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Music to my ears

Patients chatting in the waiting room is a sign that all is well

Leigh Spielberg

Posted: Saturday, June 1, 2019

“How big is your gas bubble? Mine was 80% last time, but now it’s down to 40% and I can see over the top. I call it my aquarium, and I hate it. But I think I might miss it when it’s gone. And the doctor says a big gas bubble is a good sign, and that’s really all that matters.”

It’s like music to my ears. I hear it when I open the door, and it provides me with a brief, uplifting moment as I call in the next patient from the waiting room.

“My gas bubble is gone, which is great because we’re flying to Italy this weekend and I wouldn’t want to have to cancel the trip!”

Patients who are happy with their results, patients who are at ease, patients whose problems have been solved, are sometimes comfortable enough to start chatting with their neighbours in the waiting room.

“You had floaters too? I had three little clouds and what looked like a fly in my right eye and now they’re gone! I hope I can get my left eye done soon too, but first the right eye has to heal. I can’t wait.”

This casual chit-chat keeps me motivated as I get back to work examining patients.

“Did you have a retinal detachment too? Macula on or macula off? Mine was macula off. I can’t believe I didn’t notice it sooner! But the doctor said that my photoreceptors are recovering and that they can keep improving until one year after surgery.”

“No, I had a macular hole, and I also got a gas bubble. I was happy to hear that my other eye probably will never develop a macular hole because the vitreous has already safely detached.”

On the first day after surgery, patients are generally quiet and reluctant to interact with their waiting-room neighbours. They might be tired, even afraid. The surroundings are unfamiliar, the experience is new and their eye might be a bit uncomfortable. Especially ill at ease are patients who were referred for retinal detachment repair. They were likely to have experienced acute visual loss, which is frightening for anyone, followed by urgent surgery.

Regardless of the pathology, the only thing any patient wants to hear on day one after surgery is that everything inside their eye looks good, so they can get on with their lives.

But by the second or third postoperative visit, most patients are usually more at ease. They know the routine: front-desk sign-in > IOP measurement > auto-refraction > macular OCT > pupillary dilation > off to the waiting room until I call them in for their examination.

Some of those returning for the second or third visit start to recognise the members of their surgical “cohort”: other patients who were operated on the same day and generally return on the same days for follow-up.

“Oh hello, nice to see you again. Here for your second post-op visit? Are you allowed to drive yet? Today I’ll hear whether I’m allowed to get back on the road.”

At my macular surgery practice in Ghent, I see 24 patients on Friday mornings: six new patients who were referred for surgery, six who were operated the day before, six patients who were operated two weeks ago and six more who are coming for their week four and hopefully final visit.

“Well, it was nice meeting you! Good luck and maybe we’ll run into each other sometime.”

“Yes, we have the same general ophthalmologist, don’t we? Maybe I’ll see you there.”

Cataract and refractive surgeons are used to hearing this lovely chit-chat in the waiting rooms. After all, just about everyone is happy after elective anterior segment surgery.

Vitreoretinal surgery is another story. The list of potential problems is long. Slow visual recovery after macula-off retinal detachment. Persistent metamorphopsia or macular oedema despite anatomically successful pucker peeling. Long-term gas tamponade, impairing the ability to drive a car for weeks on end. Hypermetropic anisometropia or ocular hypertension due to oil tamponade. Fortunately, these are uncommon occurrences in this era of small-gauge surgery.

But even if it all goes as planned, the experience generally isn’t very pleasant for patients. General anaesthesia can cause fatigue or nausea, which is why I’m moving towards performing more procedures under sub-tenon anaesthesia. Scleral sutures cause foreign-body irritation, so I try to minimise their use as much as possible. So, when I overhear the light-hearted conversation in the waiting room, I can get a sense that all is well.

If everything looks good at the third post-op visit, I refer patients back to their general ophthalmologists, at which point I get to say my favourite thing to patients: “Good-bye, have a nice day, and I hope, for your sake, that I never have to see you again!”

Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University, Belgium