REFLECTIONS: THE HUMAN SIDE OF OPTOMETRY
What I Learned at School
A stuck lens reaffirms a personal philosophy.
BY EMILY NICOLL, O.D.

One Friday afternoon, I received an emergency message from a local elementary school about one of my patients, Ann, age 5. With blond hair and blue eyes, Ann was a 4.00D myope whose mom had a -5.00D soft lens correction and whose dad had a -11.00D soft lens correction.

Two weeks earlier, I'd fit Ann with rigid gas permeable (RGP) lenses. I usually spent two 1-hour sessions teaching children about the insertion, removal and care of lenses before dispensing them. But I had to bring Ann back for a few more sessions before I felt comfortable dispensing the lenses to her. During the sessions, I let her take breaks to have cookies and milk, a technique I often used with kids, because the office was in my house.

When I returned the call from the school, a near-frantic school nurse told me that a contact lens had slid off Ann's cornea. While the nurse was trying to help remove it, the lens became firmly adhered to the nasal sclera, causing discomfort.

The school couldn't reach Ann's mother or father, so she asked the nurse to call me. The administration thought that they should take her to the hospital emergency department, but that prospect upset Ann even more, and she repeated her request to call me.

"Dr. Emily is an eye doctor and she can fix it," she said. "She'll use that sucky thing [rigid contact lens plunger]. Mommy would say it's okay to call her. Please call Dr. Emily. We always call her with eye problems." Ann took my card from her contact lens case and showed them that I'd written, as I usually did, "Call me any time you have trouble."

I drove the few miles to the school with the DMV remover, fluorescein and a Burton light and removed the lens. "I told them to call you," Ann said. "I knew you'd come and fix it."

I later showed the school nurse RGP removal techniques and gave her the plunger to keep. I also explained to her that I fit RGP lenses on a child so young because they'd proven to retard myopic progression. The earlier children start to wear RGP lenses, the less myopia they're likely to have. That was especially the case with Ann, because both of her parents were very myopic, and she had a high correction at a young age.

Following the incident, Ann was a celebrity among her friends because her eye doctor came to school to help her. What's more, the nurse and other school staff members avidly supported our practice by referring patients. Ann's parents appreciated my extra concern and help.

A good day

My encounter with Ann happened 12 years ago. Ann remained my patient until my husband and I retired from practice 3 years ago. Recently, I saw Ann in a store. She was still wearing contact lenses and had experienced only a slight increase in her myopia since I originally fit her with RGPs as a child.

When I think back on removing Ann's lens, I realize that most days don't get much better than that Friday afternoon. Helping Ann reaffirmed my feeling that the time and effort we spend caring for patients who wear RGPs leads to a special doctor-patient bond. It's one of the special treasures of our profession, and something they don't teach you in optometry school. 

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