do discover I have a condition, and I manage to find a decent job with insurance in the near future, would I still be disqualified from that insurance due to a pre-existing condition? Do I actually want to avoid getting diagnosed?
#2
Old 02-01-2013, 02:23 AM
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The first thing I noticed about my cataracts was that the vision didn't clear up so quickly after rubbing my eyes. But the circles and spots are a mystery.

Call the guy, or email him. Or talk to his nurse.
#3
Old 02-01-2013, 02:59 AM
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Optometrists check for glaucoma in routine eye exams - it's that test where they shoot a puff of air at your eyeball. A friend had to be treated for early stage glaucoma at age 41. Ray Charles went blind from it as a child. Just because it's uncommon at your age doesn't mean it can't happen.

My eye exam with an optometrist at Walmart cost about $70 this year, I think, but it included an eyeglasses prescription. It seemed very thorough, and included the glaucoma test. I don't know about ophthalmologist costs.

Last edited by needscoffee; 02-01-2013 at 03:02 AM.
#4
Old 02-01-2013, 03:16 AM
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The appearance of bright spots or dark spots in the visual field is diagnostic of many disorders, but your GP was clearly thinking of glaucoma. An optometrist can diagnose glaucoma and, in some states and under certain circumstances, treat it also (though I don't think I'd go to Wal-Mart for that).
#5
Old 02-01-2013, 04:06 AM
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I recently had a Walmart eye exam. They do a puff test for glaucoma. The actual optometrist does even not do that. There's a tech who walks you thought the vision testing machines prior to the actual prescription exam, that's where the puff test occurs. There's a good chance the opthamologist would have an assistant or tech doing that also.

It's an interesting question. The Walmart tech had been there for 10 years and had probably done many, many thousands of exams. Would I trust him more or the average nurse in an Ophthalmologist's office given he probably has far more experience testing people? Not sure I'd given the opthamologist office personnel the edge there.
#6
Old 02-01-2013, 04:10 AM
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Originally Posted by astro View Post
I recently had a Walmart eye exam. They do a puff test for glaucoma. The actual optometrist does even not do that. There's a tech who walks you thought the vision testing machines prior to the actual prescription exam, that's where the puff test occurs. There's a good chance the opthamologist would have an assistant or tech doing that also.

It's an interesting question. The Walmart tech had been there for 10 years and had probably done many, many thousands of exams. Would I trust him more or the average nurse in an Ophthalmologist's office given he probably has far more experience testing people? Not sure I'd given the opthamologist office personnel the edge there.
True, but if I didn't know what the problem was, I'd be concerned about Dr. Walmart missing something that might be more rare. Of course, the odds of that are low, pretty much by definition.
#7
Old 02-01-2013, 04:08 AM
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Would the likeliness of diagnosis significantly increase for an opthamologist, though? I assume they're generally more qualified pretty much across the board to diagnose occular diseases. But if they cost 3-4x as much for a normal exam, it'll be a while before I can afford it.
#8
Old 02-01-2013, 04:22 AM
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Originally Posted by SenorBeef View Post
Would the likeliness of diagnosis significantly increase for an opthamologist, though? I assume they're generally more qualified pretty much across the board to diagnose occular diseases. But if they cost 3-4x as much for a normal exam, it'll be a while before I can afford it.
I don't think there is a general answer for this. except to say that the more common the problem is (like cataracts or glaucoma), the more likely it is to be picked up in a routine exam. But you do have some very specific issues which you can ask about, which should give you substantially better odds of a successful diagnosis.

But seriously, call your doctor back.
#9
Old 02-01-2013, 04:46 AM
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Quote:
Originally Posted by SenorBeef View Post
Would the likeliness of diagnosis significantly increase for an opthamologist, though? I assume they're generally more qualified pretty much across the board to diagnose occular diseases. But if they cost 3-4x as much for a normal exam, it'll be a while before I can afford it.
An opthamologist has a medical degree, and an optometrist doesn't, but is still qualified to diagnose and treat many eye problems. Since your GP suggested an optometrist, I'd go see one. It might be that your GP has a good general idea of what your problem is, but doesn't have the equipment to test for it.
#10
Old 02-01-2013, 07:13 AM
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Glaucoma (or the early stage, elevated intraocular pressure) is kind of hard to miss. Either your pressure is elevated (or borderline) or it isn't, and there are a few different tests one can do to check it. They're more or less the same - either a puff of air, a blue light sensor, or a handheld device that looks like one of those in-ear thermometers.

