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For both the patient and the physician, the health care market place has become extremely complex. Yet with all the advances in technology and medical and surgical management of eye disease, patients want, and absolutely should have an eye doctor they feel is truly interested in caring for them. A patient must know that their doctor will take the time to listen to his or her concerns, and ensure that each question is answered clearly, to the patient’s satisfaction. It is the doctor’s responsibility to thoroughly investigate the causes of a disease process in a wise, cost effective manner, and educate the patient and family about the problems which exist, and the treatment alternatives available.

There are many misconceptions concerning the disease processes which affect our eyesight, and this confusion often adds to our fears when we are diagnosed with an eye problem. For example:

“WHAT IS A CATARACT, HOW IS IT TREATED, AND HOW DO WE KNOW WHEN WE MAY BE READY FOR SURGERY?”

A cataract is a gradual pacification of the eye’s natural lens, which causes diminished clarity of vision and color, increased problems with glare from lights and shiny surfaces, and ultimately makes our daily activities, such as reading, sewing, or driving, very difficult or no longer possible. This opacity is similar to looking through a frosted light bulb. A cataract is not a film or growth over the eye, and can only be treated with surgery. The time for cataract surgery is dictated by the needs of the patient. If your vision is adequate to satisfactorily and safely perform your daily activities, then you may be able to delay the need for surgery. Remember, you, the patient, are the boss.

“WHAT IS GLAUCOMA, AND WHY IS IT SO DANGEROUS TO MY EYESIGHT, IF IT USUALLY CAUSES NO PAIN, AND I AM NOT EVEN AWARE OF THE CONDITION?”

Glaucoma, one of the three leading causes of legal blindness in the country, is dangerous exactly because we are usually unaware of its presence! By the time the patient notices that there is a problem, (such as tunnel vision), the disease has progressed irreversibly to a severe degree. Glaucoma is caused by pressure in the eye (this is different than blood pressure) which is not tolerable to the sensitive fibers in the optic nerve. Left untreated over a long period of time, this pressure will destroy these fibers. Therefore, early detection during routine eye exams is critical in uncovering the presence of glaucoma, before it has time to progress.

“WHAT ARE THESE FLOATERS, AND ARE THEY DANGEROUS TO THE HEALTH OF MY EYE?”

Normally floaters are caused by small pieces of debris floating in the back part of the eye called the “vitreous.” This debris may have come from the retina, or the degeneration of the vitreous itself, and is often seen as part of the normal aging process of the eye. Sometimes, however, new floaters may be from a hole, tear, or detachment of the retina, and represent an ocular emergency. So, new floaters, especially when associated with decreased vision or flashes of light, should be evaluated immediately.

These questions regarding common ocular conditions, illustrate the priority which doctors should place on public education. An educated patient is able to face a medical problem with less fear and apprehension, and may make an informed decision about how to proceed in a manner that is best for that individual patient.

The doctor – patient relationship is an exquisitely unique, and special bond. So how do we find an eye specialist who is honest and practices with integrity, who is compassionate and truly concerned for the best interests of the patient, who is competent and well educated, and up to date with new advances in medical and surgical skills? As is no surprise, often other patients know best. Speak with you friends, neighbors, and family members, and discover why they either do or do not like their eye doctor. Public opinion about the quality of individual physicians is often amazingly accurate. Also, ask your family doctors and hospital and office nurses which eye doctor they feel delivers the best care. There are a number of excellent ophthalmologists and optometrists in this area. I have developed a great respect for many of my colleagues.

I cherish and hold sacred the doctor – patient relationship. It is, in essence, the very reason I entered the field of medicine. I have learned that people are usually very private about matters concerning their own health, and it is not easy to turn ourselves over to the care of strangers in the time of need. It is precisely for this reason of privacy and trust that this relationship is so delicate, and so important. The opportunity to participate in patient care is the most privileged responsibility I have. I truly hope that each of you is able to find the eye doctor who is the very best for you.

Steve M. Silverstein, M.D.

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