Routine Eye Exam

May 15, 2012

Two weeks later, after being pensive and reflective about my 5 semesters on the island, I am wide awake at 4:00 in the morning with not enough energy to work on Kaplan, but too much energy to fall back asleep and a lot on my mind.  ::sigh::

I’ve been out of touch intentionally–I can’t imagine that reading about someone who lives in the middle of nowhere waking up and studying everyday can be that interesting.  So instead, I think I’ll discuss the non-studying outliers.

Yesterday was my annual eye appointment check-up.  This was the first follow-up appointment since my big eye crisis last year where I was afraid that I was going blind/had a brain tumor.  I went to the office with the intention of getting contacts fitted and mentioned nothing to the flippant eye assistant who was updating my history about last year’s traumatic events.  I mean, after all, it should all be there in my chart anyway, I haven’t had any follow-up symptoms, and technically she asked me if I’d had any previous conditions and at that point I still didn’t know what the technical term was for what happened to me.  Eye-numbing drops, dilation drops, and subsequent ennui associated with waiting for my eyes to dilate were all routine.  Eye exam went fine until we got to the part where my ophthalmologist was in the room and went to do the advanced ophthalmoscopic exam; he spent 2 or 3 minutes shining an extremely bright light into both of my eyes then said that it looked like there was something “floating around” in my left eye (the bad one) and that he’d have to “give the drops more time to work” (i.e. more dilation).  Crap.

Half an eternity or 20 minutes later, he came back with a brighter light and after about 5 minutes of looking around, told me that I still had drusen in my left eye.  Oh, so that’s what it was.   Drusen.  We’ve talked about this in class before–now what was it concerning?  Also he mentioned that where the optic nerve enters the eye, that the vessels were still enlarged.  Papilledema?  But just on the left side.  He seemed puzzled but not panicked at all.  I calmed down.  But then he kept talking.  He also said that I needed to make sure that I kept coming back every year for check-ups, that he’d noticed a spot on my left lens.  He said it was below my field of vision, but then proceeded to show me my chart where he had marked the site on a diagram of an eye and scrawled PSCC below it. Wait a minute.  What involves a C and spots on the lens? “…cataract?”  I asked, before he could explain what PSCC completely stood for.  “Yes, how did you know that?” He responded incredulously.  At this point, I sort of tuned out.  I heard “…not anything to worry about right now…can be fast growing…” and then found myself alone in the room again, waiting on another assistant to come in and fit me with my first pair of contacts.

Before I could pull up wikipedia on my phone, I was staring at the ceiling with nervous anticipation as a freshly-washed, yet ungloved finger ::shiver:: with a small bluish disc on the tip came closer and closer to the periphery of my vision.  All I could think about was the scene from the Star Trek TNG series of movies where Picard is transformed into Locutus and has an implant drilled into his eye.  ::Grips the arm rests tightly and tries not to blink::  Contacts weren’t nearly as bad as I’d imagined them to be.  They don’t feel like there’s a disc of gel-like plastic stuck to the front of your eye, but more like you’ve got some peripheral non-compliant eyelash intruding into the white of your eye.   Before wikipedia would load on my phone so that I could get back to my previous crisis, my doc was back to check my vision with the contacts in.  20/20.  Asked me in passing if I’d been on any steroids lately, “you know, for infections and stuff.”  Stuff?  What, like pseudotumor cerebri?  “No.” I said.  “Oh.” He looked slightly crestfallen.  He asked me how the contacts felt and I admitted with honesty that I couldn’t even tell they were there.  He giggled somewhat sadistically and remarked that the anesthetic solution must still be having an effect.  And with that I was lead off to the contact room.

