5. Don't Just Show Up: How to Prepare for Your Eye Exam Like a Pro

Most people show up to their eye exam with absolutely no preparation — and honestly? I get it. It feels like the kind of appointment where you just sit down, read some letters off a chart, and you're done. But here's what I know from 15 years of seeing patients: the people who come prepared get so much more out of their visit. Better questions answered. Better treatment decisions made. Better outcomes.

I'm Dr. Parul Khator, a board-certified ophthalmologist and glaucoma specialist in Marietta, Georgia — and this episode is essentially everything I wish every single patient knew before they walked through my door.

In this episode, I'm giving you the insider's guide to preparing for your eye exam so you can walk in confident, get the most out of every minute with your doctor, and leave with real answers.

In this episode, I'll cover:

• Exactly what to do — and bring — before your eye exam
• The questions I wish more patients would ask me
• How to describe your symptoms in a way that actually helps your doctor help you
• What to tell your eye doctor that you might not think to mention
• How to make sure nothing important gets missed at your visit

Your eye exam is so much more than reading letters off a chart. And you deserve to get everything out of it. 👁️See well and be well.

📬 Have a question or topic you'd love me to cover? I'd love to hear from you! Email me at demystifytheeye1@gmail.com

📱 Follow along on social media: Find me everywhere @demystifytheeye

🌐 Learn more about Dr. Parul Khator, MD: https://www.gaeyepartners.com/metro-atlanta-eye-doctors/parul-khator-md/

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Demystify the Eye is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your eye doctor or qualified healthcare provider with any questions you may have regarding your eye health.

