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The best treatment is sometimes none at all
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“Quality of life” is a term uttered every day — for good reason, as it has become so much more than a buzz phrase.
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Communities boast of their quality of life in an effort to allure new residents. Employers speak of quality of life to sway potential new hires. Marketers use the phrase to sell specific products or services – health care being no exception. One need look no further than a magazine advertisement or television commercial to witness the plethora of drugs portrayed as vehicles for enhancing quality of life. Even the FDA has implemented quality of life metrics for assessing the efficacy of certain new drugs and devices.
It is for just this reason that all health care providers – optometrists included – consider how effective our efforts are in improving our patients’ quality of life. Simply put, it is time we look beyond 20/20 when assessing patient care outcomes.
Admittedly, this is not new to optometry as we enhance quality of life in virtually everything we do. Continuous wear contact lenses and laser vision correction provide our patients with ease and convenience in correcting refractive errors. Ocular allergy medications offer symptomatic relief and improved productivity for millions annually. For others, progressive-addition lenses provide a singular solution for a variety of complex visual demands. Sometimes, improving one’s quality of life actually requires doing nothing at all.
This was certainly the case with Mr. J. This delightful 93-year-old’s complex history includes pseudophakia in both eyes, age-related macular degeneration in the right eye more than the right and chronic open angle glaucoma in the left eye more than the right – conditions that have resulted in visual acuities of 20/200 in each eye. Unfortunately, Mr. J’s general health is equally complex and complicated by dementia.
At this recent visit, Mr. J’s mental decline was particularly evident; in short, he did not recognize me or where he was. He was unable to communicate a history or respond to any subjective testing. Mr. J’s visiting nurse assured me that he was ambulating well and executing basic living skills, but that he was no longer reading or playing cards.
As you might imagine, this patient’s glaucoma medication compliance was questionable, at best. To complicate matters, his IOPs were slightly elevated with progressive optic nerve changes. While I contemplated my next strategy – repeat his HRT [Heidelberg Engineering, Vista, Calif.], try another medication(s) or consider surgical intervention – it became perfectly clear. The best treatment was, quite possibly, no treatment at all. Additional testing, medication changes or surgical intervention were, in all likelihood, not going to benefit Mr. J in a significant way.
In consulting with Mr. J’s family, they opted for no treatment. While the family was concerned about his comfort, they spoke freely about the challenges of tracking numerous medications, coordinating nursing care and attending frequent doctors’ appointments. In the final analysis, a simpler management strategy was the best way to enhance Mr. J’s quality of life.