It seems to people that the ophthalmologist is a separate thing and it is not so

Do you need to have skills in your hands to exploit such a small area?

– Yes, absolutely, it requires very specific training, in fact we operate with a microscope.

And what other technologies have you incorporated over the years?

-In ophthalmology, everything is material, from observing a patient to prescribing glasses, passing through the detection of other pathologies, with more sophisticated equipment.

For instance…

-We have equipment to see the retina, to do a tomography of the optic nerve and the macula (OCT), this topographically takes the structure of the macula and the structure of the optic nerve, there you can see, for example, how the diseases evolve, what treatment we will give him. It also allows us to closely monitor patients with glaucoma. For the cataract operation we have a specific device that measures which lens the patient is going to wear inside the eye, in this operation the lens of that eye is removed and with the equipment, which is calls Aladdin, we can determine the lens based on what the patient needs. Astigmatism is evaluated with the fundus, but also with a topography that measures the surface of the cornea, to know how oval it is, in which axis, if there is another pathology such as keratoconus, where the cornea instead of being curved it is cone-shaped. And like that a lot more equipment.

How do they acquire this equipment and how do they absorb the costs so that these treatments are accessible?

-Unfortunately we are facing a crisis, even a Chamber of Ophthalmologists has been formed at the provincial level that did not exist, that is to say to be able to do something because they do not give us the costs. But you have to be equipped, the measurements are more and more precise and you have to have everything to be able to measure the patient. Social works find themselves with costs far behind.

How has invasiveness evolved in ophthalmology?

-It’s impressive. When I did the residency, the technique that was used was that of before, you opened the eye, you removed it with a kind of spoon, so that it is well understood, you removed the whole nucleus and then it had to suture this. Now we do it with millimeter incisions. These are most surgeries. The evolution is impressive, in ophthalmology it is permanent.


What pathologies do you find in the office?

-There is a huge range. It seems to people that the ophthalmologist is a separate thing and it is not. The ophthalmologist is part of the medical clinic and is very useful there. Diabetics, for example, must undergo a fundus examination once a year, because ophthalmologists are the first to discover microaneurysms that occur in the retina, which are asymptomatic. We therefore help the endocrinologist in the evolution of this patient. We also discover tumors, because there are metastases in the eye, we help medicine in general. There is a set of manifestations that occur in the eye, in addition to typical pathologies.

-What we are currently seeing is a lot of delay, there is a demand contained by the pandemic which is impressive. People were late at checkpoints. People go to a cardiologist, which is the most important thing, and they leave out ophthalmology. We see pathologies produced by screens, especially in children, myopia and astigmatism have evolved a lot. In adults, too, presbyopia came on suddenly.

Is there still a delay in controls, more than two years after the declaration of the pandemic?

-You ask people and they tell you, “I haven’t controlled myself for a year.” So you ask: “before or after the pandemic? And they answer: “yes, before”. So it’s been almost three years, folks and we’ve all lost and kept a year or more, it feels like a year has passed and it was almost three. This is why there are very sad cases of regression.

Is not going to class and seeing the blackboard something that has consequences today?

-It is a reason for consultation, “I come because I do not see the blackboard”. And another question we get a lot from kids is “I’m coming because you have a headache”. These pathologies begin to manifest themselves as a result of frequentation.

How often should checks be carried out?

-In general, annual, it depends on each case. The high myopic person needs a fundus once a year because retinal alterations or asymptomatic degeneration may occur. Most are annual.

To what extent are pathologies genetic?

-It is always important to investigate the patient’s history, there are many that are hereditary and others that are not. If a patient tells you that his father has diabetes and he went blind because of it, I have to open my eyes because the more he has a metabolic disorder, the more he is at risk. There is a trend. Sometimes that doesn’t mean that because someone in your family had a disease you have it too, but I love having this information.

What about the sun and the plastic we wear as sunglasses?

– This is a very hot topic. People believe that when you buy sunglasses on the street, you look better. And no, with that they are worse. Don’t wear anything for it. Because with a dark lens that has no filter, the pupil dilates a little because the light enters less, the light enters less than before. And when the pupil opens, these solar rays pass directly without a filter, which is why they contribute to the development of cataracts, retinal damage, among other conditions.

-Another situation I would like to mention is that there are many opticians who give shifts, charge for consultations and prescribe glasses. In Argentina, it is the illegal practice of medicine. And we have cases in town, people believe that with that the control has already been done, and it is not like that. It’s a bigger problem than selling unapproved sunglasses. There are, the vast majority of opticians work with us to better serve each patient.

By Fernanda Bireni

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