WALK A MILE In a Patient’s Shoes

Laser retinal repair is routine for the surgeon, but a mix of hope and anxiety for the patient, as this health-care writer reports.

BY LINDSEY GETZ

I knew my eye doctor had found something simply based on how long she had been looking in my eye. I was there for a routine eye exam and was in the last leg of the visit. My left eye had obviously checked out fine under dilation, but now the doctor was staring into my right eye and the silence was eating at me. Was it glaucoma? My grandfather had spent the last 20 years of his life blind from the disease.

As a former editor of one magazine for eye-care professionals and now a regular contributor to another, I knew the odds were in my favor. I get yearly exams and never messed around when it comes to my vision. At the first sign of anything, I head to the doctor. I hadn’t been experiencing any symptoms, so if there was something, I knew we would be catching it early. Still, even knowing the facts, I was scared.

Calm and Straightforward With the News

When my doctor finally slid her chair back she told me that she saw a tear in my retina. I immediately appreciated how calm and straightforward she was with the news. She took a photograph and showed me on the screen and in a printout where the tear was and explained what that meant. She also told me that even though the tear was relatively small and had already started healing itself, I should have it surgically repaired as soon as possible to protect against the chance it might tear further or detach completely. Until then, she said, I should be careful with jogging or high-intensity aerobics. I’d be putting my Zumba classes on hold.

While my diagnosis and the resulting treatment were nothing out of the ordinary, a recount of my experience just may give you an inside look at how a patient feels from the initial diagnosis through the recovery period of a retinal condition.

I was diagnosed with a retinal tear for which both my primary eye-care doctor and surgeon advised laser repair.

When it came time to check out, my eye doctor gave me a printout with information on the diagnosis. I found this incredibly helpful once I got home. It helped make it easier to explain to my family. My doctor also gave me the name of the retina specialist to whom she refers patients, and walked with me to the front desk to have her staff schedule my appointment with the specialist as soon as possible. Having all of this handled by her staff made it easy on me — and also ensured I got the appointment as soon as possible instead of putting it off.

A couple days later I met with the retina specialist. I was nervous for the exam but also eager to get more information. Perhaps he would say I didn’t need the surgery? My husband had accompanied me to the appointment because I was told that my eyes would be very dilated for the exam. While I’ve had my eyes dilated routinely for annual eye exams, I was surprised how disorienting it was for this appointment.

Exam Room Jitters

The staff was accommodating in letting my husband accompany me to the exam room, which was helpful for me. Even though my job as a reporter requires me to take good notes and ask a lot of questions, when it comes to my own “medical stuff” I can get a little overwhelmed.

The retina specialist came in and introduced himself to us both. I liked that he spoke to both my husband and me throughout the exam. The exam was a little more intense than I had anticipated. It included a lot of bright lights that ultimately became a bit painful, and lots of poking with a cotton swab. Finally he told me I definitely had a tear and recommended I have it fixed. He said that, although I could probably find a retina specialist out there who would say it was OK to “let it go,” (as it had already begun to repair itself) he felt it was safer to use the laser to completely seal it up.

I was reluctant about the idea of eye surgery, but the doctor told me many people say the exam is actually worse than the laser. Even though he had done this procedure countless times, he did not wave off my concerns, which I appreciated. He said if I survived all the poking, prodding, and bright lights that I could survive the laser, which, he explained, would essentially just be a lot of bright, flashing light. “Would it hurt?” was my next question and he was honest in his response: “I’ve never had it done personally but my patients tell me there can be pain if we hit a nerve.”

During the procedure I saw flashes of intensely bright light, but didn’t feel much until the end.

He compared it going to the dentist for a cavity, an analogy I found helpful. “The drill doesn’t really hurt unless they hit a nerve,” he explained. “There are nerves in the eye, so there’s a chance you may feel something, but it’s nothing you can’t handle.”

Anticipation

We scheduled the surgery and I went home and tried to put it out of my mind. When the day arrived, I was pretty scared. I had an early morning appointment for the surgery. My palms were sweaty and I had a knot in my stomach. I was worried I might throw up. But my biggest fear was what if I move my eye? I remembered during the initial exam that the doctor had told me where to look.

The tear was in a far corner so I sort of had to strain my eye to look in the direction he needed to see it. After a while I found the bright lights disorienting and I could no longer tell where I was looking. When the exam started I could see where he was holding a finger for me to focus on, but in time I couldn’t see anything and I wasn’t even sure if I was perhaps moving my eye. My biggest fear was that I’d move my eye during the laser surgery.

Once in the procedure room, an assistant came in and explained everything that would be happening. She also patched my left eye so that I couldn’t “look at the laser.” I found this explanation a little unsettling considering my fears. Knowing that I shouldn’t be looking directly at the laser intensified my fear of moving my right eye during the procedure. Plus, between the dilation and the patch I felt fairly disabled sitting in the exam chair, waiting for the doctor, which didn’t help with my nerves. Doing the patching at the last minute might have made me less anxious. Fortunately, I didn’t have to wait terribly long before the doctor came in.

An Infusion of Confidence

I told the doctor about my concern over moving my eye, and he told me he wasn’t operating anywhere near the part of the eye that produces vision. He also told me he has done enough of these procedures to anticipate movement. His confidence helped ease my nerves (somewhat) and he got started almost right away.

As he had described, there were a lot of flashes of intensely bright light and I didn’t feel much until the end, when I sensed a bit of a stabbing feeling and assumed he was near a nerve. I definitely couldn’t tell by then if I was looking in the right spot anymore and started to feel a little panicked. I spoke up, but to my surprise the doctor told me he was pretty much done. A few more flashes and it was over.

When he was finished, I couldn’t see anything at first and felt a little panicked. The room was dark, my left eye was patched, and everything looked black in my right eye. I told the doctor I couldn’t see and he said it was just because I was recovering from the bright lights. Sure enough, things started to fuzzily come into view a few seconds later but that initial panic was scary and I do wish I’d been warned that I might not be able to see right away. In those few anxious moments I started worrying something had gone wrong.

Post-surgery Hangover

Postoperatively, I had a killer headache from all the bright light and dilation, but felt fine otherwise. In the week following surgery, I did feel like I had more eyestrain than normal when I looked at the computer or read, but for the most part I had no symptoms. At the first follow-up everything looked good and I was reminded to pay attention to symptoms such as flashes, floaters or other signs of another tear. To date, I’ve had no symptoms. I will have a final follow-up at six months to ensure the tear healed well, at which point I’ll just resume yearly checks with my eye doctor. Considering I never experienced any symptoms to begin with, this entire experience has certainly reinforced my belief in the importance of annual eye exams.

In reflection of the experience, I appreciated that my primary eye doctor walked me through the diagnosis and had information for me to take home. I liked the professionalism of the retina specialist and appreciated his confidence and also candor about the procedure. Certainly the anxiety leading up to the surgery was probably worse than the procedure itself.

The vulnerable feeling of sitting alone in the exam room fully dilated with one eye patched was also a bit intimidating and raised my anxiety level, and the initial panic over feeling I couldn’t see was unexpected. Overall I felt the process was handled well and, although I was scared, the fact that the necessary steps were handled smoothly certainly made a huge difference in improving the experience. OM