Apr 10, 2008

THE EYE MAN: Patient left wondering after cryptic diagnosis

Dr. Andrew Soss / Daily News columnist

Dr. Soss: I had an eye exam a couple of weeks ago. My eye doctor told me that I have something like a freckle in the back of my eye that he needs to check every six months to a year. He didn't seem too worried about it, but said that it can be the start of cancer someday in my eye. I've been thinking about this a lot lately. It sounds serious. How come he's not more worried? I am. I haven't been able to sleep well since then. Is there any advice you can give someone like me who has this problem?

R.W.



R.W.: Your question to me relates more to the fact of how important it is for doctors to spend the time to accurately provide information to their patients. Many times doctors are rushed and fail to inform patients properly in a manner which can easily be understood by a layperson. Certainly, there are times when doctors do try to inform their patients with details related to sensitive conditions, which unfortunately may be misconstrued. But, the vast majority of times, I find that it would take far less time and energy to properly discuss the patient's condition the first time. This would reduce anxiety and the dissemination of misinformation.

As an example, what you are describing to me does not at all sound like a "freckle" in the back of your eye. The condition is called choroidal nevus. This condition is completely benign (nonthreatening) except in about one out of approximately 80,000 cases. As eye doctors, we should find this condition in about 10-12 percent of our patients. Therefore, it is quite common. A nevus is analogous to a mole, not a freckle, in that it is not just a color change, but an actual mass of tissue substance. The reason we call it a choroidal nevus is because this very tiny mass of tissue is located in the eye just beneath the bottom layer of the retina known as the choroid.

There are many presentations of this condition. Some presentations warrant more frequent evaluations than others depending on the size and location of this lesion. I am sorry that you were stressed out in relation to this condition. As I have said many times, do not be afraid to get another opinion from a doctor who might be more willing to explain findings more accurately and thoroughly.

Questions to Dr. Soss should be sent to his e-mail theeyedoctor@att.net or via his Web site at www.dr-andrewsoss.com. All answers & opinions are those of Dr. Soss and not necessarily shared, endorsed or affiliated with this or any of our newspaper agencies.

Dr. Andrew C. Soss, OD, FAAO, has been practicing for over 20 years. During that time he has been a clinical instructor in the department of ocular pathology at the University of California. As a primary eye care provider in private practice in Burlingame, he is also board certified in the diagnosis, treatment, and management of primary open angle glaucoma.