reflections

Uncharted Waters

With some patients, the line between doctor and parent becomes blurred.

Suzy Lake, O.D., F.C.O.V.D., Warrensburg, MO.
THE HUMAN SIDE OF OPTOMETRY

Certain patients, especially children, tug at our heartstrings, and we become parent-like toward them. Specifically, we take pride in and become cheerleaders for their success. Shilpa is one of those patients.

A new home

Shilpa first presented to my practice at age seven. She had just been adopted from India, and her new family had brought an interpreter to the appointment. She cautiously climbed into my exam chair.

Her past ocular history revealed a botched congenital cataracts surgery. Upon exam, Shilpa's eyes watered constantly from general sensitivity to light. Her left eye exhibited an obvious corneal scar. It was also soon diagnosed with glaucoma and an almost constant strabismus. Her entering acuities were 20/400 OD and Hand Motion OS.

She avoided using the interpreter. Looking at this timid little girl, I tried to put myself in her position: Although the conditions of her orphanage were reportedly awful, it was the only home she'd ever known. Now, she was on the other side of the world with new caregivers, a language barrier and a woman she'd just met using strange instruments on her eyes. I realized I simply couldn't fathom her the fear.

Dr. Lake and her recent 20/40 patient, Shilpa.

The plan

Shilpa's amazing adoptive family was very realistic about her visual limitations, but they were also determined to maximize her vision.

To accomplish this, the last five years have included patching the strabismic eye, vision therapy to maximize her acuity, contact lens wear for her high prescription and the anisometropia, glaucoma drops and visits with numerous eyecare specialists. Her left strabismic eye is now 20/200, with any possibility for improvement slim. Her “good” eye bounces between 20/100 and 20/60 +.

A 20/40 prescription has always been my goal for Shilpa's “good” eye. A new country, family and opportunity were not enough for me with this girl. I wanted her to be able to drive. I vividly remember the freedom of driving and how fortunate I felt to experience it.

This year as we began her exam, I realized that Shilpa, who now wore a comfortable smile during her visits with me, was only months away from being a teenager. So, our time to reach my goal was fast approaching.

The outcome

We, as O.D.s, know that our patients' pace and certainty hints at how far they'll read the chart. With Shilpa, I noticed that as she hit the 20/50 line, she was still correctly identifying the letters and doing so rather quickly. As she moved to the beginning of the 20/40 line, I swear I could feel her dad thinking the same thing as me: “Come on, come on…” Then it happened. Shilpa made it through the 20/40 line, and the waterworks started — from me.

At the moment Shilpa got through the 20/40 line, I knew the improvement in her acuity had opened a door for her that had previously been closed. As a parent and as a doctor, I'm thrilled to report that Shilpa will have the opportunity to “fly from the nest” while driving herself. OM