Transcript

SPEAKER_01 0:01

Hello, my name is Parl Kutor MD. I'm an ophthalmologist in Atlanta, Georgia, specializing in cataract and glaucoma surgeries. After practicing medicine for over a decade, I have learned that the more a patient knows about their disease, the better they do. Patient education is a passion of mine. But like most doctors, I have a lot of patients and not a lot of time to see them. So I created this podcast where I could spend the time I don't have during the day to give you insights into the eyeball and ocular disease. Let's empower you as a patient or a patient support system. Together, let's demystify the eye. I have asthma and went to see my pulmonologist. That's a lung doctor a few weeks ago. And I felt like an A plus student sitting in the waiting room. I was so prepared. Form of ID? Check. New insurance card? Check. Referral notes from my primary care doctor? Check. List of my medications? Check. I was so going to crush this visit. I'm an MD myself, after all. Of course I know what to bring with me to a doctor's visit. After the whole triage process, I finally got to see my doctor. And the first thing she asked me to do was pull out my actual asthma inhaler and spacer. That's a device that helps you take a proper puff of medication, because she wanted to watch me use it correctly. Um, I don't have my actual inhaler with me, I said with chagrin. I got the look of disappointment I get from my dad when he realizes I don't have any cash in my wallet. One must always carry cash in the event of an emergency, apparently. The second thing she asked me for was the results of my allergy testing from seven months ago. Um, I had completely forgotten I even did that allergy testing. The silence in the room was interrupted only by the crinkling of my clinic gown as I slunk farther down the exam chair. So I totally failed. And I'm a physician, for goodness sake. How in the world is the average patient expected to know what to bring to a doctor's appointment, especially one as specialized as an ophthalmic appointment? Well, that is where this podcast episode can help. Because today we are going to talk about how to prepare for an eye exam, even subspecialized ones like glaucoma exams. The basics. Firstly, an eye doctor's office is a doctor's office at its core. So you need to bring in the usual suspects, a form of ID like a driver's license, and your insurance card, even if you haven't changed insurances. Some eye doctors' offices accept vision insurance and will bill exams under this. My practice, for example, does not accept vision insurance, so everything I do is billed under a patient's medical insurance. Be sure to bring in both your vision insurance and medical insurance cards. Life is so digital these days, and everyone has forms you can fill out in the office or online prior to your appointment. My strong recommendation is to fill these out ahead of time. Your appointment slot is carefully curated and is actually calculated on the assumption these forms are filled out in advance. The additional time it would take to fill out these forms could actually put you in a different time slot that would require additional waiting. If that doesn't make sense, don't worry. It really doesn't make sense to a lot of people. Patient scheduling is more complex than physics level three in college. Thank goodness I have people in my office to do it for me. And they have a tough job because I see anywhere from 50 to 60 patients in one day, and they have to figure out how to make this work. Bring in a list of your medical problems. You might be wondering, but you're not a primary care doctor. Why do you need to know if I have high blood pressure? We do need to know for two reasons. The first is that there are ocular manifestations of systemic diseases. This means if you have a disease like diabetes, I need to look for complications of the disease in your eye. The second reason is that the medications we prescribe could be contraindicated with certain diseases or medications you are currently taking. There is a glaucoma drop that should not be used in patients with asthma, for example, because it can make breathing harder for these patients. Hand in hand with a list of your medical problems, bring in a list of your previous surgeries. And hand in hand with all of that, bring in a list of your medications. Eye specifics. What to bring. Now there are a few things that are a little bit more specific you need to prepare for when seeing an eye doctor. The first are your glasses. All the pairs of glasses you own that have a prescription in them. This includes sunglasses. We can actually put your glasses in a machine where we can read the prescription that is in them. We can then compare that number to the number we get that day when we do our four-opter exam. That's the better one, better two exam to really tell you if you need a new prescription. A lot of patients tell me they got their last prescription from us, so we should have that information without looking at their glasses. The problem is that what we prescribe is usually, but not always, what gets put into the lenses when the glasses are made. So if you get a new pair of glasses but you aren't happy with your vision, the first thing I will want to do is read the prescription off your glasses to ensure they have been made correctly. Well, what if you wear contacts instead of glasses? Then bring in the box your contacts came in or the little pack your individual contact came in. We can read the prescription off this and we can also read your BC or base curvature off of this. The base curvature refers to how steep or shallow the contact lens is, and it is customized for each person. If I give you contacts and I put the right prescription in but the wrong base curvature, you will not be able to wear those contacts comfortably. They will either be too tight or too loose on your eye and you will not be able to see clearly. Bring in any eye drops you were prescribed or you are using. Notice how I said prescribed or using. That is because those two things are not always the same. Sometimes we will prescribe a brand name drop, but the drop will get replaced with a generic at the pharmacy. We need to know if this happened because not all brand