Ophthalmologist + retina specialist and repeated tests, is it worth the cost?

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My mother is 84. She has had cataract surgery on both eyes. She sees an opthamologist twice a year. In February, the eye doctor said that my mother has developed dry macular degeneration and referred her to a retina specialist. I questioned the reason for this referral (and extra cost) and was told that the only the retina specialist could treat macular degeneration.

So we made an appointment with the retina specialist. I was told that, at the FIRST APPOINTMENT, they would do all kinds of tests which would take 2 hours. After all was said and done, the retina specialist said that the macular degeneration wasn't advancing and told my mother to come back in 4 months.

Both of these doctors are in the same building (right across the hall from one another) and use the same computer system and same patient files.

Last week, we saw the opthamologist and he said everything was fine and to come back in 6 months.

Yesterday, we went back to the retina specialist. We started the appointment with this nurse's aide doing EXACTLY THE SAME preliminary tests and asking EXACTLY THE SAME questions. Since the computer and patient files are shared within the clinic, I asked if this was really necessary since everything had just been updated 1 week earlier. I was told it was!

Then, they did all of the same tests that they had done 4 months ago, when my mother saw the retina specialist for the first time. I questioned this and was told that they will do these tests EVERY TIME my mother comes to see the specialist.

At the end of two hours, the doctor told my mother that nothing had changed and she should come back in 6 months.

First, I'm questioning the necessity for 2 different eye doctors.

Second, I'm wondering about the necessity for all these tests.

I'm my mothers medical and general POA but she pays her own bills. I don't know how much the out of pocket expenses were for the first retina specialist's tests/appointment. But, I hate to see her spending her money on (what I consider) unnecessary tests.

I'm also concerned that the retina specialist is just stringing us along, since there's no way that my mother's eyesight is ever going to improve (it's still good enough that she can drive).

My mother believes that these visits are a necessity.

What can I do?

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Your mom is with it more than mine. Good question. My mom wouldn't understand what the hell is going on with her eyes to even do cataract surgery, etc. she rubs her eyes without any procendure......
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My mom was diagnosed with AMD in both eyes, very advanced in the left eye. Yes, she needs two docs, as the ophthalmologist prescribes glasses so she can read with her right eye. The retina doc is checking the progression of the AMD in the right eye, not because he can make it better but to watch for other changes. Some retina changes are only found by testing, but may be assymptomatic and so you don't know you have it. I have a retina issue that was only caught because of testing done prior to cataract surgery..I never saw any vision change.
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Retina changes can be seen by testing prior to your Mother having symptoms. They can see clots about to burst and other internal issues that might not be noticed by your Mother until it is too late to repair. Just a word to the wise.
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When my mother goes to either the opthamologist or the retina specialist, her medical information is put up on the computer screen for that particular doctor (and his aide/nurse) to see and update. The same information is on both offices' screens. Both can update the files and the other doctor will be able to see the updates.

Additionally, the same paper file folder is used by both doctors and their aides. So, I believe that both doctors are able to see everything that relates to my mother's eye care.

That being said, I wondered why the retina specialist's aide had to ask my mother the VERY SAME questions and do the VERY SAME preliminary tests that the opthamologist's aide had just done 1 week before. All of the information, from just 7 days prior (about vitamins, medications, etc.) was clearly listed on the screen. The date of the week-earlier visit was also visible. My mother reported absolutely NO CHANGE in her eyesight, from the previous week's exam and NO CHANGE in any of her medication/vitamin dosage or usage during that same 7 day period.

I do not understand why the repetitious questioning and preliminary eye tests had to be done. My mother was very frustrated by the time it was taking the retina specialist's aide to get done with the preliminary part of the appointment. However, she is very timid. She would NOT, under ANY circumstances, ask why she was being questioned or why a test was being done. So, that duty falls on my shoulders.

