Frequently Asked Questions
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An optometrist is a licensed professional who can diagnose many common ocular conditions. An optometrist specializes in contact lens fitting and giving prescriptions for glasses, however they do not perform eye surgeries.
A general ophthalmologist is an eye physician and surgeon who has completed 4 years of medical school and 4 years of ophthalmology residency. Most general ophthalmologists perform cataract surgeries. They can also diagnose and treat many common ocular conditions such as cataracts, glaucoma, corneal ulcers etc. A general ophthalmologist may
refer you to an ophthalmic subspecialist for specialty evaluation and management.
A vitreoretinal specialist is an eye physician and surgeon who has completed 4 years of medical school, 4 years of ophthalmology training, and 2 years of sub-specialty training in retinal surgery. A retina specialist deals only with conditions affecting the back lining (“wallpaper”) of the back of the eye, the retina. Common conditions that retinal specialists manage and treat are retinal detachments, diabetic retinopathy, macular hole, retinal tears,
age -related macular degeneration, choroidal melanoma, and vein occlusion.
A retinal examination cannot be performed without dilating the pupils. It may not be necessary to have your pupils dilated every time you get an injection, but it is important to monitor the disease process in the eye during and following treatment. It is also important to examine both eyes periodically to detect any condition that may threaten the vision in the eye that is not being treated. This may require dilating one or both pupils for examination and other tests. It is not always possible to predict in advance whether one or both pupils will have to be dilated for an exam so it is important to let the staff know before your appointment if you are not willing or able to be dilated to avoid having to reschedule your appointment after you arrive.
Many people consider an eye blind if it is not able to distinguish any detail (make out letters, recognize faces, etc.) But an eye that can see anything at all may have some useful areas of vision that can help to detect moving objects and direct the vision in the better eye toward an object. Also, patients often consider an eye useless if it sees very poorly compared to the other eye which has good or much better vision than the bad eye. Unfortunately, people do, on occasion, lose the vision in the better eye due to a disease process or injury and the “bad” eye may then become the only remaining eye with vision. Ophthalmologists only consider an eye totally blind if it is not capable of seeing any light. That is why it is important for us to test the vision in the bad eye to see if it will allow you to count fingers or see any motion if you can’t read any letters on the eye chart. By preserving what vision you have left in the bad eye, we may be creating a “spare tire” eye, so to speak, that will allow you to function independently if the good eye is ever lost. We have many patients that are able to live an independent, rewarding life even though they don’t have vision in either eye that is good enough to read or drive.
Glasses correct many optical problems in an eye. Consider the eye as working like a camera. In a camera the lenses mounted on the front focus the light rays on the film (or electronic digital imaging device in an electronic camera). This should form a nice sharp picture on the film if the lenses are working properly. But the camera will only produce a good clear picture if the film is also good. So a clear picture requires both the right lenses and good film. In your eye the lens system is the cornea (the clear dome that covers over the eye in front of the pupil) and the natural lens which is inside the eye behind the pupil. The film is the retina and the part of the retina that can see the finest detail is the macula, directly behind the pupil. Unfortunately, some people are born with a lens system that is not correct to focus the light rays on the retina in the back of the eye. Some people develop problems with the lens system later in life due to disease or aging. When this occurs we always attempt to correct these problems, which are called refractive errors, with glasses, contact lenses or, sometimes, surgery. The goal is to correct any optical errors in the eye so that a sharp image is projected onto the retina. Once this has been achieved, if the vision in the eye is still poor, we can then begin to determine whether this is being caused by a disease of the retina, macula or some other part of the eye. We have had countless patients come in to our office telling us that they never wear their glasses because they don’t help, only to find that their vision does improve several lines on the eye chart when we finally get them to bring their glasses in. The vision may not be good, but it is better than it is without the glasses on. This can be very important to us in determining whether a treatment is helping your vision. Testing your “best corrected” vision with your most recent glasses prescription allows us to better determine how your retina is functioning. To most patients bad vision is bad vision, no matter what is causing it, but it is our job to determine why the vision is bad and try to fix it if possible. Asking us to try to determine whether a treatment is helping to improve the function of your retina without bringing in your glasses because “they don’t help” is like taking your camera to the camera repair shop and asking them to determine if the film in the camera is OK, but refusing to focus the lenses.
No. Our practice is restricted to the medical and surgical management of diseases of the retina and vitreous. As such, we don’t evaluate or treat cataracts, cornea problems or prescribe glasses. We will usually refer you back to the general ophthalmologist or optometrist that referred you to us for other eye problems including glasses.