name and generic drops are equivalent. Also, you may have been prescribed a drop, but you could not tolerate it, so you are not using it. We want to see that bottle so we can add it to your list of allergies. Finally, bring in any post-surgery kits you may have received. We give our patients little blue bags after surgery that contain special sunglasses as well as a shield to put over the eye at night, and we like to show patients how to tape the shield on properly. Eye specifics. What to know? So that covers the things you need to bring in. What about the things you will need to tell us? Most doctors' offices archive or destroy paper records after a patient has been absent from the practice for a while. Our practice archived them after three years. Once archived, the chances of laying hands on these records is akin to taking a flight to Mars. Good luck. Nowadays, many practices like ours are digital. So that should solve the problem, right? Wrong. Electronic medical record systems are constantly being updated or purged. And many practices switch electronic record systems as new and improved ones are released. So when we see you, it is often with minimal or no records. We need to recreate a story of your eyes from clues we get by looking at them. Anything you can tell us will go a very long way in helping us recreate the story. In order to know where your eyes are headed, we need to understand where they have been. Here is what we will ask you that you can be prepared for. Number one, family history. We want to know about eye diseases, but especially glaucoma and macular degeneration, because these are the ones that tend to be inherited. Now, let me warn you, when you ask your family, you will find that someone had cataracts, even had cataract surgery. Cataracts are not a disease, folks. Number two, previous surgeries. Yes, we would like to know if you got your wisdom tooth removed and there was a problem. But we are mostly interested in any previous eye surgeries. And this includes lasers like LASIK. If you had any previous eye surgery in an operating room, the surgeon may have implanted something in your eye. For example, after cataract surgery, you get a new artificial lens. This means you got a wallet-sized card with information about the implant. Now, trust me, I have a basket of paperwork in my house that I truly believe is a black hole with a vacuum attached to it. Stuff goes into that basket, never to be found again. So it is quite possible that little wallet-sized card is long gone. But perhaps you or someone you love has a bit of OCD about filing information away. Perhaps you do have this card somewhere. Bring it to your appointment. It gives us valuable information. Number three, previous allergies to eye drops. Eye drops are the worst. A hundred years from now, we will have better delivery methods for eye medications. But right now we rely quite a bit on eye drops. These drops have preservatives in them and can create eye allergies. How would that look? Redness, burning, itching, dryness, blurry vision. Basically, you want to pull your eyeballs out and dunk them in a cool glass of water. Obviously, if you ever had this before, you do not want to experience it again, and we do not want to prescribe these for you again. Number four, previous episodes. I had a patient come to see me because she had an infection of her cornea or the clear front portion of the eye. She said she could not recall having any similar infections in the past. I gave her an antibiotic drop, which is our first line treatment because it is so effective. Lo and behold, a few days later, the infection was still there. So I tried a stronger antibiotic drop, and a few days later, the infection was worse. I had used a cotton swab to gather some of the infectious material from her eye and had sent it to the lab for processing, but the sample had gotten lost and the lab was attempting to locate it. So I tried a third antibiotic drop, and this didn't work either. When she saw me that day, she told me she had talked to her mom about the infection, and her mom reminded her of a similar episode 10 years back. She had an eye infection that was resistant to multiple antibiotics until finally they found a rarely used antibiotic that worked great for her. Aha! I pieced together what that antibiotic was, prescribed it for her, and within a week the infection was gone. Two days later, I got the results back from the lab, which showed her infection was resistant to almost every antibiotic except for the one that finally worked. She and I could have saved a lot of time in visits if I knew going into it she tended to be antibiotic resistant. I often see patients who have inflammation of the eye. This is different from an infection. There is no bug that is creating havoc inside the eye. Rather, the patient's own immune system attacks the eye, and we need to calm down the immune system with steroid drops. However, there are multiple drops to choose from, and there are many different ways we can start these drops. For example, I could prescribe a low-strength steroid drop twice a day or a very strong steroid drop every hour. And then there is a matter of getting off the drops once the inflammation has been conquered. If you get off steroid drops too quickly, the whole process starts over again. So it is important to taper someone slowly. However, it is equally important not to take too long with a tapering process. This is because steroids have real side effects, like raising the pressure in the eye or making cataracts grow faster. So we need to get in and get out. Does this seem dizzying and confusing? That is because it is. Treating a patient with inflammation of the eye is a bit like being a tightrope walker. Like most people, I don't want to waste time or make anything harder than it should be. So if you see me for inflammation of the eye, or uveitis, as we call it, the first thing I will do is ask you to take a trip down memory lane. Has this happened before? How many episodes? What were your symptoms then? What drops did your doctor prescribe? How often and for how long? Did the episode come back? When was the next episode? You get the idea. It is really helpful if you have thought about this stuff before coming in to see me