Specialty Area: Ophthalmology

Description of Specialty: Ophthalmology is the field of medicine specializing in the diagnosis and treatment of disorders of the eyes and visual system.

1. Diagnosis: Refractive Error/Eye Glasses

Questions that should be asked:

  1. For anyone: Should I expect these new glasses to correct all my symptoms?
  2. What problems might remain?
  3. Should I expect any difficulties adjusting to these glasses?
  4. How can I minimize those difficulties?
  5. How do I know if the glasses have been made correctly?
  6. Do I need to wear the glasses all the time?
  7. If the patient is a child: Will wearing glasses make my child's eyes better?
  8. Will wearing glasses make my child's eyes worse?
  9. What kind of frames should I get for my child?
  10. How do I know they fit properly?
  11. What lens material is best for my child?
  12. When should my child wear these glasses?
  13. Do you have a suggestion for a place to get glasses for children?
  14. You say my child is farsighted, but you aren't prescribing glasses. Why not?

2. Diagnosis: Presbyopia/Reading Problems

Questions that should be asked:

  1. I used to read fine. Why am I having trouble now?
  2. Should I get bifocals or separate glasses for reading?
  3. Will these glasses be good for (whatever activity is important to me in everyday life)?
  4. How does the invisible bifocal (progressive bifocal) differ from the bifocal with the line?
  5. Which would be better for me?

3. Diagnosis: Glaucoma

Questions that should be asked:

  1. Any time: Do I have open angle or narrow angle glaucoma?
  2. What is the difference?
  3. What causes glaucoma?
  4. How does glaucoma damage sight?
  5. Am I going to lose my sight?
  6. How do I know if treatment is working?
  7. I understand the eye pressure should be kept below a certain level -What is the target pressure for me?
  8. Is this hereditary?
  9. Are my children at risk for glaucoma?
  10. At what age should they be checked?
  11. Do I need to limit my physical activities?
  12. If eye drops are prescribed: What is the best way to instill eye drops?
  13. How long will I need to take eye drops?
  14. Will they cure my glaucoma?
  15. Are there generics of these drops, and are they alright to use?
  16. Are there any medications, over-the-counter or prescription, which I should avoid taking?
  17. Should I expect any side effects from the eye drops which you prescribe?
  18. Should I tell my internist that I am taking these eye drops?
  19. Should I take the eye drops the day I come for my next appointment?
  20. If surgery is recommended: Why do you feel surgery is necessary?
  21. What other alternatives might there be?
  22. How does the operation lower the pressure in my eye?
  23. What are the risks of doing the operation?
  24. How long will I be limited in my activities after the surgery?
  25. Will I need help after the surgery?
  26. Will I still need glaucoma eye drops after the surgery?
  27. If the doctor says you have narrow angles: What does narrow angle mean?
  28. What are the symptoms of angle closure glaucoma?
  29. If I think I might be having an attack of angle closure, how soon should I contact the doctor?
  30. How would I contact the doctor if the office is closed?
  31. Do I need medicine for this problem?
  32. Do I need a laser operation for this problem? (If laser is recommended, ask how laser works for this problem.)

4. Diagnosis: Cataract

Questions that should be asked:

  1. What is a cataract?
  2. What causes cataracts?
  3. What is my vision now?
  4. Can you improve my vision by changing my glasses, without performing cataract surgery?
  5. If so, how long will I be able to see well with the new glasses?
  6. Why do I have more trouble seeing in bright sunlight or when headlights hit my eyes?
  7. (if these apply to you) Should I be driving?
  8. How will I know when it is time to have cataract surgery?
  9. Is there anything wrong with my eyes which might keep me from seeing well after cataract surgery?
  10. What are the risks and complications associated with cataract surgery?
  11. How long will I be limited after my cataract surgery?
  12. Will I need help after the surgery?
  13. Will I need to use eye drops after my operation?
  14. Will I need glasses after I heal from the cataract surgery?
  15. When will I get them?

5. Diagnosis: Macular Degeneration

Questions that should be asked:

  1. What is the macula?
  2. Do I have dry macular degeneration or wet macular degeneration?
  3. What is the difference?
  4. Will I go blind?
  5. Are there glasses which will help me to read?
  6. Are there glasses which will help me see to drive?
  7. Is there any magnifier which would make it possible for me to read?
  8. How difficult is it to use that magnifier?
  9. What can be done to keep my sight from getting worse?
  10. Should I be taking antioxidants?
  11. What is the likelihood surgery will make me see better?
  12. What are the risks that surgery will make my vision worse?
  13. How long will it take for me to recover after the surgery?
  14. Are my children likely to develop macular degeneration?
  15. Are there any limitations on my activities?
  16. . Can I drive?

