After reading my past few posts I’ve noticed I had become a bit cynical. Worst yet, very down on myself. I think it’s easy to spend time focusing on your faults and all that isn’t in your life. I recently went out with (fingers crossed) soon to be very good friends. After a few drinks and a great chat I realized I am young. Sometimes I forget that being a doctor is actually something to be pretty proud of. I work hard and it isn’t easy.
Yesterday I had a patient, a young 20-something, in for a routine exam. She lost her glasses a few months ago and as a moderate myope (pretty nearsighted) she really needed a new pair. All new patients get a full exam meaning including dilation. I love my job because not only is it faced paced, but it is full eyecare. It isn’t a corporate sell out job. I dilate as many people as need it. Optos ( a new photographing machine that can take a picture of most of the retina) is not a replacement for dilation. You can see a lot with a photo, but it does not beat a doctors eyes. Anyways, I refract and find her prescription, drop her and send her to pick out some new specs. So 20-something? actually she is my age… picks out her specs and heads back to my chair to check out the back of the eye. Every doctor has their own routine and I usually start with a 90D view of basically the optic nerve and macula. I generally have the patient look around a bit too and then head for the BIO. For the laymens who read – its that really funny hat with a light that makes us look like coal miners. It, along with a lens, condenses light so we get a 3D view of the retina’s periphery. After 90 I was already thinking “F@#$@K”. I take another look around, take off my miners cap and get comfortable in my chair. I ask again if she has ever had a dilated eye exam – no. Does anyone in her family have any eye problems? Any trouble with nighttime vision? I send her for an optos just so I have something to show her to explain. See this? It’s a normal retina. Here is a picture of your retina. Notice the black spiny area in this donut around the midperiphery? We generally refer to these as bony spicules. Now I haven’t done all of the testing needed to confirm this diagnosis, but it appears that you might have an eye disease called Retinitis Pigmentosa. If in fact this is RP, she will steadily lose her peripheral vision and although she may remain 20/20 will have a field of maybe 10 degrees. Take your hands make them into fists and place them over your eyes as you look through your curled fingers – that’s what she could end up with. My stomach turns and I hold in the tears. I cant say this is what she has for sure, but it’s the most likely cause of the way her retina looks. She is my age and by 40-50yrs she will be with a white cane, having trouble navigating. This is not to say her life is over – many people do wonderfully with a little low vision aid and training.
I am in my mid/late twenties and ya know, life isn’t so bad. I may not have a boyfriend or a super busy social life, but I am happy. I am meeting new people and hope to really solidify some friendships Ive already made here. I think of the trip to Cappadocia, Turkey I want to take with my sister… and the dive trip to Honduras with my friend Katie… I think of camping and skiing in NH and surfing right here in RI… I think it was a wake up call to do things while you can. Live life to the fullest. More importantly, be happy for the things you have and not so sullen by what you don’t. The grass can be greener on your own side of the lawn.
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