and organized your thoughts. It's also really helpful if you've asked your parents, your friend, your significant other to help you remember. Number five, T Max. What in the world is that? This is a crucial number for my patients with glaucoma. It is the highest pressure that has ever been recorded in your eyes. This number is usually your pressure the first time you were diagnosed or the pressure at the visit right before you were started on medications. Why is this number so important? Glaucoma treatment is really a numbers game. It's all about percent reduction. We are trying to lower your pressure a certain percentage away from the number it was at when all the nerve damage happened. Now imagine a patient comes to see me and their T max, their highest pressure, is 35 millimeters mercury. If I get that person's pressure down to 20 millimeters mercury, that is a significant reduction in pressure. But imagine if that same patient's starting pressure is 22 millimeters mercury. Now lowering the pressure to 20 doesn't seem so impressive. So again, seeing you in the office is about recreating the story of your eye. I need to know the story of how your glaucoma damage happened to know how to stop it in the future. Number six. This leads to the final and most important thing you can do to be prepared for an eye exam. Get your old records. This is the best way for us to recreate the story of your eyes because we have every single piece of information we need. Well, isn't it your job as a doctor to get my records for me? Of course. We always try to get records from your doctor before you arrive, but that involves you identifying who we should reach out to. Also, and it shouldn't be this way, but getting outside records is hard. You as a patient are actually much more powerful here than me as a doctor making a request. You are the most powerful if you physically walk into the office and say, I want my records. It is difficult to deny a patient who is standing in the office requesting something. I recently booked an appointment with a sub-specialist myself. The call center told me it was my responsibility to get records from my previous doctors. No problem, I thought. I put in requests and then forgot all about it. I was shocked when I received a voicemail message two weeks before my appointment from my subspecialist's office saying my appointment would need to be rescheduled as I had not gotten records for them yet. Wow! These guys take their records seriously and expect a patient to take ownership in their care seriously as well. I would not be surprised if this is the way all practices work in the not too distant future. Wait time. If you call to book a new patient appointment with me, you will be told to plan for a three-hour visit. There is no way my appointment will take that long, you think to yourself. When I go see my regular eye doctor for glasses, I'm in and out in under an hour. There is just no way I'll be there that long. That must be a worst case scenario situation. I can completely understand this internal conversation, and I wish the three-hour quote was a worst-case scenario, but it's not. It is a real time estimate. And I insist the person booking your appointment say it not only once, but at least three times. Why? Because I think a lot of frustration can be avoided by setting proper expectations and planning. I see a sub-specialist myself. There are only a few of her kind of doctor in Atlanta, and I'm lucky that she happens to be one of the top specialists in the world. The first time I saw her, I did not have a clue what the wait time would be. It was four and a half hours. I was beyond frustrated. I was cold, hungry, my phone died, and I was thinking about all the work I could have done if I had my laptop. I asked why the wait was so long and was told she operates that morning at the hospital on patients who have already had multiple surgeries. Sometimes the surgeries go as planned, and sometimes they are much tougher than initially anticipated. The next time I had an appointment with her, I brought lunch, a snack, a sweater, my cell phone charger, my laptop, and a book I had been wanting to read. I was so ready. I waited four hours that day and was totally fine with it because I got all my emails answered, was sated, cozy, and got a few chapters into a really good book. To understand your wait time, you need to evaluate the doctor you are seeing and your own eye situation. What I mean by this is, are you a healthy person with great vision going to see an eye doctor to get a tweak on your glasses prescription? Or are you someone who has had a corneal transplant on a lot of different eye drops and you are worried you might have an eye infection? If you are the first patient looking to get your glasses tweaked, are you going to see a doctor who mostly sells glasses and contacts and sees generally healthy patients? If so, you will likely be in and out in under an hour. If you are the second patient, are you seeing a doctor who is a surgeon specializing in complex corneal diseases? If so, plan for that three hours. Think about medical subspecialties like an upside-down triangle. The more specialized the field, the fewer doctors there are in that field. The more patients they see, because there's just not enough of them, and the more complex the diseases they are likely treating. I see 50 to 60 patients a day. So the moment I walk into work, I'm already behind schedule because seeing that many patients is hard for any person to do if all goes smoothly. And I will tell you folks, there is not a single day that all goes smoothly. Patients may come in for one thing, but turn out to have a completely different thing. I might be swimming along one day, doing great, and managing to keep up with my schedule, but then a patient walks in with a pressure five times the normal amount, and I know right then and there I'm going to be an hour behind. What are examples of doctors you may see on the top of the inverted triangle? Those would be primary care doctors, OB gynecologists, family practice doctors. In our world, this might look like optometrists who are working in places that provide a lot of glasses and contact lens care. In the middle of the triangle are your specialists, such as