The Importance of Digging Deeper: How Careful Clinical Decision-Making in Eye Care Can Save Vision (and Life)

Every once in a while, optometrists have an opportunity to act swiftly to save a patient’s vision, and perhaps his/her life. The case we had just a few days ago certainly qualifies.

Here’s what happened:

A 13 years old young man whose family has been longtime patients at Optique developed some headaches and blurred vision after losing his glasses. His parent brought him for a comprehensive eye examination, believing that simply replacing the glasses would solve the problem. At first, we thought the same thing.
We told him, “Let’s get you some new glasses, and see how you do.” That’s when things grew dramatic.
During the course of the boy’s eye examination, our experienced Optique doctor, Dr. Barbara Odes, discovered some unusual features of his eyes. Dr. Odes told me, “I couldn’t improve his vision using our equipment, possibly because of the large amount of astigmatism he has. But I think it goes beyond that.”

Optique’s Immediate, “Dig Deeper” Response

Clearly, there was something unusual here—something else going on. And that’s when we did what we ALWAYS do at Optique. We immediately started digging deeper.
We performed a dilated-pupil examination, and saw he had severe swelling of his optic nerve. When the optic nerve appears swollen, this can either signal normal anatomy, or a life-threatening condition. First, a swollen optic nerve can be difficult to pick up, particularly if you don’t have the kind of state-of-the-art, 3-D imaging equipment we use at Optique. And second, the doctor must know if the swollen appearance is normal or dangerously urgent. Luckily, in the case of our patient, we were quickly able to confirm that we were dealing with a very serious condition, even something as deadly serious as a brain tumor.

Figure 1.  The optic disc is shown prominently in this picture of the back of the eye.  The fluffy, yellow boarders of the disc were the first clue that there was a problem.

 

Figure 2.  3D imaging performed at Optique of the swollen optic nerve confirmed that the situation was dire.

The incorrect response to this situation—especially given that the eye appointment had finished at 6:30 p.m.—would have been something along the lines of, “We have a situation we want to examine in further detail. Let’s send you for some more testing whenever we can get it scheduled.”
But we knew that this would be an inadequate way to handle this. The boy needed immediate attention. So I quickly called the Emergency Room attending physician at Vanderbilt Children’s Hospital and said, “I have a patient who needs an MRI, and he needs it TONIGHT. This could literally be a matter of life or death.” I explained the urgent nature of the case to the attending doctor, who understood the gravity of the situation and got the urgent MRI scheduled for midnight that night.

What the Urgent MRI Revealed

After the MRI, I heard directly from the Chief Resident physician that my worst fears were dead-on accurate: The boy’s optic-disk swelling had been caused by a severe sinus infection, which spread intracranially. In layman’s terms, that meant that mucous was filling the space that holds the brain. But it was what the Ear, Nose, and Throat (ENT) surgeon told the family next that was most chilling—but which also brought the biggest sigh of relief.
The surgeon told the family, “If the doctors at Optique had not pressed for that emergency MRI, your son would have been blind—or dead—by the weekend. That’s how dire this situation was.” Our patient had emergency surgery to remove the mucous and is recovering well.

The Optique Difference

To me, this recent real-life story is a perfect illustration of what I call “The Optique Difference.” It’s a different, higher, more devoted level of service we bring our patients every day. It’s not merely about having the optometric expertise to diagnose and remedy problems—although that’s obviously extremely important. It’s also about having the MEDICAL CONNECTIONS and “PULL”—such as we have within the world-class Vanderbilt medical community—to literally change the course of a young boy’s life for the good.

Final Thoughts . . .

I also think of this dramatic, real-life case in terms of what’s happening—right now—in the world of eye care. These days, online optical services are trying to gain traction on the Internet. Start-up companies who are purely profit-motivated and care nothing about the wellbeing, health, and long-term results of patients are trying to deceive the public into thinking that looking at a screen and answering some questions is the same as expert, in-person eyecare.
But ask yourself these critical questions: “If you or your son were the boy we just helped, would an online test have picked up on this? Would it have properly diagnosed the “lose your vision—or your life” condition the boy was battling? Are you willing to take these chances with your family’s health?
When time is of the essence—and expertise and medical connections spell ALL the difference in an outcome—“The Optique Difference” can be the difference for YOU.