6. Diagnosis: Blepharitis/Chalazion/Eyelid Infection

Questions that should be asked:

  1. Is this infection contagious?
  2. How can I eliminate the redness from my eyelid?
  3. How long should I expect this problem to last?
  4. Are there any side effects or risks from the treatment you suggest?
  5. What problems might occur that I should call you and report?
  6. How can I keep this problem from recurring?
  7. Can I wear makeup?
  8. Should I discard my present makeup?
  9. Is this problem from allergy?
  10. Can this problem affect my eyesight permanently?
  11. .If I have a lump in my eyelid, does the lump need surgery and could it be cancer

? 7. Diagnosis: Conjunctivitis/"Pinkeye"

Questions that should be asked:

  1. What is the difference between conjunctivitis and pinkeye?
  2. Am I contagious?
  3. How can I avoid spreading this infection to others? How will I know when I am no longer contagious?
  4. Can I go to work?
  5. How can I get rid of this infection?
  6. How long should I expect this infection to last?
  7. What is the best way to instill eye drops? 
  8. Is there any risk of side effects from the eye drops you have prescribed?
  9. How will I know I am having a side effect from the eye drop?
  10. What will happen if I don't use the eye drops you have prescribed?
  11. Will this infection harm my vision?

8. Diagnosis: Iritis/Uveitis

Questions that should be asked:

  1. If my eye is not infected, why is it red?
  2. What is the difference between inflammation and infection?
  3. What is causing my eye to be inflamed?
  4. Do I need to have my internist test for disease elsewhere in my body which might be causing my eye problem?
  5. Will I lose the vision in my eye?
  6. How can the inflammation be controlled?
  7. Can it come back again, after this episode is resolved?
  8. Is there a best way to instill the eye drops which you prescribe?
  9. Are there any side effects from the medicine you are prescribing?
  10. .What would happen if I don't take the medicine?
  11. .How soon will my eye be feeling better and my vision get better?
  12. .Can I work while I am treating this problem?

9. Diagnosis: Floaters/Light Flashes

Questions that should be asked:

  1. What is a floater?
  2. Why do I see light flashes?
  3. Will the floaters and light flashes go away?
  4. How soon?
  5. Are there any limitations on my activities?
  6. For how long ? Will this lead to retinal detachment?
  7. Do I have a retinal hole or tear now?
  8. Are there any symptoms which would indicate that I should return for another retina examination before the next scheduled appointment?

10. Diagnosis: Retinal Detachment

Questions that should be asked:

  1. What is the retina and what does detachment mean?
  2. How can the detachment be repaired?
  3. If my vision is poor in the eye and I need surgery, will I see after the operation?
  4. How long will it take for my vision to get better?
  5. If my vision is good in the eye, why do you need to operate?
  6. What will happen if you don't operate?
  7. How long will I be limited after my surgery?
  8. Will I need help after the operation?
  9. How long must I stay off work? Will my other eye get a detached retina?
  10. If you do not specialize in retina work, should I see a retina specialist?

11. Diagnosis: Dry Eye

Questions that should be asked:

  1. Why are my eyes dry?
  2. Is there a disease causing my eyes to be dry?
  3. Will my eyes always be dry?
  4. What can I do to make my eyes feel better?
  5. Will I need to use artificial tears forever?
  6. Should I use artificial tears with or without preservatives?
  7. Will an eye ointment help?
  8. How do I use it?
  9. Is there any medicine which can make me produce more tears so I don't need artificial tears?
  10. Are there any medications, over-the-counter or prescription, which might make my dry eye problem worse?
  11. What is punctal occlusion?
  12. Do I need that?
  13. Should I tell my internist that I have dry eyes?

