The ‘gatekeepers of primary eye care’
When Andrew Morgenstern, O.D., asked other doctors of optometry on social media if they “ever saved a person’s life through optometric examination and diagnosis,” posts flooded in—more than 105 of them, in fact.
Dr. Morgenstern’s question was posed Sept. 3 on the ODs on Facebook main page. The replies not only provide a snapshot of contemporary optometry but also amplify the literally life-saving difference optometrists make; shine a spotlight on their expertise and training; and underscore their role in delivering safe and essential eye and vision services through the nation’s health care network.
“This is a great thread,” Dr. Morgenstern says. “Makes us all appreciate what optometry does on a daily basis even more.”
Here are some of those comments:
“Retinoblastoma in an 18-month-old who is now monocular and a healthy 26-year-old!! So happy for him!” -Dr. R.M. “At least 2 severe dry eye Scleral have commented that they were so depressed they had contacted Dignitas. Now they have clear, comfortable vision in their lenses. That, and amelanotic melanoma.” -Dr. T “Many diabetics (memorable one with blood sugar in the 500s, another with HgA1c in the 15s), strokes, choroidal melanomas, metastatic lung cancer, metastatic breast cancer, 7 cm brain tumor, spousal abuse. One patient told me the only reason he didn’t commit suicide about 5 years ago was because I was kind to him the day of his eye exam and scheduled him for a 3-month glaucoma follow up.” -Dr. J.S. “Acute, bilateral uveitis that was recalcitrant to cycloplegia and significant Durezol use turned out to be neurosyphillis. The patient had no idea they were ever infected. They were administered antibiotics in the hospital, and all was well again.” -Dr. M.L. “Fabry disease, 1 patient led to 17 of her extended family being diagnosed. The history of mortality was very high in the previous generations. Most ended up doing fabrazyme infusions.” -Dr. K.S. “Choroidal melanoma, conjunctival melanoma x 2, handful of acute or subacute strokes, 2 CCF, a few pituitary tumors, invasive squamous cell carcinoma spreading to skull base x2 (always check all cranial nerves- V1 and V2 numbness were subtle findings for both!!), handful of orbital cellulitis, very severe anemia, OIS last week with severe stenosis of ipsilateral carotid (too stenosed to treat surgically), primary intraocular lymphoma, a lot MS, a lot of untreated syphilis, few TIAs, malignant hypertension, handful of GCA, sickle cell patients with advanced disease, 2 sebaceous carcinoma, metastatic breast carcinoma, metastatic prostrate carcinoma.” -Dr. A.B. “Not long into my private practice, a new pt presented for exam complaining of headaches. He was a newly retired Navy pilot. He told me how he had started having visual symptoms and headaches but the Navy dr ‘helped’ him keep passing his vision exams bc he knew the pt was retiring soon. I ordered him an MRI and it found a very, very large pituitary tumor. The Neurosurgeon said that while the tumor was benign, it was so large it was pressing against the arteries, and he said that could have killed him at any moment. The Neurosurgeon had to pump air up his spine to lift his brain up off the tumor to get it all removed. Apparently, it was the largest pituitary tumor the Dr had ever seen. Neurosurgeon told pt he was really lucky I ordered imaging and to make sure he thanked me for saving his life. Patient sent me flowers.” -Dr. C.D. “98% blocked carotid” -Dr. E.K. “95 % blocked carotid artery. Fungal meningitis. MS.” -Dr. S.B. “A 40ish year old African American woman - I was the 4th Dr she'd seen for headaches. I saw bilateral ONH swelling and sent her right off for lumbar puncture and MRIs. I called her a week and a half later to follow up out of curiosity, and she was tripping over herself thanking me. She told me she had just spent 8 days in the ICU because they found clots all over her brain. She and her mom came in later to give me a cake they had baked for me.” -Dr. A.B. “Yes at least three times I'm aware of. First one I found Hollenhorst, ordered carotid ultrasound. Patient was getting on a plane the next day. His cardiologist told him he couldn't fly and because I insisted he handle this before he went. Cardiologist said it likely saved his life.” -Dr. A.G. "Young healthy female came in for acute onset progressive horizontal diplopia. Identified CN 6 palsy, no other neuro symptoms but referred for stat MRI, while waiting for the MRI the aneurysm in her brain stem ruptured. She was airlifted to the university where they performed emergency surgery, she lived,” -Dr. J.A. “Bilateral papillitis, which the MRI confirmed as papilledema secondary to medulloblastoma. The patient was 13. One year later, he is still recovering and has had lots of challenges from chemo and radiation side effects. His pediatrician had attributed his symptoms (fatigue, malaise, headaches) to mono. The patient’s Mom trusted her gut and kept fighting for him. Such a hard road for them, but grateful to have been involved.” -Dr. L.B.
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‘Saving lives every day’
Having read the responses to his original post, what did Dr. Morgenstern take away?
“My conclusion is optometrists are not only gatekeepers of primary eye care, but we literally save lives every day,” says Dr. Morgenstern, who is AOA director of clinical resources. “Maybe not always via an acute medical event like in an emergency department, but in ways that no other health care professional can.
“The public needs high-quality comprehensive eye examinations on a regular schedule … especially if they have certain risk factors,” he adds. “It’s truly an honor to be the director of the clinical resources group that works to develop the highest-quality clinical practice guidelines in eye care around the globe. It’s even more of an honor to work with the incredible members of the AOA clinical practice guideline development group (including AOA staff) who give up so much time, clinical experience and brain power to produce documents that undoubtedly improve the public health.”
Before publishing this article, the AOA reached out to Alan Glazier, O.D., founder of ODs on Facebook, about respecting and preserving the privacy of members of the thriving online community in this story. The community has more than 45,600 members—four out of five doctors of optometry in the United States are members.
The AOA has attempted to honor the online community’s privacy by removing the full name of its members cited in this article. From time to time, other posts on ODs on Facebook also highlight the tremendous contributions of doctors of optometry to the health care of the public. These are identified and can be searched in the community using the #ODSave hashtag.
“ODs on Facebook, also known as ‘Optometry's Community,’ is an OD-driven eye care industry discussion where doctors share clinical and practice management experiences, network and have fun but not at anyone's expense,” Dr. Glazier says. “Its mission is to bring the optometry community together in order to elevate the profession and patient care."
Dr. Glazier calls the online community a stalwart supporter of the AOA at the local, state and national levels.
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