Monocular and Moral Blindness

I saw a 30 year old patient in the clinic who came for an initial visit. His past history was remarkable for a Cholecystectomy (gallbladder removal), and a healed contusion of the scalp from a stray gunshot while he was driving. He has a strong family history of gallstone disease. He showed me pictures of his superficial wound and a bullet casing in his car. At the end of his discussion of his past history, he nonchalantly stated that he could not see out of his left eye for 3 years. His wife was with him, and she nudged him into talking about his eye. He had no known trauma to the eye. He worked in the construction industry.

On exam, a dense cataract was easily seen. There was no red reflex on the left light shining back from the retina, in the back of the eye. On the ophthalmoscopic exam, the field was entirely black. A cataract is an opacification of the lens, which is in the front of the eye. It is common in the elderly. It is unclear as to why this young person developed one.

I understand that the clinic I volunteer at is for uninsured patients, and that access to medical care is limited in this population. But for it to take 3 years to have a young patient get a 20 minute procedure to restore vision in his left eye is a travesty.

In my previous medical practice, I had a 50 year old patient who presented to me after she suffered a right occipital (back of the brain) stroke from a ruptured aneurysm. She had a diagnosis of hypertension. She saw me soon after being discharged from the hospital. At that time, she told me that since the hospitalization, she was not able to see in her right eye. A patient may have developed cortical blindness from an occipital stroke, but the blindness is typically on the side opposite the stroke. She was not examined by an ophthalmologist during her hospitalization. When I examined her right eye with an ophthalmoscope, the field was completely red. She had apparently bled into the vitreous (the gel that makes up the body of the eye). I had her see an ophthalmologist, who said that he could operate on her when he came back from a week long conference. He thought that evacuating the blood at this point would not help. Angry, I referred her to another ophthalmologist, who successfully evacuated the blood within days. The sight in her right eye was completely restored. Needless to say, I had not referred any more patients to the first ophthalmologist.

So here we have first world care in my practice, with third world care (or worse) in the clinic. This, to paraphrase President Trump on the Supreme Court case which overturned his tantrum tariffs, is “shameful”. I don’t know the reasons why my clinic patient is uninsured. He is hard working, has a wife and a two year old daughter, and deserves to have full vision when it is so easily accomplished.

Shame on us.