reflections

Two Lessons in One

Be vigilant when examining patients and check your baggage when receiving a compliment.

ANDREW S. GURWOOD, O.D., F.A.A.O. DOYLESTOWN, PA.

Ocular conditions, deemed "textbook" by their various signs and symptoms, are not always as they seem. Similarly, compliments are not always received as they're intended.

Cataract surgery gone awry?

A chief of surgery who recently underwent cataract surgery in his right eye said his vision was initially fine after the surgery, but it had now "dropped off." He reported no pain or acute disturbance.

The following diagnoses crossed my mind: A changing or unstable spectacle correction requiring refraction; recurrent or residual inflammation producing some medial clouding; posterior capsular opacification (Elschnig's pearls); dislocation of the intraocular lens implant or macular edema.

Grossly observing no redness, I employed my retinoscope to check for refractive changes. Following some minor adjustments, I corrected his 20/30 vision to 20/25. Next, I tweaked his bifocals to which he excitedly replied, "Perfect! That's it. Thanks," as he headed for the door.

Unconsciously suspicious

Although I solved the problem, I asked the patient to stay for a few more minutes so I could check his ocular health. I'm still not sure what compelled me to do this; perhaps it was out of habit. Anyway, slit-lamp exam revealed a slight posterior capsular opacification (not unexpected or clinically relevant). His pressure was normal. I also asked him to permit me one last procedure: direct ophthalmoscopy. I noticed something in his right eye that I couldn't identify. To get a better look, I used undilated 90D lens technique. Unsure of the diagnosis, I dilated him.

The result: the patient had a rhegmatogenous retinal detachment temporal to his macula that needed immediate repair. A retinal specialist confirmed the diagnosis and immediately repaired it that day.

"You're an amazing refractionist!"

A few months later, I was browsing in a department store while my wife shopped. A woman behind a counter said, "You look really familiar. Have I helped you here before?" I replied, "I bet you say that to all the guys," — I didn't recognize her. Positive she knew me, she began drilling me with questions. "I know who you are," she said, her eyes widening with recognition. "You're Dr. Gurwood. You've given my entire family glasses, and you treated my husband after his cataract surgery. You're an amazing refractionist!"

I smiled and thanked her for remembering me, but inside I was miffed. Here, I discovered an asymptomatic retinal detachment that was encroaching on her husband's macula and as a result probably saved his career, and all she remembered me for was great glasses?

As we left the store, I vented to my wife. Her reply surprised me: "Andy, most patients don't have the vaguest idea of what optometrists do. But what that woman does know is that you provide her and her family with excellent vision. I think you've been so sensitized by the political environment between the professions that you think what she said wasn't a compliment. But … it was a very nice compliment."

What could I say but: "Thanks." OM

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH JENNIFER KIRBY, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8139, OR -KIRBYJ@LWWVISIONCARE.COM. OM OFFERS AN HONORARIUM FOR PUBLISHED SUBMISSIONS.