The medical field consists of many different specialties and subspecialties these days. For better or for worse, many of us have chosen to pursue an area of expertise in just one small area. The doctors at Retina Consultants of Southern California are all fellowship, subspecialty trained to diagnose and treat diseases of the retina and vitreous. We feel that we can provide our patients with the highest level of proficiency in this field by restricting our care only to disease in this area. For this reason we do not treat external eye diseases, such as conjunctivitis, styes or corneal problems. We do not manage cataracts or glaucoma or most neurological conditions affecting vision. For these problems we will usually refer you back to the eye care professional that referred you to us, or to direct you to a competent doctor if you don’t have one.
Unfortunately, there is a lot of hype and advertising about the benefits of vitamins, natural health products and nutraceuticals. Most of this is based on either no evidence or very loose evidence such as testimonials, case reports, and some epidemiological studies. Most doctors trained in evaluating scientific studies don’t find this sort of evidence very convincing. The only strong scientific studies that have been done on the use of vitamins in eye disease are the Age Related Eye Disease Studies (AREDS and AREDS 2). These were randomized, controlled clinical trials where thousands of patients were given various combinations of vitamins, followed for years and tested against patients that received placebos. These studies have determined that a particular combination of vitamins (called AREDS 2 vitamins) reduces the risk of severe vision loss from progression of dry macular degeneration or conversion to wet macular degeneration. This conclusion only applies to patients that have Age Related Macular Degeneration. There is no strong scientific evidence that vitamins benefit any other eye disease, or in general make the eye “stronger”.
Yes. We recommend that patients with Age Related Macular Degeneration should take the “AREDS 2” vitamin formula. This is based on the most current research study on vitamin therapy. If you buy your vitamins at a drug store you should look for the words “AREDS 2” vitamins on the label. AREDS 2 is a particular combination of vitamins, but there are different companies that make AREDS 2 vitamins under different brand names, so it is important to read the label. The older formula of vitamins for macular degeneration was the “AREDS” formula, without the 2 at the end. This formula has some constituents that may not be beneficial for some patients, and may actually be harmful. We use a brand of AREDS 2 vitamins called EVOA for a lot of our patients because it is mailed directly to you monthly and it is less expensive than some of the drug stores. They also have a toll free phone line where the staff can be very helpful with any questions.
Many patients or their family members ask whether they are safe to continue driving as their vision diminishes. The incidence of motor vehicle accidents rises considerably after the age of 65. The law in the state of California, requires that an individual`s vision be 20/40 or better in at least one eye to qualify for an unrestricted driver`s license. This means that a patient is legally able to apply for a driver`s license even if that individual is completely blind in one eye, as long as the other eye qualifies visually. An individual is allowed to have a restricted driver`s license, driving only during daylight hours and in familiar surroundings, until that individual`s vision has been reduced to 20/200 or worse in California.
However, it is important to understand that safe driving requires more than adequate vision. The ability to drive is dependent on at least three factors. 1) Adequate vision, 2) Unimpaired cognitive ability, meaning that an individual`s judgment and memory are not impaired, and 3) Adequate motor skills. This means that an individual must have adequate reflexes, strength, and range of motion to function a motor vehicle. These factors can be affected by strokes, Alzheimer`s disease, microinfarctions of the brain, as well as other medical conditions. When we examine you in our office, we are only testing your visual ability. The fact that you may have vision adequate to qualify for a driver`s license does not insure that you also qualify in these other two important categories. If you or your family members feel that you may not be safe driving despite the fact that you qualify visually, you are encouraged to see a neurologist for testing of your cognitive ability and motor skills.
If you do not pass the vision tests at the Department of Motor Vehicles, you may ask them to provide you with a form for us to fill out, documenting that your vision meets the standards for a driver`s license. However, the fact that your vision meets these standards does not guarantee that you will be issued a license. Only the Department of Motor Vehicles has the authority to grant you a driver`s license. If they decide that you are not safe to drive, based on their testing, they still may not grant you a driver`s license despite the fact that your vision meets their standards.
We feel that it is important for your safety, and the safety of others, that you have all of your driving skills evaluated if you or your family members have any question about your ability in any of these three areas. Many times patients are not aware of the fact that these areas have been impaired without formal testing. Stroke victims are frequently unaware that part of their vision is missing without formal testing. It is not uncommon for a person to tell us “I have always been a good and safe driver, and there is no reason why I should not be one now”, despite the fact that they are found to have a serious disability which would impair their driving ability.
If diminished vision is the only reason for your driving impairment, low vision aids may assist you in your ability to drive. You should contact the Braille Institute or a low vision specialist to be evaluated for these devices.
It is also important for you to understand, that if we advise you not to drive due to your visual impairment, this will be documented in your medical record. If you choose to drive despite this warning, your medical record may be accessible to an attorney if you should become involved in a motor vehicle accident. This could be a significant liability in your attempt to defend yourself should you be found at fault in a motor vehicle accident.