Hi guys,
It is your favorite Optometrist here once again, and you know how we do it, once I am here we are definitely taking a look at our general and ocular health. It is always my priority, and I admonish all my readers to prioritize their health.
@nattybongoToday I would be telling you a story, a true story of course based on one of my patients whom I have been seeing for a while and I am hoping that what I have to share today would go a long way to help my readers when it comes to making medical decisions. Before we dive in though, how are we all doing? I hope all is well with you all?
The Story
I have a glaucoma patient whom I have been seeing for the past few months, well he is a teacher and quite the intellectual I must say, he is a very interesting person to talk to and he is one of the most open-minded individuals I have met in my line of work. When I first met him, thus, his first visit to my facility, he came with his diagnosis as a glaucoma patient and his issue was that he was dissatisfied with his previous place and so he eventually had to come here.
@nattybongoAt that point he didn't give me the full story so I let it hang in there, we looked at the most important things regarding his eye, I asked him to do some scans, we underwent the routine tests and then we realized that his intraocular pressures were too high if my mind serves me right, he had about 50mmhg in the right eye and 60mmhg in the left eye. Ideally, your intraocular pressures should be between 10 and 20 so you can imagine how bad this is.
He was in pain, which I explained could easily be attributed to the rise in intraocular pressure, which is putting pressure on all the ocular structures. I gave him Diamox stat, gave him some local anesthetic to ease the pain just a bit on the eye, and then started him on antiglaucoma drugs. Over the next couple of months we have been managing the pressure and today when he came in the right eye was 23mmhg which was very good however the left continues to remain in the 40s, and the actual figure was 45.
The right eye sees very well to the ideal point that the emmetropic eye ought to see however the left eye is completely blind. So today he decided to share with me how he lost the vision in that eye and inquire if anything could be done and if he is going to lose the eye so he can psych himself now, prepare for retirement, and other stuff. As I said he is one of the most open-minded patients I have ever encountered so I understood and was quite frank with him.
According to him, when he was initially diagnosed with the glaucoma condition, he use to ask his healthcare provider a lot of questions however he wasn't getting the feedback he wanted and at a point, it seemed like he was being a nuisance so he stopped. Then he noticed that his vision in the left eye was declining rapidly, anytime he went for a checkup his intraocular pressure in that eye was 60, however, his medication wasn't been changed, and he wanted to get a second opinion from another however he wasn't sure if this could prove negative against him in any way.
So he waited until he realized that he could no longer see with the left eye, that was when he got scared of losing the right eye and came to my facility. I was quite sad when he said this because I was thinking, if only something had been done he could have at least maintained some small amount of vision in that eye. I further went on to explain that the cells or the nerve died due to the high pressure and so nothing could really be done for him now with regards to the blind eye however if he is consistent with his medication and does not miss his appointments we could preserve the vision in the right eye.
@nattybongoI then went on to encourage him not to give up because the other eye is still quite healthy and the OCT results didn't show severe or extensive thinning however his next appointment would assess his visual fields again just to be sure. He promised to abide by our management regime and also to always ask when in doubt and seek a second opinion if not satisfied because it is his right as a patient and a client.
Lesson
The point of the story is that had he acted on his impulse to want to get additional information or even check up on a different healthcare provider just once, he could have saved his vision in that eye. As a healthcare provider, I would admit that as human as we are sometimes we do miss out on certain things and even make mistakes sometimes, which is why we even encourage interdisciplinary consults and discussions for the benefit of our patients.
@nattybongoSo long as you do not abuse your Doctor in any way if you do not understand anything and would want more information or better clarification, please ask because you are entitled to it, and if you are still not satisfied, get a second opinion, there is nothing wrong with that, however, please do not be jumping from one Doctor to another especially if you are being managed for a chronic condition since this would make it difficult to monitor your progress.
And so once again, I would conclude by reminding all of us to prioritize our health, not wait for things to get worse before we seek care, and avoid over-the-counter drugs without proper care and examination as this could be quite dangerous in a lot of instances and remember, good health is wealth. It is a pleasure serving you today and thanks for your time.
Further Reading
Collignon-Brach J. (2004). Le glaucome aigu [Acute glaucoma crisis]. Revue medicale de Liege, 59(4), 232–236..
Weinreb, R. N., Aung, T., & Medeiros, F. A. (2014). The pathophysiology and treatment of glaucoma: a review. JAMA, 311(18), 1901–1911. https://doi.org/10.1001/jama.2014.3192.
Mohan, N., Chakrabarti, A., Nazm, N., Mehta, R., & Edward, D. P. (2022). Newer advances in the medical management of glaucoma. Indian Journal of ophthalmology, 70(6), 1920–1930. https://doi.org/10.4103/ijo.IJO_2239_21.