Sudden change in vision
DR. Johnson is a 55-year-old experienced surgeon
who works in a big hospital in one of our cities.
He is extremely busy, attending to over 150 patients and performing about 25 surgical operations every week.
Last Monday was not a particularly good day for Dr. Johnson. He had about nine patients on his operation list and having commenced work at 7.00am, he was just on the third patient at 11.00am. He knew he was unusually slow, yet he could not pin it down to anything. He seemed to be in good health and had remembered to check his fasting blood sugar last week because he had passed urine a little more frequently than before. The result was however reported as within normal limits.
“May be it is this heat” he rationalised. He had had to do the last surgery without any air-conditioning in the operating theatre because the notorious PHCN had done what it knew how best to do – “Power Holding.” The larger generator in the hospital had broken down from overuse and the smaller one was barely adequate to power the lights and the key items of equipment needed for the surgery.
Intermittently, Dr. Johnson experienced mild blurring of his vision. “I think I will call it a day after this one” he said to himself. “Michael” calling to his assistant, “You may have to do the other cases except the next one which I expect may give you some difficulties. We shall do that on our next list on Friday.”
“What is the matter sir?” asked Dr. Michael. “You seemed to be doing quite fine except…” “Except that I am unusually slow,” added Dr. Johnson, completing the sentence for Dr. Michael. “I have intermittent blurring of vision and I have to go and see my ophthalmologist” he added.
Dr. Johnson discovered to his amazement that he could see distance clearly with the reading part of his glasses. This he knew was unusual and later told the ophthalmologist. In the past, he saw blurred objects whenever he looked through that portion of his glasses.
“Are you a diabetic” asked Dr. Owo-Eye, the consultant ophthalmologist. “Not at all” replied Dr. Johnson, showing him the result of the fasting blood sugar he did a week before. “I have examined your eyes and cannot find any abnormality. The commonest cause of fluctuation in vision is diabetic hyperglycaemia (high level of sugar in the blood). I am sure you know that. We must repeat this test,” said Dr. Owo-Eye.
Dr. Johnson had a random blood sugar done immediately and a fasting blood sugar the following morning. He was alarmed at the very high values. The fluctuations in his vision had saved him from going into coma by forcing him to seek attention.
Apart from Diabetes, there are other causes of painless loss of vision or fluctuations in acuity of vision. These include mild bleeding into the eyes from sickle cell disease, sudden increases in intraocular pressure due to various causes, severe hypertension and neurological causes.
“By the way, you said your blood pressure was normal. Didn’t you?” asked Dr. Owo-Eye. “Yes it was 140/90mmHg” replied Dr. Johnson. “I think I would like to check this personally just to be certain the reading is correct.” Dr. Owo-Eye was satisfied with Dr. Johnson’s BP and decided to admit him for treatment. Just as he was concluding the arrangement, a call came through to Dr. Johnson’s cell phone. As he answered, his face was twisted and mouth wide open. “What is it?” asked Dr. Owo-Eye. “My wife just reported that she couldn’t see well with her glasses. It all started suddenly after a meeting she held in her office” related Dr. Johnson.
Now both doctors were puzzled. Before they could gather themselves together and decide what next to do, another call came through. This time it was from Mrs. Johnson’s secretary. There was a smile on Dr. Johnson’s face. “What’s up?” asked Dr. Owo-Eye in anticipation. “Mrs. Johnson had picked up someone else’s glasses!” said Dr. Johnson gleefully.
