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BLOG: The optometric physician can make a difference beyond eye care
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I saw a very interesting patient this month and had an experience beyond my normal role.
As do most optometrists, I get to know my patients very well over the years of providing their eye care. Many see me more regularly than any of their other health care practitioners. This is especially true when they wear contact lenses and they go through early cataract-related refractive changes in their fifth, sixth and seventh decade.
One of my long-term patients presented a year ago for an annual eye exam and contact lens follow-up. During the newly extended medical history required by my electronic health record (EHR), she could not remember some of her systemic medicines. This was unusual for her, as she would usually rattle them off and discuss any side effects. This tipped me off to listen a little more carefully to other aspects of her history. Finally, I asked her if her husband or other family members had noted changes in her memory. She reported that indeed they did and that she herself noted that she often could not think of the name of a common object.
The optometric examination continued along the normal course. Her vision was fine, the external exam with pupils and muscle testing all normal. Her contacts were great and unchanged. The slit lamp only showed the mild cataracts as in the past. Tensions were normal, dilated fundus exam was A-1. Nothing was found in the traditional optometric exam to report to anyone.
But my exam is no longer traditional. My new philosophy of an optometric physician calls for a session of “doctoring” at the end of each exam where I bring together all of the findings of the history and the examination and discuss the overall wellness of the patient and design a care plan. For this patient, a frank discussion of her memory issues was a required part of my doctoring. I discussed that her memory issues were not normal for her age and that she should see a neurologist to formally evaluate the problem. I gave her the name of the neurologist at the hospital where I maintain staff privileges.
She called me back about 3 months later and reported that she had been diagnosed with Alzheimer's disease.
This month, she came in, like clockwork, for her annual exam. I must say that when I saw her on my schedule, I was a little nervous. I had urged her to explore an issue that became a major life crisis with a poor prognosis.
To my surprise, when I walked into the room she threw her arms around me and thanked me profusely. She remained in a very clear state of mind and had not progressed. She said that my examination with her last year had pushed her to pursue the neurological work-up that explained her symptoms and allowed her to alter the course of the rest of her life. With the definitive diagnosis of Alzheimer’s, her husband had cut back on work and they were traveling the world. Her family and friends are completely supportive and she has made a living will with definitive plans for the rough road ahead.
She reported that she would never have made the move to formally evaluate her symptoms without my advice and counsel. She said that my knowledge of her personality and overall health allowed me to see the change in her demeanor and urge her to the next level.
The new role of the optometric physician is indeed a different model of health care than that of the traditional optometrist. The responsibly is greater, but so are the rewards. I am sure that many of my colleagues who have evolved into the optometric physician role can relate to this story and provide many of their own. The profession is changing, and it is exciting to be involved.