reflections THE HUMAN SIDE OF OPTOMETRY
Give It Your Best
This O.D. couldn't solve his patient's problem, but he did help him maintain his quality of life.
BY ADAM P. RUBIN, O.D., GAITHERSBURG, MD.

When I saw Sam Gossard just after the New Year in the waiting room, I immediately thought I knew why he came in to see me. His right eye and the skin all around it were extremely red and swollen. I had never seen an orbit that looked so swollen except in textbooks, and I was already thinking of a specialist for Mr. Gossard.

"So how long has the eye been like that?" I asked now that he was in the exam chair.

"Since June," Mr. Gossard said, "but it's a long story."

I was about to ask him why he had waited so long to seek treatment for the eye, which must have been painful for the past six months. I almost started writing the chief complaint on the exam form, but I put my pen down to listen.

PHOTO BY JOHN BROWN

Listen first -- then diagnose

He proceeded to explain what had occurred. He was diagnosed with cancer, a squamous cell tumor in the sinuses around his eye, over the summer. Surgeons removed the tumor and rebuilt the entire area around his right eye with tissue and bone from other parts of his body. In September, he underwent chemotherapy and radiation. An infection developed under his right eye in October and didn't respond to antibiotics. Over the Christmas holiday, the inflammation worsened terribly. He returned from vacation and underwent more biopsies, CT scans and MRIs. The doctors found another tumor, but this one was inoperable. The tissue around his eye was swollen, the eye was displaced and a temporal mass still existed. I let Mr. Gossard speak, but I didn't pry for too many details as he sounded exhausted and upset.

I continued to listen. "I can't wear my glasses anymore," he said. They wouldn't fit on his face any longer despite a temple, padded to relieve some of the pressure it was causing on the side of his face, that was bent well away from his right ear. "I need a contact lens for my left eye so I can read," he said.

Finally, I picked up my pen and recorded the reason for Mr. Gossard's visit. Mr. Gossard was 52 years old, never wore contact lenses, and his left eye was +2.00 ­1.25 x 90 with a +2.25 add. Uncorrected VA OS was 20/70, best corrected to 20/20.

I explained why his vision would seem less clear with a contact lens compared to the vision he had with his progressive lenses. He accepted the compromise as he no longer drove, and he wanted to continue working and reading. Next, I proceeded by teaching him contact lens insertion and removal. The +4.00 ­1.25 x 90 lens worked well. His distance vision was 20/40 and he could read everything.

A success, sort of

Mr. Gossard was pleasantly surprised at how easy the whole lens fitting process was and how comfortable the lens felt. "I can read again," he said enthusiastically. "This is going to work great." He thanked me and set up a follow-up appointment to re-evaluate the contact lens's performance and fit.

When Mr. Gossard left I felt torn. I was saddened by his story, but happy that I could provide a service for such an appreciative, special patient.

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@BOUCHER1.COM. OM OFFERS AN HONORARIUM FOR PUBLISHED SUBMISSIONS.