Definition and Overview

Ocular pathology consultation is an appointment between an ophthalmic pathologist and the patient’s attending ophthalmologist to discuss the results of diagnostic tests that were requested by the latter in order to make or confirm his initial diagnosis.

Patients with eye concerns or those who experience vision-related problems typically visit an ophthalmologist for a consultation. The ophthalmologist will then perform various tests to try and diagnose the problem. If the tests are inconclusive or if the ophthalmologist wants a confirmation of a suspected condition, he will order additional tests that an ophthalmic pathologist can perform. The patient is then referred to the latter. Once the tests are completed, the results are forwarded and discussed with the patient’s attending ophthalmologist so diagnosis can be made or confirmed.

Who Should Undergo and Expected Results

Specialised tests can be performed by an ophthalmic pathologist if the patient:

  • Has gone through surgery – At this point, the ocular pathology test begins with a biopsy, in which a sample tissue is obtained after surgery and sent to the lab for study. In other cases, it’s the fluid of the eyes that is extracted through a procedure called an aspiration.

  • Is showing symptoms of eye problems – Common signs and symptoms such as blurred vision, appearance of floaters, and difficulty in focusing may indicate problems of the eyes, especially if these situations occur more frequently and for a longer period.

  • There’s a prominent change in eye structure – An example is the growth of a tumor or a mass that can affect the eyes, even if it doesn’t originate there (like an overgrowth around the nasal cavity). The patient may then undergo a biopsy to determine whether the cells present in the sample are benign or malignant.

  • Has a high risk of developing an eye condition – Patients with diabetes, for example, can develop diabetic retinopathy wherein the nerves of the eyes are damaged as a complication of the disease.

When patients are referred to an ophthalmic pathologist to undergo diagnostic tests, it does not automatically mean that the patient has eye conditions. That is for an ophthalmologist to figure out based on the results of the tests, including imaging and physical. Nevertheless, the results can still be a huge part in helping the ophthalmologist come up with an accurate diagnosis and treatment if it’s necessary.

How Does the Procedure Work?

A consultation occurs when the eye doctor or the ophthalmologist requests the patient to undergo a pathological exam. In this case, the patient is referred to an eye pathological lab, which can be its own facility or a part of a hospital.

A professional staff from the lab prepares the patient for a biopsy or an aspiration. A form will also be filled to collect the information such as the patient’s name, his birth date and date of the procedure. The person who performs the procedure then identifies the specimen obtained, the procedure performed, and the ophthalmologist who will receive the results. The form should accompany the sample container.

After the patient has gone through the procedure, the staff will orient the patient on what he needs to do for the recovery process. It’s required that the patient is accompanied by someone who can drive. The patient’s activity may be limited for a day or two after the procedure.

The patient waits until the results have arrived. They will be sent to the ophthalmologist’s clinic. He will then make a diagnosis or request for more exams. It usually takes up to a week before the results are released. During this period, the ophthalmologist may prescribe medication to treat symptoms, if there are any.

Possible Risks and Complications

One of the possible challenges with the consultation is the patient's lack of enthusiasm to participate in the whole process. First, he may not fully understand the importance of the pathology exam. Second, there can be a miscommunication among involved parties. It’s also probable that the patient hesitates to go through the test due to fear or anxiety. A strong, comfortable, trust-oriented relationship between the doctor and the patient can help reduce these types of occurrences. It’s also essential that the health care team has a good communication system, which may include automatic notifications to help remind the patient of the pending consultation.

Reference:

  • Fisher YL, Nogueira F, Salles D. Diagnostic ophthalmic ultrasonography. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 2, chap 108.
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