Much like last year’s experiences during my emergency visit to the local eye facility, I was getting to see a new room in the maze of exam rooms and rooms with sophisticated instruments and a line of 2 or 3 old people waiting outside.  This time, it was a high-traffic room.  I walked in to a room that resembled Olivander’s shop in Harry Potter–with the walls stacked with small boxes.  There were two desks with mirrors and sinks, and a chatty lady in dark blue scrubs on the other side of the desks who was rattling off numbers to a man dressed in business casual, yet not formal enough to be one of the aging doctors in snappy suits and bowties.  Hmm, must be a sales rep.  This must be the contact lady.  She greeted me warmly, but with the professionalism that’s come from the routine of breaking in hundreds of newbies with their first pair of lenses.  I smiled nervously.  She pushed a mirror towards me along with a few sheets of paper towels, a box of saline, and a couple of empty lens cases.  Then it was like someone pressed play on the VCR.  She held up and demonstrated both cases and the differences between the two; described the importance of sterile saline and the brand preference of the establishment; gave a brief lecture about the importance of removing contacts nightly as prescribed and the gruesome consequences if these directives were not followed; explained the process of starting out wearing them just 4 hours daily, then 5, 6, and so on; then just like a flight attendant, began demonstrating on her own face, the awkward poses necessary to remove one’s contact lenses.  Suddenly, I was yanked out of my trance of head nodding as she said “Ok, now you try.”  Wait, what?  You want me to take these things out?  But we just got them in, they fit so nicely.  Crap.  Like trying to play out a jingle you’ve got stuck in your head, I remembered and repeated the steps she’d acted out and low and behold, 30 seconds later, my contacts were sitting in a case in solution.  Sweet.  Now her video-like demonstration started again, except this time, the poses were even more awkward and involved more steps.  Ugh, you want me to put them back in?  Isn’t this the part they make fun of all the time on tv?  I followed the steps and on the third poke of my left eye, I managed not to blink and looked around just enough to make the contact make contact (heh) on all edges and slide into place.  That wasn’t bad at all.  ::Jinx:: 10 minutes, 8 or so re-washes and seemingly 50 tries later, I lucked out and got the right contact in after much reassurance that I was doing fine, it wasn’t taking long at all and that I would get it any minute, and would most likely be able to do it without a mirror in 2 weeks when I came back for my follow up appointment.  Wait, I have to come back and do this song and dance in front of you again?  With the distinct paranoia that she’d been lying to make me feel better and that I might soon be the subject of exasperated discussion–I’m hard on myself, no?–as soon as I was out of earshot, I went to update my insurance information, pay the “fitting fee,” schedule my 2-week follow-up appointment and be on my way back home.

With a growing, familiar unsettling feeling of camaraderie with the older patients waiting to be tested on the sophisticated machines in the unvisited rooms at the eye doctors’ office, I googled “pscc.”  Too vague.  “Ophthalmology pscc.”  From what I could glean, it is a type of cataract and is fast-growing but is NOT usually seen in young patients.  Great.  The same unfamiliarity with association with my age group was the case with “drusen” although even more unsettling was the association of drusen with “macular degeneration.”  I read on.  There was a subtype of drusen called ODD or optic disc drusen.  Wasn’t it my optic disc the doc was talking about when he brought up the term ‘drusen’? It makes me very nervous to think about what I read concerning that subject.  Here–knock yourselves out: http://en.wikipedia.org/wiki/Optic_disc_drusen.  In particular, the sections entitled “Epidemiology” and “Prognosis” are daunting.  Hmm.  Good thing I don’t want to be an air force pilot?

The rational part of me reminds my panicking self that I could be barking up completely the wrong tree.  I didn’t clarify with the doc exactly what my conditions were, HE didn’t seem to be overly worried or concerned, plus I have NOTHING as far as risk factors or family history or associated conditions that are mentioned on the ODD page.  Positives: I can see FINE right now, I’m losing weight thereby reducing my risk of developing NIDDM & HTN [and the associated ocular manifestations], and my main objective of visiting the eye doctor for my yearly checkup and leaving with contact lenses was a success.

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