I have a patient, already blind in his right eye, who just suffered his third retinal detachment in the last 2 months in his remaining, left eye. I am operating, again, to try and prevent his going totally blind.
I trained with a world famous and world class mentor, Steve Charles, M.D. of Memphis, TN. My fellowship lasted a year, where I learned my specialty, and some lessons, that will last a lifetime. Among the lessons learned…”sometimes the disease wins.”
Retinal Disease Often Means Lost Vision
Retinal disease often leads to permanent loss of vision. Sometimes mild, yet often, significant loss of vision. As a young physician I remember tending to believe that I might just be the one “super hero doc” who was better than most. I remember thinking that maybe my surgical results would be better than any others.
As a practicing physician of 18 years, I know, and have witnessed, so many times that outcomes are not what we had hoped…despite perfect surgery and treatment. I have learned to respect eye disease. Doctors don’t always “win” as there is no such thing as a “perfect surgical outcomes.”
Poor Outcomes are Disappointing
Poor surgical outcomes may be defined as results that are less than perfect. In my case, I often perform surgeries that were technically perfect, yet the visual results are disappointing. Nothing went wrong, but it is just the nature of the disease.
Doctors Are Still Not Perfect
In this highly technological age, with advances such as Avastin, laser surgery, Ozurdex, etc., it’s hard to tell patients that we are not perfect and results can not be guaranteed. In fact, it’s hard to tell patients that despite our best efforts and intentions, outcomes may be disappointing.
Medical care, especially surgery, gives us the opportunity to alter the natural course of a disease. For instance, the natural course of a retinal detachment is blindness. The success rate of retinal detachment surgery is about 95%. This means that 95% of the time we are able to reattach the retina and prevent blindness. This does NOT mean that 95% of the time patients we well.
The eye disease still wins 5% of the time.
What Does This Mean? What Dr. Charles taught me, was that I shouldn’t (and physicians as a whole) take poor outcomes on a personal level. This is easier said than done.
With time, I learned how to do this. Perhaps this is manifest in my “explanations” that highlight the potential pitfalls of a particular disease. Through education, I hope to convey my expectations and hope they are aligned with my patients, because I have learned that “sometimes the disease wins.”
With my particular patient above, I saw him Saturday morning. While his retina is now reattached, it must remain this way for before we can have some hope. Right now, his eye disease is winning.
4 replies on “Sometimes the Disease Wins”
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My son was born premature at 26 weeks gestation as a result he is blind. Both retinas have detatched. He had 3 eye surgeries as an infant in 1993. 29 years later with no follow up his eye has become disfigured shrunk and visually upsetting to other people. As joshs mother this breaks my heart as my son has no friends or social circle. People are affraid of the way he looks and Void him. Is there anything you can do to fix my sons eyes tosee if both retinas have detatched. Or cosmeticly can you fix his eye to close. Please help
I am very sorry to hear about your son’s condition. Retinopathy of prematurity is a common cause of blindness for those born before 31 weeks of gestation. At this time, there exist no treatments that would restore your son’s vision. However, he’s young and we remain optimistic that in the future, that answer could change.
In terms of his shrinking eye, this is a condition called phthisis bulbi, and it is an unfortunate possibility in eyes with a chronic retinal detachment. If he is not in pain, he may want to consider something called a scleral shell. A scleral shell prosthesis is a thin prosthetic eye designed to be worn over a disfigured eye to restore its cosmetic appearance. If you are able to secure an appointment with an ophthalmologist, your son will be examined and you can discuss the option of a scleral shell fitting.
Hope this information is useful to you,
Dr. Mike Rosco