Eye office myths are common, and a wide variety exists—from the feeling of receiving too many tests to thinking that all cataract surgery is the same.

Don’t worry—Dr. Mittleman is here to help! In episode 6 of “Through the Eyes of Dr. Mittleman,” Dr. Mittleman discussed some of the most common misconceptions that patients have about an eye office. We’ve broken down the key points from that episode—Check it out below!

Common Eye Office Myths

1. “Why so many tests?”

One of the most common frustrations patients have in an eye office is the feeling that they are receiving too many tests. Dr. Mittleman acknowledged this frustration and noted that it sharply contrasts from other specialties. For example, when visiting a cardiologist or gastroenterologist, patients expect many tests because they have already noticed that something is wrong and want answers.

As Dr. Mittleman stated with unflinching honesty, eye disease is different—and more insidious—because you often cannot feel it coming. Here are just a few examples of eye diseases that do not announce themselves early:

• Glaucoma.
• Macular degeneration.
• Diabetic retinopathy.
• Corneal cell loss.

By the time a patient notices something is wrong, the window for intervention may have already narrowed. The tests exist precisely to find what neither the patient nor the doctor can see unaided.

What modern diagnostics can reveal is remarkable. Dr. Mittleman used an apt analogy—Imagine replacing an old RadioShack microscope with an electron one. Below are just some of the functions that today’s tests can perform:

• Identify your optimal eyeglass prescription.
• Monitor structures in the back of your eye (retina, optic nerve, etc.).
• Measure your ability to see things out of the corner of your eye (peripheral vision).
• Measure the thickness of your eye’s outer layer (the cornea).
• See into structures that no exam light can reach—like cells on the back surface of your cornea.

The sooner an eye issue is detected, the sooner you can get the care you need to preserve your vision.

2. “Why does it take so long?”

Dr. Mittleman put it plainly: A visit that feels long is not inefficient but rather doing what it is supposed to.

At the start of a regular eye appointment, about 15 to 20 minutes is set aside for a technician to perform a variety of tests. As mentioned previously, many eye issues are not easy to notice early on. Thorough testing each step of the way helps ensure that any eye issues are detected early enough to maximize your visual health.

After the initial tests, a technician will place dilation drops in your eye. Dilation drops alone require half an hour to work. These drops are essential because they allow the doctor to see the inside of your eye.

For surgical patients, counseling on options and implant choices involves multiple conversations with different team members. At Mittleman Eye, we have many interconnected departments—from surgery to communications to billing. The goal is for you to gain the holistic, nuanced understanding you need to maximize your visual health.

3. “Why won’t a doctor perform all my tests?”

Most eye tests are run by technicians and not doctors. In both the Mittleman Eye Jupiter and West Palm Beach offices, technicians are certified, trained in increasing levels of complexity, and capable of performing these tests with precision.

Delegating the testing is not a lesser standard of care. It is how a high-volume practice maintains a high standard of care for everyone. According to Dr. Mittleman, if he ran every test himself, he would see only five patients a day! What’s more, the wait to get an appointment, already a month or two out, would stretch to years.

4. “Isn’t all cataract surgery the same?”

Absolutely not. Dr. Mittleman walked through the evolution of cataract surgery, from the old intracap procedure to today’s advancements:

• Large Incisions — Long before modern cataract surgery, procedures with large incisions were used, thus requiring multiple stitches and a longer recovery period. Here are some examples:
  • Extracapsular (ECCE) — An extracap procedure removes the cloudy center of the natural lens—while leaving its back membrane intact. To remove the entire lens, an incision of over 10 millimeters is required. This procedure initially had a success rate of only 50%. Today, it is still used to remove particularly dense cataracts, with a 90 to 95% success rate.
  • Intracapsular (ICCE) — An intracap procedure involves an incision of 6 to 8 millimeters, which removes both the eye’s natural lens and the thin membrane around it. Without a natural membrane, there is nothing to support the artificial lens implant, leading to a high potential for retinal detachment. Therefore, this procedure has been replaced by more modern methods.
• Phacoemulsification (Phaco) — Phacoemulsification involves making a small incision (initially 3 to 4 millimeters) in your eye’s outermost layer (the cornea). The goal is to be able to insert a thin ultrasonic probe, which breaks up the cataract inside your eye. Once all the small pieces of the cloudy natural lens are sucked out, a clear artificial lens is inserted. This procedure has advanced over time, with a main incision of just 1.8 to 2.75 millimeters, no stitches needed.