Similarly, cataract is also easy to diagnose; it just requires an exam and looking to see whether or not your lens is getting cloudy.

If those aren't the issue, however, you may want to see an ophthalmologist.

Last edited by Ferret Herder; 02-01-2013 at 07:13 AM.
#11
Old 02-01-2013, 07:19 AM
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Oh, as to cost - that really depends, especially on how detailed the exam turns out to be, and new patient exams are typically more than established patient exams. Then if they need to do any kind of imaging, it can really get expensive. If you see an ophthalmologist at a non-profit hospital/medical center, they should have some provisions for sliding scale, charity care, that kind of thing. Each place is different as to the qualifications and details. You could ask about that before actually making the appointment and see what they say.
#12
Old 02-01-2013, 04:26 PM
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Quote:
Originally Posted by Lynn Bodoni
An opthamologist has a medical degree, and an optometrist doesn't, but is still qualified to diagnose and treat many eye problems. Since your GP suggested an optometrist, I'd go see one. It might be that your GP has a good general idea of what your problem is, but doesn't have the equipment to test for it.
Emphasis is mine.

I agree with Lynn Bodoni's post and second her advice. Just wanted to note that I have been to optometrists who were immigrants to the USA. They were licensed and practicing ophthalmologists in their home country and were working as optometrists until they passed their (US-state) medical license exams. So, while they may not have had the equipment (or legal permission) to treat advanced/complicated eye conditions, they sure could recognize them. If you choose to see an optometrist as a cost-saving measure, I recommend you seek out a recently immigrated doctor of ophthalmology. Best of luck!
#13
Old 02-01-2013, 08:42 AM
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I'd hope an optomotrist would reckonize if a problem was outside his league, and if so refer you on.
#14
Old 02-01-2013, 10:21 AM
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Probably a biased response, but...

Glaucoma is jumping the gun just a bit here. "More time to focus" could be any number of things including dry eye or simply the onset of presbyopia. Either way you need an eye exam, as you know. And as an optometrist who treats glaucoma, regularly diagnoses cataracts, as well as all sorts of other ocular diseases, I do think you'd be perfectly well off going to see an optometrist.

If you are concerned that the doc at Walmart (or wherever) isn't going to be able to diagnose something, just call up a few doctors in the area and ask them if they have glaucoma imaging equipment (visual fields, GDx, OCT etc.) People who regularly work with patients with ocular disease should have these in office because it's standard of care nowadays. So that's an easy way to tell, rather than simply looking at the degree after the doctor's name. Nonetheless I would imagine the exams at one of these medically-oriented practices would be pricier than an exam at Walmart Optical.
#15
Old 02-01-2013, 02:32 PM
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Forgot to ask. If the optometrist can figure out what it is, and it's treatable by something like eye drops or some other medication, are they allowed to prescribe it?
#16
Old 02-01-2013, 03:03 PM
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Quote:
Originally Posted by SenorBeef View Post
Forgot to ask. If the optometrist can figure out what it is, and it's treatable by something like eye drops or some other medication, are they allowed to prescribe it?
According to this site, yes. There may be some limitations on what they can prescribe, though. For instance, if your visual issues are a symptom of some problem elsewhere in your body, they may not be able to prescribe something for that. I would guess the limits on their prescribing powers are determined by individual states through agencies or licensing boards.
#17
Old 02-02-2013, 10:28 PM
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If I were to go see an optometrist I saw a year or two back, would we have kept data on me like actual visual acuity results, pressure test results, notes about what he saw in the dilated pupil exam, etc?
#18
Old 02-03-2013, 07:57 PM
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Originally Posted by SenorBeef View Post
If I were to go see an optometrist I saw a year or two back, would we have kept data on me like actual visual acuity results, pressure test results, notes about what he saw in the dilated pupil exam, etc?

Sure, I don't see why not.

FWIW at work (IANAD) I've seen 20 somethings with BAD glaucoma (I'm talking IOP's in the 60s -- yes, 60s, as in, eyeballs damn near exploding). It tends to hit older people of course, but being young definitely doesn't exempt you. Are you diabetic?
#19
Old 02-02-2013, 11:46 PM
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The not clearing thing was something that I noticed with my eyes a while back. It turned out I had pellucid marginal degeneration, but the optometrist couldn't tell me that. They could just tell me that something was wrong, and that they couldn't correct me to 20/20. So it really depends.
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