Friday, June 10, 2011

In a flash

The first time I saw a streak of light in my peripheral vision, I thought it was the arc of a falling meteor. Before I could focus on it, the light was gone. And then it came again, and again, always on the far left side of my visual field. Over the next few days, I realized that I was experiencing some kind of occular phenomenon. The flashes were most visible in the dark and they increased in frequency and intensity and began to look more like lightning than shooting stars. Even during the day, I would occasionally blink and glimpse a burst of light and a negative image of a blood vessel under my eyelid. I also felt some irritation in the affected corner of my eye, as though something were stuck under the lid. Sometimes I would wake up in the morning with a bright red eyeball.

Naturally, I called my fabulous eye doctor. She didn't like the sound of what I was describing and told me to seet a retina specialist without delay. Being a reasonably smart cookie, I went to the Internet and looked up my symptoms. It could be retinal detachment, which is not a good thing. However, blindness usually occurs within 24 hours or so of the retina detaching, and I had been having symptoms for several weeks. More likely, my symptoms were due to posterior vitreous detachment. This happens with, ahem, age. The vitreous gel that fills up your eye ball starts to thicken or shrink, form little clumps, and pull away from the retina. While posterior vitreous detachment can lead to retinal detachment, it's usually just another annoying sign of physical deterioration they forgot to mention in the annual health issue of Parade magazine.

I have a PPO and pay through the proverbial nose for catastrophic coverage, with a $5,000 deductible. (Actually, since the passage of the healthcare bill, I have had four rate increases to my husband's five. The insurance industry is making up for having to cover people with preexisting conditions by gouging the self-insured). So I selected a group practice of retina specialists and was given an appointment with the aptly named Dr. Light.* (Dr. Light the retina expert. Almost as good as Dr. Bottoms the gyne, Dr. Head the Shrink, and of course, that renowned proctologist, Dr. Seymour Butz).

After his charming assistant dilated my pupil, Dr. Light breezed in and examined me. He was a young man of few words. Very few words. Look left, look right, look up, look down. He gave me an abbreviated explanation of the abbreviated explanation I just gave you: " You have posterior vitreous detachment. It puts you at risk for retinal detachment, so if your vision becomes blurred or you start to see a rain of floaters, come in immediately. I expect you may start seeing flashes in your other eye but you don't have to come in if that happens. Nice meeting you. Bye bye."

I asked about the redness and gritty sensation. It was nothing, he saw nothing, there was nothing to worry about. To mark a definitive end to our visit, he put out his hand and shook mine and then marched swiftly out the door before I could ask any more questions. After all, it was just a routine diagnosis. For him.

For me, it meant resigning myself to random flashes in my left eye, the visual equivalent of tinnitus. And now, I was being told that the lights would eventually spread to my right eye. Oh yeah, and if my vision ever suddenly goes south while I am climbing Mt. Everest, hiking the wilds of Patagonia, or driving the Paris-Dakar race, I won't be able to make it to the emergency room in time. Which means I'll have to learn to accessorize with eye patches. So thanks, doc, for your compassion and understanding.

Meanwhile, the gritty sensation of having something stuck in my eye didn't go away, and I kept waking up with that scarifying red eyeball. Since Dr. Light had nothing illuminating to say about this, I decided to see a different ophthalmologist - a generalist. Now, I could have, and probably should have gone to my fabulous eye doctor, but she is a fifty minute drive away, and I had a lot of work. Instead, I tried somebody new near home. In order to get back to my desk as quickly as possible, I made the first appointment of the day: 8:50.

The new eye guy's lobby was huge - never a good sign - and despite having the day's "first appointment" time, I waited a good half hour. Then, off to an examining room where I parked my butt for another 15 minutes before a technician came in to administer the requisite dilating drops and vision tests. After that, I got moved to a cramped little seating area outside the examination rooms where I waited for an additional hour. Two elderly French ladies were already sitting there, a mother and daughter. The mother looked to be well into her nineties. They told me they had been sitting here in the wait-some-more room for over thirty minutes, which probably amounted to a fiftieth of the older lady's remaining life span.

It was 11:00 before I finally got to see the doctor. (As far as I know, the two French ladies are still there. I hope someone is feeding them). Two hours and ten minutes had elapsed. Exactly the amount of time it would have taken to drive to my regular doc's, be seen immediately and drive home. I wanted to give Dr. Wait-In-My-Lobby-'Til -You-Grow-Cataracts** the benefit of the doubt. Surely something unusual had caused the delay - car crash, food poisoning, pink eye epidemic? "So," I said, "Guess you must be understaffed today?" Nope. Just another busy day at the office.

It turned out my irritated eye had nothing to do with the posterior vitreous detachment. Still, the famed retinologist Dr. Light had missed something rather basic. Although I had complained about the discomfort and redness in my left eye, he never bothered to look for the cause. A blocked pore at the base of one of my eyelashes had formed a little bump, like a grain of sand under my eyelid. Sounds simple, but eye doctors, like all other medical specialists, have now become so vertical in their expertise that a retina guy can't diagnose a clogged eyelash.

Dr. Overbook'em-And-Let'em-Rot*** prescribed a daily lash and lid scrub with Cetaphil, eyes shut tight, followed by five minutes of a hot towel on my face to loosen up the blocked eyelash root. He never apologized for the two hour wait, but he did try to talk me into coming back in three months for an eye exam.

I'm afraid he's going to have to wait.

*not his real name, but close.

** Also not his real name.

*** Should be his real name.

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