What you can expect on your initial office visit:
A patient’s initial visit to a retinal specialist is understandably a stressful experience. Often times, a patient has been referred due to a recent decrease in his or her vision and is anxious to know the diagnosis, potential for visual recovery and what sort of treatments are available. Rest assured that Dr. Girschek will do everything possible to provide you with as much information as needed on the initial visit. For some conditions, it is not unusual to be examined, diagnosed and treated all on the initial visit.
Upon presenting to the clinic, a history will be taken from you by one of Dr. Girschek’s dedicated retinal technicians. You will be expected to fill out a history questionnaire that will help Dr. Girschek focus his initial interview with you.
Your best-corrected visual acuity and intraocular pressure will be checked and your eyes dilated. Based upon your reason for referral, a variety of imaging modalities may be performed before you see Dr. Girschek. These images are done before you are evaluated in an effort to increase the efficiency of the practice and, ultimately, shorten your visit time. Your eyes will be dilated in almost every circumstance. Your eyes will remain dilated for four to six hours afterwards.
Most patients will have a high resolution spectral domain OCT image performed. This is a non-contact image that provides Dr. Girschek with a extremely high-resolution cross-sectional infrared image of the retina providing an ‘optical ultrasound’. Acquiring this image takes no longer than one or two minutes. Additionally, an autofluorescence image will be quickly taken at the same time as the OCT image in most circumstances.
Fluorescein, and occasionally, indocyanine green angiography may be performed on your initial visit. This requires a small injection of dye through a vein in the back of one’s hand. This imaging technique allows for the evaluation of fine retinal blood vessels that may be contributing to a patient’s visual disturbance. Angiography is most commonly performed in patients with significant diabetic retinopathy, age-related macular degeneration and retinal vein occlusion. A sequence of images to both eyes are then taken over the course of 12 to 15 minutes. These images are acquired by a non-contact digital camera and evaluated by Dr. Girschek right away. It is important to let the office staff know if you have an allergy to contrast dye, iodine or shellfish as these are important contraindictations for angiography. Your skin and urine may become yellow-colored for the next 24 hours and it is important to avoid direct contact with sunlight as much as possible during this time.
Dr. Girschek will then perform a thorough dilated eye examination with particular emphasis placed on your retina. It is important to allow both eyes to be dilated and examined, at least on your first visit. It is encouraged that you prepare a list of questions you may have with you to your visit and go over these with Dr. Girschek. In addition, it is recommended that someone accompany you on the first visit. A friend or family member will act as another ‘set of ears’ and understanding as Dr. Girschek explains your diagnosis and recommended personalized treatment plan. In most circumstances, you will be provided with an AAO (American Academy of Ophthalmology) -published handout regarding your diagnosis to assist you in learning more about your retinal condition.
In most circumstances, patients do not need to return to start treatment of one’s retinal condition. Laser surgery and intra/peri-ocular injections are routinely performed immediately after being seen by Dr. Girschek.
Laser surgery requires the use of a highly-focused laser beam to target extremely specific area of one’s retina. Examples of retinal laser surgery would include ‘spot welding’ around a retina tear to prevent a retinal detachment or damaged retinal tissue in the setting of diabetic retinopathy leading to bleeding inside your eye from abnormally-developed blood vessels. Laser can cause some mild discomfort and local anesthesia is often used to make the procedure one that is both comfortable and efficient.
Intraocular injections are performed quite commonly in the treatment of age-related macular degeneration, diabetic retinopathy and retinal vein occlusion. An extremely small needle will be used to inject medicine into the gel inside your eye. Dr. Girschek’s skilled technicians will spend approximately 5-10 minutes preparing your eye for this procedure. The surface of your eye will be sterilized and fully anesthetized before Dr. Girschek performs the injection. At most, patients may feel a slight amount of pressure during the procedure. It is not, however, painful and patients commonly express that the anxiety of awaiting the procedure is the worst part. You, your technicians and Dr. Girschek will be wearing a face-mask over the mouth and nose during the preparation and actual injection in order significantly minimize the possibility of infection.
Patients may drive home after dilation if they feel comfortable and feel that one’s vision is adequate to drive. Dilation of both eyes does not preclude one from driving home although one may be quite sensitive to bright light. It is advised that patients bring sunglasses with them to help with this. Our practice will also provide disposable sunglasses to you should you need them. Patients who have received an intraocular injection or had a retinal laser surgery performed may drive home should they feel comfortable. Nonetheless, it is advisable to bring a responsible driver with you, if possible.
Please understand that due to the nature of Dr. Girschek’s practice that emergencies are often added to his schedule with little-to-no notice. Because of this, we ask for your patience in the event that you visit duration is longer than what is normally expected. In most circumstances, please budget one to two hours to spend with Dr. Girschek and his staff.