As for the other tests, I guess I didn't state things very clearly. My concern is about the repetition of the tests by the retina specialist, not both of the eye doctors.

When my mother went to the retina specialist for the first time, we were specifically told that for the FIRST VISIT, there would be all these tests and that they would take about 2 hours to complete. The lady was very specific about emphasizing FIRST VISIT. From that, we assumed that there might be other tests done at subsequent visits, but the 2 hours spent on the FIRST VISIT would be abnormal, not the usual occurrence. However, that turned out not to be the case.

Since I'm "just the daughter", and my mother is so timid, the tests were done anyway. It turned out that there was no change in my mother's eyesight from the previous appointment with the retina specialist. So, really, the extra expense was for nothing.

IF my mother had said that her eyesight was different, or that she was now seeing fuzzy areas that she hadn't seen before, I could certainly understand why the tests would be done on the subsequent visit.

However, this was definitely not the case!

I appreciate how important one's eyesight is! I would NEVER do anything that would allow my mother's eyesight to deteriorate or cause her any harm.

I DO QUESTION the costs for these tests and the fact that they were done when there was no reported change in her eyesight.

While I've never seen a bill for these eye doctor visits, I hate to see my mother having to pay for things that could have been avoided.
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I'm not sure about this but I find this a little complicated, myself, and I'll tell you the odd things I've run up against, as they're similar:

First of all, my mother is part of a large health system with computers where doctors can share everything.

When you become the health system's patient, there's a huge on-line survey of health, yet most doctors have a piece of paper they make you fill out when you become their patient to ask pretty much the same questions.

Also, I found that doctor's are only notified of tests that they request. So, my mother had a special thyroid treatment at the thyroid part of the hospital. Her endocrinologist sent her there, where she was temporarily transferred to the hospital's doctors. When we returned to her endocrinologist, her endocrinologist asked us if Mom had been released back to regular care. When we responded that Mom had been released by the hospital's thyroid doctors, her doctor started reading through the records and saw all Mom's tests. Otherwise, she had no way of knowing that Mom was done with the special thyroid clinic at the hospital nor what her tests showed.

Her endocrinologist then canceled and reordered all Mom's blood tests. That way, the same tests would be done, but the endocrinologist would be notified each time results came back in order to keep track of what Mom's thyroid progress is.

Part of the problem might be that only the doctor that asks for the tests is being notified of the results and that could be one reason both are ordering the same tests. By what you've said, I'm assuming each can see the other's requested tests. Have you asked them to coordinate/share the tests?

One concept we have in our health system, and I'm not sure if this is a Michigan-specific term or if all health systems use the same term, but it's call "health care home" which means that you have a medical "home" and all doctors in your system work together for you to have a single set of health records and for all to share test results.

The system my mom is in is probably the best coordinated I've ever seen, I'm quite impressed, but I still notice places where it falls-through. If your doctors are supposed to be sharing information, ask them, directly about this and ask what can be done to make this happen.
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If your mom is still driving, then she is competent to make her own decisions re medical tests she does and doesn't want to have. Really, that's the end of the story.

Further, many eye conditions are progressive. The doctor would be remiss if he didn't suggest they be monitored. And, if testing is the way to monitor progression? Then testing it is.

We are called upon to make some hard decisions as children. As long as mom's capable of making her own, take advantage of that and do as she wishes.
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Your Mother is correct, the tests are necessary if her vision is important to you at all. With MD, blindness can come gradually or very quickly. I was diagnosed with MD 4 years ago; just woke up one morning with a big fuzzy ball in place of my husband's face. Everywhere I looked the fuzzy ball was in the middle of my field of vision. Driving would become impossible when that fuzzy ball becomes black hole (which it will without treatment). Blessedly, after two painless shots in my right eye, I have had perfect vision. Some people are not so fortunate; the shots do no good or have to be repeated on a regular basis.

I see my retina specialist every 4 mouths but my ophthalmologist only once a year to have my glasses checked.
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