THE HIDDEN QUESTION: “Am I Going Blind?”

In my 20 years of treating patients with glaucoma, I have come to realize that this question, “Am I going blind?” is a concern for almost every patient who has glaucoma. This question is not directly asked by the patient or addressed by the doctor. Most patients seem to be waiting for me to shake my head approvingly or say that things are going well so that they can go home feeling more assured that glaucoma will not take their vision. However, not asking the question leaves a lot of room for interpretation. I may have been having a hard time with the patient just before your examination, and may have a slight frown on my face. You could, perhaps, interpret this to mean that your disease is not going very well.

I think the question needs to be brought out into the open, as this is the question which lives in the “unsaid” and I think it is time we make it a constant ongoing conversation.

I have now begun asking almost every patient if they think they are going blind from glaucoma. The answers are quite interesting. I find that there is a very poor correlation between a patient’s true risk of going blind and their concern about it. For example, a 9O year old patient with severe heart disease and diabetes, who probably won’t live another three or four years, may be very worried about losing their eyesight, and it may be very unlikely in their particular case. Also, I see other people who have a very high risk of blindness, and they are very unconcerned, saying, “You’re a great doctor.”

The question is really rather easy to answer. In fact, if you take a look at your own visual field examination, with a little help from my technicians or me, you will be able to see for yourself if your sight is preserved, getting worse or stable.

I encourage you to bring this question out into the open whenever you see me.