12. Diagnosis: Epiphora/Watery Eye

Questions that should be asked:

  1. If the patient is an infant: Why is my child's eye watery and full of mucus so often?
  2. Can you explain for me how tears are supposed to drain from the eye?
  3. What does probing do?
  4. How likely is it to resolve my child's problem?
  5. How long should I wait before having probing done on my child?
  6. What are the risks of probing?
  7. What will happen if my child's tear duct is not probed?
  8. Do you do probing in your office or in an operating room?
  9. Why do you chose that location?
  10. If the probing does not eliminate the tearing, what is the next step?
  11. If the patient is an adult: Can you explain for me how tears are supposed to drain from the eye?
  12. Is my tearing problem from making too much tears, from weak blinking, from blockage of eyelid tear drainage channels, or from blockage of the tear duct?
  13. What can be done about that problem?
  14. Can you prescribe something to make me produce less tears to reduce the watering of my eye?
  15. What will happen if I don't do anything more about this problem?
  16. If surgery is recommended: Explain how the surgery will help me.
  17. What are the risks of the operation you are proposing?
  18. Will there be a scar?
  19. How will I be limited after the operation, and for how long?
  20. Will I need help after the surgery?
  21. Is this an operation you do frequently?

13. Diagnosis: Strabismus/"Crossed Eyes"

Questions that should be asked:

  1. If the patient is a child: Why are my child's eyes misaligned?
  2. Is the problem in the eye muscles or in the brain?
  3. Will glasses help straighten my child's eyes?
  4. Is my child's eyesight impaired?
  5. Does my child see double?
  6. How does the misalignment of my child's eye affect his/her life?
  7. Will he/she be able to read, learn, play sports, drive a car, and work like other people?
  8. Can my child's eyes be straightened without surgery?
  9. Will prisms help?
  10. What are they?
  11. If the patient is an adult: Why am I seeing double?
  12. Why are my eyes out of line?
  13. Is the problem in the eye muscles or in the brain's control of the eye muscles?
  14. Will I get better if I don't do anything?
  15. Do I need prism?
  16. How would that help me?
  17. If surgery is recommended: How will this operation help me/my child in everyday life?
  18. What is the success rate for straightening eyes with surgery?
  19. What do you do to the eye muscles in surgery?
  20. How do you get to the muscles?
  21. What are the risks of strabismus surgery?
  22. Will I/my child need glasses or patching after the operation?
  23. Is this an operation that you do frequently?
  24. What limitations are there after surgery?
  25. How soon after surgery will I/my child be able to resume normal activities, such as work, driving, school, and sports?

14. Diagnosis: Amblyopia/"Lazy Eye"

Questions that should be asked:

  1. I thought "lazy eye" meant crossed eye. What do you mean by "lazy eye"?
  2. My child's eyes look normal. Why can't he/she see normally?
  3. How will Amblyopia affect my child's everyday life?
  4. Will he/she be able to read, learn, play sports, drive a car, and work like other people?
  5. Why can't glasses correct my child's vision?
  6. Can Amblyopia be treated?
  7. How? How can I make my child leave the patch on his/her eye?
  8. Can I put the patch on my child's glasses, instead of on the skin?
  9. Must the patching be done continuously, or can I break up the time in several sessions in a day?
  10. Must I patch every day?
  11. What can I do about the skin rash my child gets from the patch?
  12. If the child's eyes are crossed, can you straighten my child's eyes with glasses or surgery, will the Amblyopia disappear, and his/her vision become normal?

15. Diagnosis: Diabetes

Questions that should be asked:

  1. How can diabetes harm my sight?
  2. What is neovascularization?
  3. Do I have neovascularization?
  4. What is clinically significant macular edema?
  5. Do I have that problem?
  6. How long does it take for diabetes to damage my eyes?
  7. Will I lose my sight?
  8. Does keeping my blood sugar controlled protect my eyes from damage?
  9. What is a flourescein angiogram, and why would you want me to have that test?
  10. How do you treat diabetic eye problems?
  11. How do I know when I need treatment?
  12. How often should my eyes be examined?
  13. How does laser therapy work to help my eyes?
  14. Does laser therapy stop the progression of diabetic eye problems?
  15. What are the risks of laser therapy?
  16. How often should my eyes be checked?

16. Diagnosis: Headache

Questions that should be asked:

  1. Is anything about my eyes or eyeglasses causing my headaches?
  2. Can you modify my eyeglasses and eliminate my headaches?
  3. If my headaches are not from my eyes, what else might cause them?
  4. What other tests should I have performed?
  5. Should you, or my internist, or a different doctor, do those tests?
  6. Do you think my headaches are migraine?
  7. What is migraine?

Barry Milder, M.D. Clinical Associate Professor, Department of Ophthalmology Washington University School of Medicine St. Louis, MO

                                                                                               

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