THE HUMAN SIDE OF OPTOMETRY
Experience is at odds with science in this
story of helping a patient.
BYRON Y. NEWMAN,O.D., ORANGE, CALIF.
This is the story of Liz (not her real name) who came to my office a few years back with a group of teenagers from a drug rehab center. She sat in the reception room quietly, not joining in whatever was causing all that hilarity teenagers can usually find in any situation.
She's a mystery
When Liz came in for her examination, I saw a gawky, 16-year-old black girl, with a somber look on her attractive face. She answered questions curtly, but without malice. She reported difficulty in school in all classes, couldn't see the blackboard, didn't like to read and suffered many headaches. Her visual acuity was 20/80 in each eye. She scoped plano and refracted plano in each eye, which caused me to recheck with the ophthalmoscope, the slit lamp and the visual fields -- all were negative.
I then performed my phorometry tests and found many problems of fusion and accommodation. Everything hurt her eyes, from amplitude of convergence to about nine inches, versions which were next to impossible; base out and in near and far hurt at 2 prism
diopters, and she had low accommodation and plus acceptance.
Striving for a remedy
My prescription was enhancement vision therapy, and I told the counselor who'd brought the children to the office to bring Liz back each time he came. I said I didn't see any reason for her poor acuity, but I could try to reduce her pain in visual tasks.
We saw her for eight visits before she was either transferred or released, trying to build up her fusional ranges, accommodation and other skills. The interesting thing was that as her skills improved, so did her visual acuity, which was 20/25 by that last visit.
I had no idea she was leaving, but on that final and exciting visit when I saw her acuity improvement, I noticed she was carrying a book.
I asked her, "So, Liz have you found that reading is easier for you now?"
She gave me a beautiful smile and said, "Now I love to read. I can't seem to read enough, now that I can. And," she added, "I have you to thank."
Finding a believer
I was pleased with that case and proceeded to tell my colleagues about it, including two ophthalmologists I knew. But they all scoffed at me. I wasn't really surprised at the
M.D.s, but I was taken aback at my O.D. friends. They all made statements to the effect that "It would have probably cleared up by itself without your intervention."
Several months later, I was at a political event where several psychologists were present. I told one about the case and his reaction astounded me.
"Why, that's wonderful," he said exuberantly. "You should write that up for the journals."
"No," I said, "no one believes me. Two M.D.s both told me that it would have cleared up by itself without my intervention."
Then he told me something that I couldn't believe because it was suddenly so logical. He said, "You should go to those M.D.s and ask, 'When, Doctors, would it have cleared up by itself?'"
DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR
LUTHER@BOUCHER1.COM. OM OFFERS AN HONORARIUM FOR
Optometric Management, Issue: April 2004