What sense could you do without?

Doctor: Hola, Me llamo Dra. – ¿Cómo está usted hoy?

Paciente: Mucho gusto. Estoy bien.

D: Venga conmigo al cuarto—(hace señales a la silla)—siéntese acá por favor, empezamos el examen...

(pocos minutos más tarde)

D: Sí, usted necesita lentes para manejar y leer – Le sugiero un tipo de lentes se llama “progresivos”.

P: Pero, mi visión, es peor desde la última visita? ¿qué es mi visión?

D: Bueno, para la distancia, la agudeza visual es 20/60.

P:   ¿Es bueno?

When a patient asks me what his vision is, my knee-jerk response is to answer by providing the Snellen chart number. However, during my years in clinical practice, I have come to find that this number, truthfully, is virtually always meaningless to patients.

Whether my patient is a U.S.-born native English speaker, a Central or South American-born Spanish speaker, whether the patient has had access to higher education or has not, regardless of origin or background, the visual acuity measurement doesn’t appear to hold any value with patients. Again, I am basing this finding on my own personal experience working with patients over the years.

However, there are a few concerns that all patients seem to have in common.  They want to be sure that:

1) Their vision over time is stable

2) Their vision allows them to do the activities that are important to them

& 3) they are not doing anything or, conversely, missing anything that would cause them to lose their vision aka “go blind”.

I have had patients with 20/60 vision come into the office, perfectly content with this level of vision, because they can still, for ex., crochet or watch TV and for them, that is good enough. It doesn’t matter if a cataract is the cause of this visual acuity, and that a surgical procedure can restore perfect vision. These patients are not interested in 20/20, they are satisfied that they can continue doing their daily routine without any problems.

Instability of vision, to many patients, represents a possibility of permanent vision loss or blindness. Here, explaining the cause of the visual change and what to do about it is very important, because some causes are out of their control and others are not. For example, an elderly patient with cataract formation, or a 42-year-old with onset of presbyopia, need to be reassured that visual changes in these instances are a normal part of aging and can be remedied with an eyeglass adjustment. These patients need to be told that the vision will continue to change over time, and this is very normal, and this is why an annual exam after the age of 40 is important.

However, for the patient with glaucomatous optic nerves or the diabetic with wildly uncontrolled blood sugar, he needs to be informed that visual change is a sign of uncontrolled disease, and without a strict treatment plan, vision loss will continue and be permanent.

In 2010 a Lighthouse International survey by Harris Interactive asked Americans what sense (i.e. vision, hearing, smell, touch or taste) they feared losing the most. An overwhelming 82% feared vision loss over all the other senses (8% hearing, 3% smell, 2% touch, 2% taste). Interestingly enough, however, of this 82%, 86% admitted to having an eye disease, diabetes, high blood pressure or high cholesterol and yet do not go for regular eye check-ups with their doctor.

If vision loss is the most feared of all losses, why wouldn’t patients get their eyes checked regularly? Well, this study revealed that the main barrier to regular eye check-ups was that these patients were not having trouble with their vision and therefore, felt they didn’t need to go. Mark G. Ackermann, president and chief operating officer of Lighthouse Guild International stated that with the number of “...aging Baby Boomers and the growing prevalence of such diseases as diabetes and age-related macular degeneration (AMD)...61 million Americans are at high risk for serious vision loss.”

The study concluded that the key to preventing this vision loss is patient education. Informing patients of their eye (and health) status and how this affects or can affect their vision over time is key to providing patients with what they hope to achieve long term:

-stable vision

-usable vision

-maintenance of visual health

Doctor: “Usted tiene una catarata – un cambio en el cristalino natural dentro del ojo. Es una parte normal del envejecimiento, y es por eso no puede ver muy claro, particularmente cuando usted maneja por la noche.”

Paciente: “Qué es lo que tengo que hacer?”

Doctor: “Si yo cambio los lentes, usted ve mejor. Entonces, aquí está la receta por lentes nuevos (le da al paciente una pieza de papel).

Paciente: “Está bien, gracias – (listo al irse)..”

Doctor: “Espere Usted, haga una cita para un reconocimiento de los ojos otra vez en un año. Usted tiene diabetes, y tenemos que examinar la retina al menos una vez cada año.”

Paciente: “Está bien, gracias, con permiso..” (se va)

References

Paunescu, Delia. “Americans Not Properly Protecting Their Vision, Shows New Lighthouse Int’l Survey From Harris Interactive.” http://www.visionmonday.com/article/americans-not-properly-protecting-their-vision-shows-new-lighthouse-intl-survey-from-harris-interactive-23475/

Adirondacks, NY