Under pressure at the ophthalmologist’s
I ask the patient, for the third time now to relax, press his forehead against the device and keep still. I try, yet again, to apply the tonometer to his cornea before he blinks.
Telling him I suspect the onset of glaucoma will definitely not get him to relax!
Darn, if I could only take this damn reading from a distance!
70% of adults and 90% of children have a pull back reflex as soon as an object touches their eye. This reflex is extremely beneficial but at the ophthalmologist’s office it may have devastating consequences, as the doctor may have to postpone IOP measurement (and treatment) if the patient is too nervous.
But I cannot postpone it any longer. If I trust my intuition, I need his pressure now.
My patient is sitting in front of me and he’s trying to understand it all even before I do. He remembers what he’s read on the internet and he comes out with some of it before I have a chance to formulate my sentences. He’s come in with his right eye vision blurred and the left side of his brain overflowing with Wikipedia. He’s understood what he has even before I diagnosed him. Well, almost. He thinks it’s a retinal detachment because he’s afraid of admitting it may be the onset of glaucoma. And yet he has all he needs to understand.
- What is it, doc?
My few years of experience in ophthalmology are of no use when trying to formulate what he’s been dreading. I choose not to play the all-knowing expert, outraged at the meager knowledge of this recently retired patient.
- Well, it’s more serious than a retinal detachment!
- Yes, it’s the onset of glaucoma, a classic form actually, and treatable of course… and since you’ve figured that much out, you can help us treat it.
- Right, of course I will. But will I need to have that air puff into my eye every time you measure my pressure? Every time I go through this I come out feeling worse.
- Yes, I know it hasn’t been easy but that’s exactly what we need – a reading every week, so that we can adjust treatment.
- But I can’t take half a day off every week!
- You’re going to take your own pressure…
- Ah, I can’t even tolerate contact lenses for more than a month so I don’t really think I can take my own pressure…
- I’m going to show you a prototype and I assure you, you’ll be able to use it in no time… Here, you’re going to help advance science, I kid him.
- Wow, it looks like a virtual broom stick. And you see better with this?
You see better after taking your treatment. Not immediately.
- Right, of course!
- The eyepiece adapts to your eyes and takes a measurement of your pressure with no contact, not even an air puff as you’ve called it.
He’s skeptical; his eyes are going to plunge into an unknown world that is more aggressive than the video games he likely knows too well. But this semi-geek seems unable to overcome the attraction of this piece of technology.
- Can I try it?
- It’s only a model. If it were the real thing I would have spared us the last two failed attempts with the air puff. I’ll be getting the prototype next week.
This is the way innovation is leading us.
Because he « knows », he’ll participate. I wonder whether his enthusiasm will have any impact on treatment. Most likely…
I have this high-tech tool at my disposal which is only one of many such innovations setting a new trend of self-monitoring and self-testing. As patients understand more and take a greater part in caring for themselves, treatment becomes more effective and more appropriate to each case… Well, at least that’s what Doctor B’s sales pitch says.
As a result of the widespread dissemination of information the trend towards self-monitoring is gaining momentum.
The more the patient participates, the better he takes care of himself.
These high-tech tools enable us to jump on the bandwagon of homecare self-monitoring.