Last Saturday, a 65 year old Hispanic female came in, looking as healthy and normal as any other patient. Her only complaint was that she felt a vague, weak pain in her right eye and it started about three days ago. She claimed that it only occurred when she forgot to take her blood pressure medication, which she always forgets to take on Saturdays. The exam went by as normal as can be (best corrected visual acuities were 20/20 OD, OS; pupils normal and responsive to light, etc) until I measured her blood pressure. I first got about 200/100, then later I got 220/104, then 200/118 right before she left!!! Also, she had non-repeatable superior visual field defects in the right eye. But here's the clincher...during the dilated fundus exam, I suddenly bumped into this in the inferior retina in the corner of my view through the lens:

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As I've mentioned in previous blogs, I've been working at a low vision site (The Center for the Partially Sighted, or CPS), so I see many patients that have lost a significant amount of their vision. About two weeks ago, I had a patient that had lost much of his sight in his left eye (his vision was 20/200 or something like that) and had a very interesting visual complaint. He mentioned that sometimes he would notice "long strands of hair" that would suddenly hang down in front of his vision in his left eye. Since there were no signs in the back of the eye that would elicit such visual symptoms, it was concluded by the staff doctor that he had what is called Charles Bonnet Syndrome. Patients with this condition are mentally sane but have unexplained hallucinations in the eye (or eyes) that have decreased vision. They can see anything from complex, colorful patterns to animals, and these objects can even fit within the area they see e.g. a perceived small pink elephant sitting on a real couch. Most patients with low vision do not experience this syndrome, but it is definitely something to consider when patients have very outlandish visual complaints!

If you didn't know already, California has a quite a large Spanish speaking population, and there is a sizable amount of people that speak Spanish only. As a result, it is inevitable that we run into such patients, so we are given a situation where we must carry out the entire eye exam in Spanish. This is especially true when I work at OCLA, which is in South Central Los Angeles, a population that is heavily Hispanic. There will even be days where I have only one English speaking patient out of all my patients of the day!

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