Dateline: An Eye Clinic in Guadalajara

My mother has now had macular degeneration in both eyes for a number of years, at least five, and possibly ten or more. The treatment, though horrifying, has been pretty much the same for this entire period: every four weeks she gets an injection of Avastin in each eye. In fact, this has been such a regular, and seemingly well-controlled part of her healthcare routine, that I essentially had been totally uninvolved. Save for the fact that I’d drive her to her appointment, and then pick her up an hour later. I never questioned the treatment, nor really had any discussions with her provider, who with several other doctors ran a large, successful eye practice.

So when we got to Mexico, I needed to find an ophthalmologist right away to resume the monthly treatments. Fortunately my friend Lisa could recommend Dra. Claudia Camacho Choza, a third-generation ophthalmologist who had done her cataract surgery, had a good reputation in the Gringo community, and who had a part-time office in Chapala to boot.

Unfortunately, when I called to book an appointment, the earliest slot in Chapala was in April, but she could see us in a week in Guadalajara. So we schlepped to Guadalajara for a morning appointment. Since this was a new doctor, I sat in on the appointment just to be sure that if anything new needed to be remembered and acted on, I could make sure it happened. I also wanted to make sure that the Doctora’s English was good, and it was.

As I sat through my mother’s very thorough eye exam, I learned several interesting things. First, my mother’s right eye retina is badly scarred from the macular degeneration. And that the vision in this eye is very bad, as in even with glasses, mom can’t properly identify the largest letter on the Snellen chart, the standard measure of visual acuity. Nor can she tell whether the doctora was holding up one or two fingers at a meter’s distance. However, with correction the left eye can see at 20/30, pretty much normal. I also learned that in Mexico, ophthalmologists don’t do the eye injections that my mother is accustomed to receiving. Instead, we’d have to see a retinologist, who would do the injections in an operating room. So Dra. Camacho wouldn’t be able to do my mother’s treatment. However, she did point out that since the right eye was badly scarred she thought it was highly likely that continuing to treat it would be non-productive, e.g., a waste of time, money, and putting my mother through needless pain in the process. In short, the right eye was a lost cause, in her view.

Snellen Visual Acuity Chart

So we scheduled an appointment to see Dr. Daniel Silva, the retinologist, a week later. When we showed up to the appointment and explained what we wanted, Dr. Silva was astonished. “What? You want eye injections now? You mean your mother has been getting these injections monthly, like clockwork???” he said in astonishment. I feared that I was about to be upbraided for not having gotten my mother in sooner. At this point, we were six weeks away from her last treatment, and I was feeling guilty that I hadn’t managed this earlier.

As it turns out, things were entirely different than I had suspected. Before leaving Redding, I got my mother’s last doctor to print a record of all treatments that she had received over the past year. Dr. Silva was looking through them and was puzzled. “When was the last time your mother had a dye test?” he asked. “A dye test?” I said I didn’t know. The doctor then explained that for macular degeneration, particularly the wet variety (which is what my mother was diagnosed with), the standard practice was to do this test at least every six months. You’d do an intravenous injection of dye, wait, then do a photographic study of the eye to see what was going on, whether there was leakage, where, etc. Only then, he said, would you prescribe a course of treatment, based on the information revealed by the test. In short, he seemed to be shocked that my mother’s doctor had her on a four-week autopilot program of injections in both eyes. And though he said he’d wait for the results of the test for a formal opinion, just looking at my mother’s right eye he concurred with Dra. Camacho: it almost certainly didn’t make sense to keep treating it.

Dr. Silva also explained that he thought it unlikely that he would be prescribing monthly eye injections in any case. Though he cautioned that we’d have to wait to get the tests done, based on what he could see, he thought my mother would need many fewer injections than what she had been receiving in Redding.

So we returned a week later for the tests. We were warned that it would be a long, boring appointment, and to bring some form of entertainment. The time estimate that we’d spend in the doctor’s office was between two and a half to three hours. Ugh! During that time, mom underwent the various tests, but mostly we just sat around, either waiting for a slot, waiting for her eyes to dilate, or waiting for the dye to travel to her eyes. After about three, long hours, Dr. Silva called us back into his office to discuss the results.

The news was very good,in fact astonishingly good. First, (and I’m backing up a bit here), the eye injections would have cost $4,000MXN, about $208 per eye, for what I was thinking would have been a $416 USD monthly expense, not an insignificant budget item. But the tests my mother had just undergone priced out at only $2,800MXN, or about $145. But the news got even better. As he suspected, Dr. Silva thought that it made no sense to treat mom’s right eye. But the best news of all? Mom’s formerly wet macular degeneration had now become dry, and as a result, required much less treatment. Dr. Silva gave us a 70% chance that mom might never need any eye injections again. So for now, no injections, though he did recommend vitamins with lutein, and for mom to wear UV-blocking sunglasses whenever outdoors.

For follow-up, he wants to see her in four months, not for the dye-injection tests that he had just done, but for him to do a visual inspection. That will cost only $800 MXN, about $42 USD. If he feels it’s warranted, then he’ll order the dye test again. But for now, a big potential expense has been taken off the table. And mom won’t have to schlep to Guadalajara every four weeks, nor endure the regular pain she’s been subject to for these past many years. This was better news than I could possibly have imagined. Mom and I were both delighted.

And this all raises an obvious question. What the heck was her old ophthalmologist doing? I asked Dr. Silva, and he didn’t really want to answer. But I pressed him. “Could there be a different standard of treatment in the USA? Different protocols?” But what he did say was revealing. “Everyone’s eyes are the same, the world over. We ophthalmologists all go to the same international conferences, use the same tests, the same drugs, the same equipment. I don’t understand why your mother’s doctor was pursuing the course of treatment he was.”

And I can’t but help being left with the feeling that my mother was essentially the victim of some kind of medical scam in the USA. Oh, it’s probably not something you could get away with actually calling a scam, per se. I’m sure there are layers of legalese and precaution wrapped around the justification for this. Maybe. But I’d love to talk to another U.S. based ophthalmologist about this story. Because from what I know now, I can’t escape the idea that at a minimum, mom’s old doctor was definitely over-treating the right eye. And possibly even over-treating the left eye. But for now, it looks like my mother’s eye situation is going to be better, cheaper, and less painful: that’s what matters the most.

And we’d never have known without the marvelous Mexican doctors we’ve seen here. Viva la medicina Mexicana!