Dr. A

Anonymous cornea specialist

Thank you for your tremendous work in launching caringforcorneas. As you know, corneal neuralgia (aka “ocular neuropathic pain”) is an increasingly recognized ophthalmic disease that can occur in a variety of settings and may cause severe functional impairment and distress to patients. The condition is likely severely underdiagnosed; for example, it is probably that many patients labelled as having “severe dry eye” have an element of corneal neuralgia, as do patients with disproportionate symptoms assumed to be “difficult patients” or having a psychiatric illness. The condition also occurs well beyond the post-LASIK setting; some patients report no history of surgery of any kind.

As an Ophthalmologist with subspecialty focus in Cornea & Refractive Surgery in the province of Ontario, I am discouraged by the lack of proper diagnosis and treatment that patients with this condition receive. Most importantly, there is no publicly available confocal microscopy in Ontario. Confocal microscopy is an imaging technique that provides real-time high resolution images of various layers of the cornea. It is the ONLY way to accurately diagnose corneal neuralgia, and apart from symptoms the only objective method of evaluating response to treatment. Although this device is expensive (at least compared to other ocular imaging devices), a single confocal microscopy in the province of Ontario would be of significant benefit in not only diagnosing/managing patients with corneal neuralgia but also in patients with other corneal disease such as complex infections. I have no doubt that the cost of the unit would provide indirect savings to the health care system in the long-term.

Without ready access to a confocal microscopy, clinicians such as myself are often left to diagnose the condition only after extensive therapeutic trials which often leads to doctor-patient mistrust and prolonged suffering of patients (at worst, self harm). Most of these treatments are expensive and not covered by provincial health plans as dry eye/corneal neuralgia lack recognition as a “true disease”. In addition, OHIP increasingly creates barriers to patients who wish to travel abroad for proper diagnosis (e.g. to Boston). While OHIP at times will provide reimbursement for the cost of an appointment, patients are otherwise left to pay themselves for travel and accommodations. Clinicians are also frustrated by the increasing bureaucratic difficulties in attaining approval for out-of-province care; I myself often receive responses from the Ministry of Health asking for unnecessary supplementary information that serves no purpose but to delay patient care. As a result, many clinicians have ceased offering completion of these forms.

I thank you again for your work in launching this website; I hope this website will increase awareness in patients, physicians, and government alike.