Tuesday, June 14, 2016

Why it’s Great to be an Optometrist

This is one of those “there I was” stories that makes me feel very proud to be in the optometric profession.

So, there I was (actually my wife and I and about 10 of my Navy buddies and their spouses) happily rafting down the Colorado River with another 20 or so individuals for a fun-filled week of relaxation, hiking, sightseeing and catching up. On the fourth day of our trip while taking a lunch break after hiking halfway up a canyon wall, one of the physicians came up to me and asked me if he could, “ask me an eye question?” Generally when this happens, people are curious about refractive surgery or contact lenses. This inquiry was clearly very different. The physician explained he had noticed a “C” shaped shadow in his vision in one eye the night before and it didn’t get any better over the course of the day. He also told me he had a history of ocular migraines. The previous evening he checked with one of the other doctors on the trip who advised him to wait and see what it was like in the morning due to his past migraine history. I immediately was suspect as ocular migraines are usually bilateral and generally present much differently. Well, that morning, since nothing apparently changed, the physician opted to go on a rather arduous group hike up about 800 feet over rocks and through streams in fairly severe heat. Needless to say, it required a great deal of effort for all of us. My wife and I opted out of the full route because of the heat and level of effort to traverse back down the steep path.

As soon as he finished telling me his story, I asked if he had seen any flashes of light and if he was a high myopic (very nearsighted), knowing both should be considered when diagnosing a retinal detachment (I do remember something from my days in clinical practice). He told me he thought he might have seen some flashes last night and he was a relatively high myopic. As a result, I did a quick confrontation visual field that revealed about 120 degrees of an inferior defect in the affected eye. He also mentioned he thought he saw some “red” in his vision in that eye! Well, from my perspective, that pretty much confirmed the likelihood of a superior retinal detachment or pretty good size tear in the affected eye.

The most impressive part of the story was when we notified the guides who were leading our trip; they immediately used their satellite phone to request a medevac. Remember, we’re on the Colorado River at the base of the Grand Canyon – no roads, no cell phones, etc. It was pretty rustic. After being told there were two other medevacs in progress – lots of tourists navigating the canyon this time of year – we received assistance within 45 minutes. Since we were on a small beach right off of the river (see the bottom photo), our guides organized all 30 of us into a bucket brigade to wet down a helicopter landing space so sand wouldn’t fly up and blind the pilot. It was very impressive to see the innate teamwork and organization that occurred within a few minutes. Everyone was calm and focused on the task at hand. As soon as we were done wetting down the beach, we could hear the National Park Service helicopter in the distance. Once it landed on a small patch of beach, the pilot and an EMT emerged to check out our patient. Within about 10 minutes they whisked him and his wife off to Flagstaff, AZ for a full ophthalmological evaluation.

A few hours later we found out the physician did, in fact have a fairly large retinal tear that required a scleral buckle and other procedures. In the end, he had to be transferred to a more specialized center for definitive treatment. The tear resulted in a 75-85% loss of his central vision but he retained good peripheral vision and of course, full vision in the unaffected eye. Based on the fact that the initial thought was ocular migraine as opposed to a retinal detachment, it appears it was a good thing I was there to help move it along more quickly. My only regret is he didn’t talk to me prior to taking that hike!

So, it’s great to be an optometrist, especially when you’re the only eye specialist within hundreds of miles and someone in your group experiences a retinal detachment. Kudos go out to the guides who were with us and the National Park Service for the quick and professional response to this emergency.  It’s nice to know they are accessible when necessary.