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How a Hero Approaches Patients

Paul S. Koch, M.D.

Tom McCauley is my latest hero. He's a quiet ophthalmologist who has an office just down the street from mine. We've been friends for years, and recently he did something that I regret to say I might not have, and in doing so changed a life forever.

A middle-aged woman came to Tom's office with her white cane and Seeing Eye dog. From the time she was a child she had been told her eyes were no good, they would never be any better, and that she was going to go blind. Her doctors were right, of course, and when Tom saw her she saw only hand-motions. Low vision aids no longer worked, and she was learning Braille.

This was the first time Tom had met her, so instead of just signing her disability form he took a peak at her baby blues. Her pupils were okay. The alignment wasn't bad. He shined a penlight and easily saw a pair of chocolate cataracts. He slipped the light further back and wiggled it over her sclera. The patient told him she saw her blood vessels when he did that.

More testing followed. Ultrasound showed an axial length longer than 33 mm. Could it be that back in the 1950s her doctor didn't pick up high myopia in a squirming baby? Could it also be that his initial impression stuck with her ever since, and she had never been reevaluated? Might she just be an unrefracted myope with cataracts?

Dr. Tom talked to his patient. Perhaps if your cataracts were removed you might see a little better, maybe enough to use your low vision aids again. Are you game? She was. You're not going to believe what happened next.

The next day through her happy tears she saw 20/40, and today she's 20/20. She learned to drive and got an unrestricted driver's license. Her dog retired from the seeing-eye business and became a family pet. They're often seen around town, her doing the driving with Rover in the passenger's seat, tongue hanging, and tail wagging.

Just because a patient was given a diagnosis decades ago does not mean that is necessarily the diagnosis today. Our diagnostic abilities have improved immeasurably, as has our ability to treat diseases. Tom's case reminds us to keep an open mind and to approach each patient as though she needs our help, not just our signature on a form.