cardiologists, rheumatologists, or dermatologists. In our world, this may be a comprehensive ophthalmologist who does cataract surgery. At the point of the triangle are your subspecialists. These would be cardiothoracic surgeons, colorectal specialists, neurosurgeons. In our world, these are cornea, glaucoma, or retina surgeons, for example. Every single doctor in the triangle is important. And every single patient seeing a doctor in the triangle is important. The patients seeing the doctors at the tip of the triangle likely have complex and challenging diseases that are not as Many people treat. So patients being seen at the tip of the triangle are likely going to need to wait longer than those patients being seen at the base of the triangle. Patients Responsibility. Doctors are trained to work on your body, but in the end, it is your body. Period. So you play the most important role in your own health care. I firmly believe patients have a real responsibility in their medical care. Your responsibilities may include being honest about how compliant or not compliant you are with a medication. Or perhaps your responsibility is to get your records into our hands. Your most important responsibility is to advocate for yourself. Let's say you run out of your eye drop medication. Instead of going without until your next appointment one month later, I want you to advocate for yourself by calling to ask for a refill. Now, doctors' practices are wonderful places. Everyone there is trying to help someone else. But doctors' practices are also chaotic and messy. Yes, I admitted that out loud. Messages can get lost or to-dos accidentally forgotten. Let's say you see the doctor and they order an MRI on you. You get the MRI, but it's been a few weeks and you haven't heard anything. I want you to advocate for yourself and call the doctor's office to request the results. Doctor's responsibility. We've talked a bit about what you are responsible for. But what about your doctor? We think of doctors as responsible people, sure. But they also have a real responsibility to you as their patient. A doctor's responsibility is not only to care for you, but to also involve you in your care. Medicine used to be paternalistic. This meant you came to see the doctor. They diagnosed and prescribed treatment and told you what to do. No questions asked. If there was a tough decision to be made, do you try the medicines longer or go for surgery? Your doctor made that decision without you. After all, you are just a mere patient. You haven't gone through four years of medical school, four years of residency, two years of fellowship. There is no way you could possibly understand what is going on enough to make an educated decision about what your body needs. Sound a little dismissive? I think so. So did a lot of other people. So medicine changed and continues to change. It is now much more collaborative. Your doctor does not tell you what to do, but rather educates you in simple layman terms that don't require 10 years of schooling to understand. You discuss together and together make a decision that is right for you as a person, not just for your body. Does this sound scary? Yes, if you rely on someone who does not believe in your capacity to understand, or perhaps their own ability to educate. But how can I understand what's going on when I don't even know basic terminology? I treat patients from all walks of life and all ages. I have a patient who is a neurosurgeon and another patient who is a stay-at-home mom with a high school degree. It truly does not matter to me because I believe from my heart that both of these patients can understand their options. I saw a patient yesterday for the first time. She had had a stroke in her left eye seven years ago. Since then, she had been receiving injections in that eye every seven weeks to keep from losing her vision. I asked her if she felt she regained vision after the stroke in her eye. What stroke? She asked me, shocked. Thinking maybe she knew it by its medical terminology, I said, oh, the BRVO, you know, the branch retinal vein occlusion, the one you had in your left eye seven years ago, the thing you're getting injections for. Well, I didn't know that was a stroke to my eye. I didn't really know what was going on. I have no clue why I keep getting these injections. I just know the doctor told me I would go blind if I didn't get them. I really don't know what's going on. I looked at my watch and sighed. I was going to be behind in clinic now because there was no way I was going to let this woman walk out of the office still not understanding what was going on in her eye. I spent the next 15 minutes walking her through exactly what happened to her eye, the long-term implications, what the injections were doing for her, and why she needed to have them. She listened very carefully and at the end asked me for a tissue. She was crying. I'd like to say this patient was an isolated incident. She's not. I hear this phrase again and again. No one has ever explained to me what is going on in my eye before. And I get it. There is one of us and 60 patients to be seen that day. But I also believe that if you invest a little bit each visit, a minute or two, over the years, a patient will understand. I have patients I've been seeing for 12 years now, and the moment I tell them what their eye pressure is, they say, Oh, that's really good for me and lower than last time. This pressure is actually two points lower than my goal pressure for this eye. The new drop I'm using is definitely working. And then I get a little teary-eyed. Conclusion. Seeing an eye doctor takes a lot of preparation. But gathering a few items and coming prepared to answer a few questions also goes a long way in making your visit as efficient as possible. And remember, it is your body. So advocate for it. Until next time, see well and be well.

SPEAKER_00 28:35

Um, like first I'd get like one of those magnifying glass little thingies, and then I'd like get one of those like medical spoon, get one of those like medical spoon thingies, and then I'd scoop it out and be done.

SPEAKER_01 28:50

You know, that's actually pretty much how we do the surgery. So that was an accurate description. Thank you.

SPEAKER_00 28:57

You're welcome.