A Picture is worth a Thousand Words: Macular Hole
I saw an interesting, second opinion patient the other day. He came in complaining that the glasses he had made at his Optometrist’s office were not working. He had returned them to the Optometrist’s office twice and was told there was nothing wrong with the glasses. He complained that objects viewed in the left eye “looked like a Bow tie”. He reported his right eye was “perfect”. His Optometrist told him that his exam was normal, except for Cataracts. He was extremely unhappy and was convinced his Optometrist had sabotaged his glasses.
As with new patients, I performed a comprehensive eye exam, including dilation. Refraction revealed his vision in the left eye measured 20/100 (1 line better than legally blind). A dilated exam (this important step had been skipped by his Optometrist) revealed early Cataracts in both eyes. They were not severe enough to explain his symptoms.
Dilated examination of the Retina showed an interesting finding, a Macular Hole. This was confirmed with an OCT (a laser scan of the eye similar to a CAT scan) of his Retina. I explained the finding, but he seemed skeptical. He kept asking about his glasses. I explained his poor vision in the left eye had nothing to do with his glasses. Finally, I showed him his OCT scan report. The right eye had the nice “cool” colors that are seen with a normal Retina. The left eye had a visible, bright hot spot in the center. A cross-sectional view clearly showed the hole created by a missing portion of his Retina. Once he saw this, he was convinced. I immediately referred to a Retina specialist for Macular hole repair surgery.
The advanced OCT Scan of his Retina was all the proof he needed. He thanked me for my time and apologized profusely for his skepticism earlier. It is important that a Physician has the right tools to not only diagnose a patient correctly but also the means to communicate this information to the patient. This was another good day for Ophthalmology.
Sidney Gicheru, M.D. is a Board Certified Ophthalmologist who practices at LaserCare Eye Center in Irving and Grapevine, Texas. He specializes in Vision Correction surgery including LASIK and Refractive Cataract surgery (ReSTOR, Crystalens, and Toric lens implants). His training was at Southern Methodist University, UT Southwestern Medical Center and Beth Israel Hospital/Harvard Medical School. In his spare time, he writes the Texas Eye Talk blog, bikes, swims and does long-distance running. For more information, visit his website, www.DFWeyes.com or call 214-328-0444. This article A Picture is worth a Thousand Words: Macular Hole was written by Sidney Gicheru, M.D.