Life throws a curve ball

D.H. was a healthy, vibrant 52-year-old woman when she came in for her routine eye exam. She took good care of herself: a healthy diet, a daily multivitamin, and she worked out at a Curves gym three times a week. She also had her blood glucose checked every three months because her father was a diabetic. Her only visual complaints were that it was getting harder to focus on her sewing and her glasses were scratched.

Her exam was proceeding as normal — just a slight bifocal change and mild dry eye. I explained the importance of routine dilation, which she readily agreed to because of her father's diabetic retinopathy. What I saw when I looked in her eyes surprised us both. She had multiple dot and blot hemorrhages in the macula and periphery of both eyes. Some of the hemorrhages had white centers indicative of Roth Spots.

Taking action

We discussed the possible etiologies, none of which were reassuring, and I obtained an urgent retinal consult. Within 48 hours she was in an appointment with the ophthalmologist, who ordered STAT blood work including a random blood glucose,

CBC with differential and platlets because of the Roth Spots. Her white blood cell count came back in excess of 230,000 cells/mcL (with normal being around 10,000 cells/mcL). She saw an oncologist in Indianapolis the next morning. Her diagnosis: acute mylogenous leukemia.

Two weeks later, after a six-day stay at the cancer center going through leukophoresis and starting on chemotherapy, D.H. came back to tell me "Thank you" for saving her life. The oncologist told her that if she had not had an eye exam when she did, her leukemia would not have been discovered as early as it was, and it would have certainly been fatal. With her white cell count as high as it was, she could have had a fatal stroke at any time. However, she now has a 98% chance of survival. She also said her oncologist was impressed that an optometrist found the hemorrhages that ended up saving her life. Needless to say, D.H. is now a firm believer in "routine" dilation!

Don't take it for granted

As I was blinking back the tears at her "thank you," I found myself saying "thank you" to God for our profession and the unique opportunity we really have to help our patients. Even the opportunity, occasionally, to help save a life.

I recently received a follow-up letter on my patient. Her retinal hemorrhages have resolved and she is still 20/20 in each eye. She'll be on chemotherapy for the rest of her life, but her prognosis is good.

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 A MODEST HONORARIUM FOR PUBLISHED SUBMISSIONS.