I Missed an Eye Condition in my Own Son - and I'm an Optometrist

Aug 17, 2017
7 min read

Doctors make the worst patients

It has been said many times that people who work in healthcare make terrible patients.

We may think because we don’t have any strange symptoms, we feel pretty good on a daily basis, and quite often we simply don’t have the time, that we don’t need to get in for routine care.

When I was working in a clinical setting as an optometrist, I would occasionally have my technician take my eye pressure and an Optomap image, and if all looked okay, I called it good. There was only one optometrist in our clinic at a time, so there was nobody to give me an eye exam other than myself, and I was not about to schedule time during my precious days off to come into the clinic.

Keeping our kids' health in the forefront of our minds

Although I don’t get my own eyes checked as regularly as I should, I am better about having my kids’ eyes checked.

I try to get them in at least once a year, just to run through all the basics, and make sure eye health and vision are okay. As all parents know, as your brood grows larger, your time grows shorter.

My son was three years old when he had his first official eye exam in my office. I had done a few screening tests at home, and he was at a normal learning and development level in his preschool. He was, and still is, quite coordinated physically for his age, and seemed to have a knack for sports.

This led me to believe that his vision, depth perception, etc. was normal.

The initial eye exam

One day, when my son had to be picked up early from preschool, I brought him back to the office, and happened to have a break in my schedule. I sat him down and started the exam (after he moved the chair up and down about 15 times…fellow O.D.s, you know this is the highlight of pediatric eye exams). We are so patient.

I had him cover his left eye, and he rattled off the 20/20 line of pictures easily. I then had him cover his right eye, and it seemed he couldn’t see the pictures. He started peeking around the occluder and calling them out. I was thinking, “Ok, maybe his vision is a little worse in that eye...no biggie.”

So, I started making them larger, and he just was not seeing them.

Next, I got out the Stereo test, which is also a highlight for most kids during the eye exam. He could see nothing! I wouldn’t say I was concerned yet, but definitely confused. “Buddy...can you really not see anything? Do you see an animal here...kind of popping out at you?”

No. And he was trying.

I took him to the Optomap. Again, he was three. But we got remarkably good images. His left eye looked a little different around the macular area, but nothing jumped out as excessively abnormal, and it looked more like photo artifact. His anterior segment, optic nerve, and blood vessels were all normal as well.

So, I took him back in the exam room, and tried the letters again. Both distance and near. I was just not getting anything out of that left eye, other than peripheral vision.

I could see him trying to move his head around to see the targets, but couldn’t get him to see anything smaller than 20/200. I was getting a little concerned.

Things weren't looking good

The next day, I took him to our larger office and had a colleague take repeat Optos images, as well as OCT scans. There appeared to be significant elevation in his left macula. Now I was really concerned.

So began a fairly long journey of visits to ophthalmologists, various potential diagnoses, and a very patient three year old sitting for OCT scans, dilation drops, and doctor waits.

He got to move lots of chairs up and down.

I thought, “Maybe I remember hearing that term once in optometry school, or coming across it briefly in a chapter about rare conditions.” But I had to do some research.

To sum it up, it is a benign lesion that most often develops in utero. An epiretinal membrane often forms over the top of the elevated lesion, causing blurred and/or distorted central vision. There are some cases in which the membrane can be removed in order to attempt to improve vision, but in my son’s case, the membrane was too enmeshed with his underlying tissue to be able to safely remove it.

Basically, it is there to stay.

How could I miss this??

Now, as a mom - and also as an optometrist - I felt like I had missed something. How did I not know he couldn’t see well out of that eye? I mean, this is my profession for heaven’s sake!

Had I not been an optometrist, I likely would not have taken him in for an eye exam that young. I would have figured they don’t do exams on kids that young. I'd think, "He sees fine...I’ll just go when his pediatrician recommends it."

The “what ifs” were going around and around in my mind. What if it had been a tumor and spread? What if he had a retinal detachment and lost all vision? What if he developed a macular hole?

At our final visit with the retinal specialist at Oregon Health & Science University (OHSU), I think the doctor knew exactly what I needed to hear. He said, “This is what it is. It is not changeable. There’s nothing you or he did to cause it, and there’s nothing you or he can do to fix it.”

I left that day so relieved. I think others were surprised to hear that I was relieved that there was no “cure,” but when I stepped back and thought about it, he was a very happy, well adjusted, athletic, smart kid who wasn’t affected by this at all. If I hadn’t taken him in that day for an exam at my office, I still wouldn’t even know he had it. Life would have gone on as usual.

Of course, he would have had an eye exam eventually and it would have been discovered, but I’m glad we found it as early as we did to monitor its stability.

I learned an important lesson about preventative care

There are some things that he will not be able to do, such as fly an airplane, but there are so many things he can do, despite this. I hesitate to even tell teachers about it because I don’t want them to expect less of him. I certainly don’t want him to think it limits him. It hasn’t so far!

It is easy to get busy and find that making the time for appointments is a nuisance, but how many times after an exam where you get a clean bill of health and a “keep up the good work” from your doctor, do you wish you hadn’t made the appointment?

Sometimes it’s nice to hear everything is okay. Get your kids in too! If there are issues that need to be addressed, early intervention is key to long term success and the ability to adapt. Don’t let there be “what ifs”. Take care of you and yours!

I think I’m going to go schedule an eye exam now.

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