Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

My 85-Year-Old Eye: Dr. Val Goes To The Ophthalmologist

Fortunately for me, my recent brush with the healthcare system was not as frightening as Dr. Dappen’s (he blogs here every Wednesday and recently had a mild heart attack). However, it was provided me with some amusing blog fodder.

Last week I was minding my own business, planning to purchase a new batch of contact lenses from a local optometrist, when I was required (under threat of withholding my lenses) to undergo a vision exam. Much to my disappointment, my right eye was not behaving itself, and refused to correct to 20/20 despite a good deal of lens fiddling on the part of the doctor. A slit lamp retinal evaluation followed, and the optometrist concluded that my right eye’s macula “looked like an 85-year-old’s.”

Well, that was not the most welcome of observations. I asked for the differential diagnosis (being that I’m quite a few years away from 85) and wondered how I’d developed macular degernation. He suggested that it could also be a “central serous” which is (apparently) a stress-related swelling of the macula that requires no treatment and usually resolves on its own.

“So basically you’re saying that my eye could be ‘bugging out’ because of stress.” I said. “And you’d like me to see an ophthalmologist just in case it’s something worse and equally untreatable?”


So I made an appointment with a local ophthalmologist – one of the few working on Christmas Eve – and was sorry to have him confirm that there was indeed something wrong with my retina.  He even ordered an eye angiogram (I didn’t know those existed, but it makes perfect sense) and I was injected with a vegetable dye. Photographs were taken through my dilated pupils at regular intervals as the dye wound its way through my retinal vasculature.

“It’s not a central serous.” He said with a serious tone. “And you can see the macular defect here on this photograph.”

“So my right eye is like an 85-year-old’s?” I asked, wondering how I’d been so fortunate to have one part of my body on the aging fast-track.

“Well, not exactly. I think it’s unlikely to be age-related macular degeneration. You probably have retinal thinning caused by your nearsightedness.”

“You mean all that straining to see the chalk board wore out my retina?”

“No. What I mean is that your eye is supposed to be shaped like a baseball, but yours is an egg shape. So your retina is stretched thin and is starting to wear in your macula area.”

“Well can you suck out some of the vitreous gel and shape my egg back into a baseball?”

“No. Unfortunately that doesn’t work.”

“How do you know?”

“The Russians tried it in the 1960s.”

“Ok, well how do I take some of the tension off my stretched out retina?”

“You can’t.”

“Well if I lose weight or eat carrots or exercise, or stop wearing contacts, or get lasik… would any of that help?”


“So there’s nothing I can do to prevent further damage, and nothing to repair or treat it.”



“I don’t like this condition.”

“Well, you’ll have to come and see me once a year so I can monitor the progression. Sometimes the body responds to the retinal damage by growing blood vessels in the area, and that can cause further visual deficits. But we can zap those new vessels with a laser and decrease the damage.”

“So my eye might overgrow with blood vessels like weeds in a garden.”

“It might. But it also may stay exactly the same for the rest of your life.”

“Well, the uncertainty is anxiety-provoking.”

“I’ll see you in a year. You’ll probably be fine. Don’t worry. Oh, and if you see any ‘floaters’ or flashes of light, come in to see me immediately.”

“What would that indicate?”

“A retinal tear that would need laser therapy right away. People with thin retinas can have spontaneous tears. Just keep that in mind.”

“Um… ok.” I said, smiling feebly.

So here I am, with one wonky eye, not knowing if it will get worse or remain the same indefinitely. There’s nothing I can do but watch the progression once a year with an ophthalmologist. Like so many patients, I’m in a gray zone where prognostication is a challenge and reversal of disease is not possible.  I have one 85- year-old eye. May it bring me wisdom, courage, and more empathy for patients.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »