diagnostics

Of all the primary senses, the loss of sight produces possibly the biggest change in a person's quality of life. For instance, sight is more related to mobility than the rest of the senses. However, the eye is also related to the human psyche symbolically, culturally and financially.

Significance of the eye

In most cultures, beauty is gauged through the eyes. And eye beautification is a large portion of the cosmetic industry. So a visit to the optometrist is a potentially stressful event (possibly more so for a woman). A patient who visits your office in fear of losing his or her eyesight may be under different stressors than those making a routine visit.

Case in point

A 45-year-old woman presented to the University of Alabama at Birmingham's contact lens clinic to be fit with GP lenses after past radial keratotomy (RK). She had been wearing monovision Dyna-intralimbal lenses that provided her 20/20 acuity for a year. She was using her right eye for distance and left eye for near vision. When she came to the clinic, she had lost her right lens. After trying various lenses on her eye, I fit her with Surgical C4 (ONSI 56) lenses in both eyes.

Although she did not complain about her lenses initially, I learned that her night vision was intolerable and she also had ghost images. Further, her vision worsened when she placed sunglasses over her contacts during the day. She is a postal worker who delivers mail from one house to the next, so this was especially problematic.

Fitting a new set of lens was an emotional experience, presumably because none of the lenses fit or felt very comfortable, though we finally fit her with surgical lenses that gave her good acuity and comfort. She apologized for taking up my time, regardless of my reassurances.

It was emotional for her to talk about her RK and she became overwhelmed by tears. I explained the incisions were en- croaching on her pupillary area, especially when her pupils dilated, which causing some of her visual complaints. The significant difference in refractive power near her pupil was causing her to see ghost images.

Because this patient was so comfortable sharing her emotions with me, after some time, I asked her if there was something else going on in her life that she would like to talk about. She broke down and informed me that her husband was struggling with lung cancer. She has two children in school and is the breadwinner of the family. She's been so reliant on her vision to carry on with her daily activities that the thought of losing her sight made her sad and depressed. She had undergone RK thinking even if she had to be fit with contact lenses, it would not be very complicated; alas, she is faced with a perceived loss of eyesight. I am glad she is seeing well and back to her routine of working as a mail carrier, caring for her cancer-stricken husband and raising her children.

What to say?

Loss of eyesight might be just one of the problems in a patient's life, but that might be the most important loss for anybody. Whether a patient's decrease in eyesight is perceived or diagnosed, the emotional difficulty is very real.

Consider: When we test a patient's visual acuity and find he or she should not be driving, as an optometrist it is our duty to report this to the DMV. But imagine the patients' emotional turmoil: They can no longer drive. They are now dependent on another person to go anywhere. Their lives have changed drastically.

As doctors, it is our responsibility to take a moment to ask the appropriate questions and listen to our patients. Just taking that extra minute to ask shows we care. And these simple steps may serve to empower the patient.

I find it best to ask direct and simple questions, such as, "What is going on in your life?" or, "What will happen to you or your family if you lose your eyesight?"

Listen empathetically

Patients are not looking for any psychological advice from us, nor are we trained to counsel. But I believe many would like to be heard by someone as credible as a doctor. Once they express their emotions, patients generally feel better and are able to think more clearly so they can make better decisions about their lives. I have personally found patients to be thankful for the empathy. What could be more important for a primary eye care doctor than a visually and emotionally satisfied patient? OM

Dr. Chandrasekaran is currently a resident at the UAB School of Optometry, focusing on cornea and contact lenses. Dr. Mugilan has a Ph.D in health promotion, an M.S. in Sociology and a Master's degree in Public Health.