Every step forward changed outcomes dramatically. In fact, cataract surgery is still advancing, with laser precision as the next frontier.

5. “Why multiple pre-surgical measurements?”

Every patient presents differently—with different corneas, dilation, and retinas. All these aspects shape the surgical plan. For that reason, pre-surgical testing at Mittleman Eye is not a single round of measurements. It is four or five different tests, run twice, on two separate days. Dr. Mittleman’s rule: Measure twice, cut once.

For cataract surgery, the goal is to have the right power implant, placed correctly, with no surprises. Preparation is what’s key to preventing complications.

6. “Why can’t I use my insurance for everything in one visit?”

Two common types of insurance—vision and medical—cover different things and cannot be used on the same day. As Dr. Mittleman acknowledged, this can be a source of constant confusion and frustration for patients.

Vision insurance covers routine eye care (ex. annual eye exams), as well as corrective lenses (ex. glasses and contacts). On the other hand, medical insurance covers treatment for eye conditions that affect your health (ex. glaucoma and macular degeneration).

Certain laws prohibit medical practices from billing two insurance companies for the same examination. Dr. Mittleman explained it plainly: If you come in for red, itchy eyes under medical insurance, you cannot walk out with a glasses prescription. If you come in on your vision plan, you cannot be treated for a medical condition. When Mittleman Eye does provide a prescription under a medical visit, it is done as a courtesy, with the goal of understanding whether vision can be improved and identifying any underlying issue.

If you have an eye appointment, consider bringing both medical and vision insurance cards, if you have them. At Mittleman Eye in Jupiter or West Palm Beach, our team can help you select the insurance type that’s most relevant to your visit.

7. “What are my options for not needing readers?”

Dr. Mittleman discussed many alternatives to readers, ranging in different levels of invasiveness:

• Bifocals — One of the least invasive options is bifocals. Bifocals are eyeglasses that contain two parts—a top designed to correct your distance vision and a bottom designed to correct your close-up vision. Bifocals can be lined or unlined and in various configurations.
• Computer glasses — Another less invasive option is computer glasses, which Dr. Mittleman keeps at his own desk. Computer glasses are tailored to the distance of the screen. They also have a narrow band at the top for across-the-room vision if needed. Computer glasses are a great option for people who often switch between looking at a screen and doing close-up work (ex. taking notes).
• Multifocals — A moderately invasive option is multifocal contact lenses, also known as monovision contacts. These are when one eye is set for near and the other for distance. Dr. Mittleman noted that only half of patients can adapt to that, and his own trial run on the ski slopes nearly left him unable to find the lodge.
• Surgery — The most invasive option is surgery. For patients 45 and older, lens replacement surgery with a multifocal implant can address distance, intermediate, and near vision all together.

The best option for you depends entirely on your daily activities—whether that’s reading in bed, driving at night, welding, etc.

At Mittleman Eye, we’re here to help!

Going to an eye office can be intimidating. At Mittleman Eye, our team is here to answer any questions you may have. We offer appointments at both the Mittleman Eye Jupiter and West Palm Beach offices. To book an appointment, text or call us at 561-500-2020, or go online to mittlemaneye.com/appointment-request.

Dr. Mittleman’s radio series—“Through the Eyes of Dr. Mittleman”—airs every Saturday at 8 am on Legend Radio 100.3 FM (WLML) with Jill & Rich. Want to watch the full episodes after they’ve aired? Check out our YouTube channel!

Stay tuned for part two of our exclusive recap of “Through the Eyes of Dr. Mittleman”! We will be hearing from Dr. Mittleman about the philosophy of care that sets Mittleman Eye apart.