reflections: THE HUMAN SIDE OF OPTOMETRY
A Test of Spirit
How would a devastating diagnosis affect a young patient?
BY MARYAM H. DOOST, O.D.

Every once in a while, a patient influences our lives in a substantial way. Whether the impact is immediate or delayed, positive or negative, the encounter affects us whether we're wearing our white coat or not.

In 1999, a boy whom I'll call Michael, age 15, walked into my office accompanied by his father. The only thing even faintly remarkable involved Michael's prescription of -2.50 OU for myopia. A week later, Michael picked up his glasses and left the office with 20/20 vision and a big smile.

One year later, Michael returned, this time accompanied by his mother, which cast an aura of innocence about him. Michael explained that he wasn't seeing as well as last year. His mother reported that he squinted occasionally, but that she wasn't sure anything was wrong with his vision.

Delivering a devastating diagnosis

I automatically assumed that his prescription had increased, perhaps to -3.00 OU, but his presenting visual acuities were 20/60 OU. I struggled for some time with the exam and later realized that using the pinhole provided no improvement.

The slit lamp exam was normal, and I explained that I might have to dilate Michael to rule out other possibilities. As different diagnoses raced through my mind, I noticed a look of worry on his mother's face.

I grabbed my ophthalmoscope along with a 20-diopter lens and started to view the eye's posterior segment. The view was perfect, but what I saw shocked and saddened me. I sat down next to both of them and started to explain bilateral papilledema. Some time later, mother and son walked out with an immediate referral to the local neuro-ophthalmologist.

A few months afterward, I received a letter from the neuro-ophthalmologist confirming the diagnosis of bilateral papilledema. He also stated that he could remove only 90% of the tumor because of its nature and location. Furthermore, Michael would remain partially paralyzed on his left side and, in his opinion, experience failure to thrive.

I read the letter with mixed emotions. I was relieved that medical care had caught the condition early enough to save Michael's life, but I was upset and disillusioned that something this awful could happen out of the blue to anyone's child.

Recognizing a soaring spirit

Approximately 1 year later, Michael returned for a routine eye exam. I was glad to see him again, even under these circumstances.

His vision was correctable to 20/25 OU, but unfortunately, Michael was left with a visible exotropia in the left eye. The surgical procedure may have affected a part of the medial or lateral rectii muscles or both.

During the exam, I remembered the neuro-ophthalmologist's remark about the boy's failure to thrive. In that regard, he was wrong. Until that point, I had failed to notice that everything in Michael's actions and attitude said otherwise. Michael's spirit wasn't broken. He smiled and displayed a great sense of humor. Michael would surely thrive in whatever he did despite the setbacks he'd experienced.

Continuing reminder

I still think about Michael. Because of my experience, I further appreciate all that I've been blessed with, try never to take anything for granted, and most of all, intend to never allow anything to break my spirit. 

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH KAREN RODEMICH, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT AT (215) 643-8135 OR RODEMICHKF@BOUCHER1.COM.