Preparing for your Office Visit – September 4, 2013

Preparing for your Office Visit

Chat Highlights – September 4, 2013
Guest Speaker – Dr. Anand Mantravadi
Lorraine Miller, Chat Topic Researcher
Brittany Morgan, Editor


Moderator: Dr. Anand Mantravadi hosted the online glaucoma chat held on September 4, 2013.  The topic was titled, “Preparing for your Office Visit.”

P: Are all patients referred to you, Dr. Mantravadi from another eye care provider for their first doctor’s appointment?

Dr. Anand Mantravadi : Most patients are often referred.  However, this is not always the case.  Many patients may come to my office through other means.  Some examples include an emergency room visit, self-motivated means, and primary care.

P: How does a doctor’s appointment with you differ from a previous doctor’s appointment a patient may have had with another optometrist or ophthalmologist?

Dr. Mantravadi: First, it is important to understand the difference between the types of doctors.  Ophthalmologists have attended 4 years of medical school followed by a medical or surgical internship as well as 3 years of ophthalmology residency training.  On the contrary, glaucoma fellowships require 1-2 years of additional residency training that focus on surgical and medical training of glaucoma of all ages.  To get to your question, I do not know specifically how other doctors with different trainings approach their exams.  What I can say is that during an initial glaucoma consultation, a patient must perform several tests (i.e., fields unless performed elsewhere) and will have a full ophthalmological examination to evaluate all treatment options.

P: What information should a patient bring to his/her first visit?

Dr. Mantravadi: It is most helpful when a patient has had prior testing.  Specifically, such tests include visual fields or disc photos.  It is helpful when a patient brings these for review to his/her first visit.  Further, it can be helpful when a patient knows of any information or ideas on maximal eye pressures.  However, that information is not crucial.

P: Dr. Mantravadi, what do you believe is the best thing that I can do, as a patient to optimize or enhance my appointment?  Would it be listening?

Dr. Mantravadi: A patient who is well versed in their history often reflects a very “hands on” personality.  This often bodes well for dealing with many conditions.  Further, listening is also critical.  Listening can often assure that time is spent most effectively and efficiently.

P: At a patient’s first visit, will the eyes be dilated?

Dr. Mantravadi: Unless specified otherwise for medical reasons, it is likely that the eyes will be dilated during the initial consultation.

P: If a patient cannot afford a scheduled office visit, what should he/she do?

Dr. Mantravadi: If insurance or affordability is an issue, there are different options available.  These options depend on one’s locale.

P: What can a patient expect to learn from the glaucoma specialist by the end of the first visit?

Dr. Mantravadi: A patient can expect to learn information about their condition and status, various treatment options as well as their prognosis.

P: How long must a patient wait after dilation of the eyes before he/she can drive again?

Dr. Mantravadi: This will depend on the patient.  Some patients are comfortable driving when their eyes are dilated.  Some are not.  If a patient is unsure with what he is comfortable with, it is best to make arrangements that are appropriate.

P: Why might some individuals only visit you once?

Dr. Mantravadi: There are two common reasons.  An individual may only see me once if the referring doctor and patient simply sought an opinion on management strategy that they together are pursuing.  Another reason is if a patient is seeking a second opinion.

P: If I have been referred to you, would I ever become a patient of yours and no longer need to see the eye care provider?

Dr. Mantravadi: It depends.  Many eye care providers refer patients with the intent that a specialist can manage the patient’s glaucoma.  However, other providers intend to remain involved.  These providers usually remain involved when a patient is referred for general ongoing eye care (i.e. for glasses prescriptions, cataract, etc).

P: I am having a trabeculectomy microstent next month.  I am concerned that I will feel the stent.  Do patients feel the stent?

Dr. Mantravadi: Which stent are you referring to?  Is it the IStent?  Many devices that are implanted, including the larger tube shunts, are not felt by a majority of patients.

P: As a patient continues to see you for appointments, is there anything that should always be brought to the meetings?

Dr. Mantravadi: A patient’s knowledge of what ocular medications are being used, how they are being used, any changes to their medical condition etc. are all pertinent pieces of information and can be very helpful.

P: If an appointment is scheduled during the time a dose of glaucoma medication should be administered, what should the patient do?

Dr. Mantravadi: Generally speaking, the patient should go ahead and take the medication, unless the doctor instructs otherwise.

P: Can my doctor tell if I am only compliant with my prescribed medication a couple of days prior to my office visit?

Dr. Mantravadi: No.  This is often not the case.  One of the real challenges in glaucoma care is determining whether someone’s disease is progressing despite good adherence to recommended treatment regimens or whether someone’s disease is progressing due to non-adherence.  It is often impossible to tell the difference but the plan is the same.  If medical therapies are not working due to taking the medications or not taking the medications, other options including surgical options should be explored, if warranted.

P: If a patient is very nervous prior to each visit with their glaucoma specialist, will the tension be visible in any of the test results or pressure checks?

Dr. Mantravadi: Anxiety related tension might lead to one “squeezing” during pressure checks, which will affect measurements.

P: What does “squeezing” mean?

Dr. Mantravadi: “Squeezing” refers to squeezing your eyelids.  This makes it harder for a doctor to measure your eye pressure.

P: Does the time of day make much difference to the outcome of eye pressure checks?

Dr. Mantravadi: Yes it can.  IOP can vary diurnally.  It is often helpful to stagger times for visits to get a broad overview of pressures at different times of day.  Alternatively, a doctor may request for a patient to spend the day at the office if a doctor thinks it will be helpful to explore, under certain circumstances, whether there is significant variability.

P: If a patient runs out of medication before an insurance company can approve a refill, what would you recommend?

Dr. Mantravadi: Unfortunately, this is a chronic problem.  Manual dexterity, lost bottles, squeezing too much out etc. are not factors taken into consideration in regards to the timing for a refill.  There are not many great solutions out there.  That said, the drug companies have been very kind in providing samples to bridge the gap when a patient appeals to pharmacies with one time refills.

P: Are there any activities that a patient could participate in prior to the office visit that would change the eye pressure or test results at the visit?

Dr. Mantravadi: There are not many lifestyle related activities that a patient can participate in prior to the office visit that would affect the eye pressure or results.  However, cardiovascular fitness, although indirect, can be helpful in many ways.

P: If a patient cannot afford the medication prescribed by their glaucoma specialist, what should he/she do?

Dr. Mantravadi: A patient and doctor should have a conversation regarding other non-medical treatment options (i.e. laser, surgery etc).  If medical treatment is still a good option, there are drug assistance programs that may apply.

P: What testing will most likely be performed during an exam with a glaucoma specialist?

Dr. Mantravadi: Typical testing includes (if not performed recently elsewhere) visual fields, corneal thickness measurements, some form of optic nerve imaging, and a complete examination.

Moderator:  This concludes the online glaucoma chat with Dr. Anand Mantravadi.  Thank you all for participating.


About the Author:

The Glaucoma Service Foundation’s mission is to preserve or enhance the health of all people with glaucoma and to provide a model of medical care by supporting the educational and research efforts of the physicians on the Wills Eye Institute Glaucoma Service, the largest glaucoma diagnosis and treatment center in the country.
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