Diagnoses

Primary examination

A patient’s first consultation comprises a detailed medical conversation to enable the physician to grasp and evaluate the type and duration of the complaints, any preceding eye intervention and existing general morbidities. Patients should bring any relevant preliminary medical reports they have received to the consultation as they are useful for assessing the course of the disease and avoid redundant examinations. This applies in particular to previous ocular procedures. Indications of any drugs or eye drops that are currently being taken will also provide important information for the ophthalmologist.

A standardized visual acuity tests will be conducted to measure the extent of vision impairment.  Patients should bring along the distance and reading glasses they are currently using so that their test results can be adapted as far as possible to current conditions. The suitability of the glasses is examined within the scope of the acuity test, while precise visual acuity is tested directly. We only advise on new spectacles in exceptional cases as this is usually undertaken by the referring ophthalmologist.

The follow-up examination is usually quicker and less extensive as the patients’ history and individual condition is already well documented.

Examination of the anterior eye segment

The external section of the eye, comprising eyelids, conjunctiva, corneal surface and tear film, is first examined with a slit lamp microscope to find out if there are any changes. In principle, even where only one eye is giving problems, the fellow eye is examined as well to exclude any bilateral affection. At this stage opacifications, acute or chronic irritation, and frequent dryness, so-called Sicca syndrome, can be recognized and treated in a focussed manner. Intraocular tension is routinely measured during the initial examination using the reliable applanation tonometry method.

Healthy clear lens

Opaque lens

Examination of the posterior eye segment

At every examination, the entire eye is thoroughly viewed with a slit lamp to detect any change in the refractive media such as cornea, ocular lens, as well as the anterior and posterior eye chambers, the latter is referred to as the vitreous body. The pupil is dilated with eye drops so that the entire posterior eye segment comprising the fundus of the eye with retina, optic nerve and retinal vessels can be examined in detail. This procedure is generally recommended for the initial examination. Pupil dilation temporarily reduces visual acuity, therefore, patients are advised to use public transport rather than driving a car following the examination. Patients are examined with special lenses for retinal examination which allow to avoid direct contact with and impairment to the eye.

Healthy retina

Early age-related macular degeneration (AMD)

Dry macular degeneration (AMD)

Wet macular degeneration (AMD)

The results of the eye examination are discussed promptly and comprehensively and any further investigations that might be necessary are planned jointly with the patient.

Optical coherence tomography

Optical coherence tomography, known as OCT, is the internationally recommended method for diagnosing retinal diseases, especially when changes in the sensitive retinal center, the macula, are suspected. An invisible laser scans through all the transparent layers of the posterior pole of the eye, the retinal pigment layer and the underlying choroid and produces an accurate visualization of any pathological changes in excellent detail. With the use of OCT, a physician can diagnose diseases of the retina and the visual pigment before they may affect the patient’s vision or permanently lead to vision loss. This is particularly important in macular diseases such as age-related macular degeneration and diabetic macular edema, where further visual loss can be prevented or lost vision can be restored by timely intervention.

OCT in healthy macula

Pathological OCT in AMD

OCT is used during the course of treatment to determine exactly how well the eye has responded to therapy and establish if follow-up treatment is required. The OCT results are printed out, discussed with and given to the patients for their own interest.

Additional investigations

Some common and, particularly, rare diseases require additional examinations, for which special devices are used for accurate identification and diagnosis. The technology of these devices is continuously being developed with a view to detecting specific conditions for individual diagnoses. With my scientific work and close cooperation with numerous expert groups I, as your consultant physician, have direct and immediate access to all clinically meaningful and necessary methods and experts to provide you with a comprehensive clarification of your eye problems.