I Can't See Clearly Now
This morning I saw Melvin Hannity, who was coming in to check on some knee pain he was experiencing. The conversation immediately went in a different direction.
Melvin: Doctor, yesterday I had a very strange experience with my left eye. I was taking a long walk, and suddenly I noticed a strange blob emerge from the upper left side of my left eye. It was shaped like a floating zigzag of black ooze that was slightly tinged on one side in red. It was pretty big, covering about a third of my vision. And, I saw layers of specs, or dots covering the rest of my field of vision. As I was walking, the big blob eventually floated down and away. But the layers of dots did not go away, and I still see a cluster floating around in my eye. I can see through it, but it is difficult. So I was thinking of going to the hospital but it was Sunday, and I knew we already had an appointment with you this morning, so I waited. I hope that wasn't a mistake.
Dr. Tanaka: I see. Well, this is definitely something you will need to see an ophthalmologist about. It might be vitreous detachment, or even a retinal tear. I will send a referral to an ophthalmologist now. They will call you to schedule an appointment.
Melvin: What kind of tests will the ophthalmologist do?
Dr. Tanaka: Well, the first thing the ophthalmologist will do what I call the puff test, which is a test for glaucoma. Then, your pupils will be dilated, and I expect they will do a slit-lamp exam, which can help diagnose cataracts, glaucoma, detached retina, macular degeneration, cornea injuries, and other problems.
Melvin: That sounds scary. As you know, I already have cataracts.
Dr Tanaka: You are over 60, so these sorts of things are not uncommon. And yes, I see in your medical record that you had been taking prednisone, which is a steroid drug that does have that unfortunate side effect. The cataracts may have been a contributing factor.
Melvin: Is there anything in the meantime that I should do or not do?
Dr. Tanaka: Don't do anything strenuous. No weight lifting, running, or sports activities. We want to make sure it does not get any worse, whatever it is. And one more thing, if you see any big change in your eyesight in the meantime, go to the hospital and have it checked out. You should be able to see an ophthalmologist tomorrow. I've let scheduling know it is urgent.
Melvin: Thanks Doctor.
Dr. Tanaka: Don't worry too much about this. It is just one of those things that happens as we get older. Shall we talk about your knee pain now?
As it turned out, Melvin was diagnosed with a vitreous detachment. Fortunately, there was no damage to the retina.
Flash Card Drill
- If you see dark specks or flashes of light, it's possible you could have posterior vitreous detachment (PVD), an eye problem many people have as they age.
- Fortunately, upon examination, I do not see a retinal tear. But, I want to re-examine you in 3 weeks.
- After I injured my eye, I made an urgent appointment with an ophthalmologist that my doctor recommended.
- He took a steroid drug for many years, and one of its side effects is cataracts.
- Mr. Hargrove's wife has had gradual loss of vision that was eventually diagnosed as glaucoma.
- The doctor thinks that his diabetes was a contributing factor in regards to his detached retina.
- As I got older, I developed a vision problem called macular degeneration that robbed me of my vision.
- While playing football my son injured his eye. The doctor said it was a scratched cornea. No more football for him for two weeks!
- The doctor did a slit-lamp exam after he gave me some eyedrops to dilate my eyes.
- I took a steroid drug for many years, which caused me to experience some serious side effects.
- Many anticancer drugs now in use have toxic side effects that can be worse than the cancer itself.
