Expect the Unexpected

Two ODs who made life-saving diagnoses on the role optometry plays in medicine and overall patient well-being

According to a 2018 Pop-up Poll by Women in Optometry, nearly 96 percent of the respondents said they have made at least one life-saving or sight-saving diagnosis during a routine exam. From life-threatening infections to malignant hypertension, many ODs have seen a wide variety of conditions and are able to make a majorly impactful change in a patient’s life.

Dr. Brisbane
Dr. Brisbane

Optometrists go into work expecting to see common conditions and perform routine exams most days. But one day, when Nanette Brisbane, OD, went to her practice in Spokane Valley, Washington, she was met with something unusual: a patient with a choroidal melanoma; a cancer developing in the choroid in the back of the eye. Her stomach sank. “I didn’t want to tell anyone this,” she says. “Ultimately, I discussed what I suspected and said we needed further testing.” Dr. Brisbane was able to expedite the patient to a retina specialist who confirmed the original diagnosis and sent the patient to Seattle for further treatment. “The patient contacted me and said their doctor said, ‘I can’t believe this was found during a routine eye exam; this saved your life.'”

While Dr. Brisbane’s story doesn’t happen to everyone every day, many ODs can relate to catching something lifesaving from an eye exam. “Had the patient not come in for a routine eye exam, this may have been caught too late,” she says. “We never know what we’ll find when a patient is sitting in our chair, but making a life-changing diagnosis gives you that aha! moment where you’re just really thankful that you do what you do.”

It’s not uncommon for eyecare professionals to discover and diagnose diabetes, hypertension and some autoimmune disorders to name a few. Dr. Brisbane reflects that some patients are less diligent about going to their primary care doctor, but will stay on top of getting their glasses prescription. “I’ll say, ‘I’m so glad you came in today,’” she says, on her way of making patients feel at home.


Dr. Brisbane takes a personal approach when it comes to following through on a diagnosis—and communication is key. “Usually I reach out to their primary care doctor,” she says. “I get ahold of them and tell them what I’m finding and what I would suggest be done further.” While she has found some doctors to be more receptive than others, she always follows up with the patient’s well-being in mind. “Sometimes I send a letter, but I try to talk to the doctor myself,” she says.

Dr. Brisbane is not alone in the shared view that there are some misconceptions about optometry in the wide world of medicine. “I wish the medical doctors really understood what we do… the instrumental role we play,” she says. “A lot of them don’t really see that.” She notes the uphill battle to get the respect and recognition from some of her medical colleagues. “I wish the medical world would value our opinions.”


Dr. Hong

Carole Hong, OD, FCOVD, of Family Vision Care and Vision Therapy in San Carlos, California, has a similar story. Dr. Hong saw a patient who wanted to know if she needed vision therapy, but when Dr. Hong saw that the patient was straining to look to the side and noticed a head tilt, she wanted to rule out a space-occupying lesion. “When there’s a rather sudden onset, non-comitant deviation, I refer patients to their primary care doctor or neurologist, stat,” she says. Days later, Dr. Hong received a call from the patient thanking her for saving her life: a tumor was found at the top of the patient’s spine. According to the patient, “’When the neurologist saw the CAT scan, he said, ‘We need to do surgery today,’ and while she was waiting, her leg began to go numb,” says Dr. Hong. The tumor turned out to be a benign hemangioma.


Dr. Hong, at right, with past intern, Dr. Teresa Chen

Dr. Hong encourages the medical community to open their minds to the world of information optometrists can provide. “I think medicine understands the value of optometry as it relates to conditions such as diabetes, but they don’t always know the full gamut of what we have to offer,” she says. “The medical community is coming around,” she says,“as neurologists are very appreciative of the help we provide their post-concussion patients who struggle because of underlying conditions such as convergence insufficiency.”

Dr. Hong notes that there are a wide variety of vision deficits that when left untreated can have a negative impact on patients of all ages. “Patients with MS, myasthenia gravis or Parkinson’s disease often have underlying binocular vision disorders that contribute to their challenges. Similarly, many children needlessly struggle with reading, learning and/or attention due to underlying binocular vision disorders as well. Lenses, prism and/or optometric vision therapy can make a huge difference in a patient and their family’s overall quality of life,” she says. Dr. Hong recommends screening for potential binocular vision disorders in any primary eye care and medical setting, as it can help more patients who do not realize they have vision deficits impacting their lives.

Dr. Hong, at right, with two of her associates Justine Bailey, OD, FCOVD, and Kristi Jensen, OD, FCOVD

What’s the diagnosis that has most impacted you? Share your story with us.

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