The patient's journey: glaucoma

BMJ 2006; 333 doi: (Published 05 October 2006) Cite this as: BMJ 2006;333:738
  1. Christine W Hartmann, assistant professor (,
  2. Douglas J Rhee, assistant professor2
  1. 1 Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA
  2. 2 Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, USA
  1. Correspondence to: C W Hartmann
  • Accepted 13 September 2006

My good news and bad news

“You have glaucoma,” an ophthalmologist informed me when I was 36 (the mean age of onset is 65). Given the uncanny ability of the human brain to compensate for missing visual information, I don't know when I would have noticed my blindness had I not had some unexplained pain in my right eye one morning. As I lay in bed with my hand over my right eye, I looked around the room using only my left eye. I noticed that when I gazed straight ahead at the dresser, I couldn't see part of the closet door. And when I moved my gaze to the closet door, part of the room door disappeared. For the first day, I tried to put it out of my mind, but when the symptoms persisted, I began to get very nervous.

A week later, I sat in the dark examining room, stunned. Tears came to my eyes despite my desperate attempt to appear in control. “You're young to have this,” explained the doctor. “But the good news is that there are lots of medications to treat it.” Without looking at me he added, “It's not something to be too concerned about.” He glanced instead pointedly at his watch. Was I going to become emotional and make it difficult for him to leave the room? Ignoring his impatience, I persisted and asked whether there was anything else that might be causing my vision loss, anything we might want to rule out. He shrugged, “Well, it could be a brain tumour. We could do an MRI, but…” His entire body language finished the sentence: “why bother?”

Why bother indeed? They were not his eyes, and he was sure of himself and the diagnosis. A week later I sat before the ophthalmologist whose specialty was vision loss from …

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