Christy is a patient of mine and has a special place in my heart. She was in my office and had a very flat demeanor. Having seen Christy for five years because of her specialty lens wear, I knew something was off.

I always see patients with my resident or a scribe in the exam room. After three minutes with Christy, I asked my team to leave the room. Christy broke down and told me that she had just gotten off the phone with her physician as she was walking into her appointment with me. He had diagnosed her with progressive breast cancer. The needs of her exam flew out the window at this point. But, numb to what to do, she still came into the office for her visit. After sitting with her for some time and listening to her, I walked her to the door and told her I would be calling in a week.

A Proactive Plan

Unfortunately, many of us know that when diagnosed with a condition like cancer, you are in for a scheduling nightmare. Testing, treatments, visits with pharmacists and various specialists all require attention, and many people become a body moving through space hoping they are putting their trust in the right people. I asked myself: How do we balance things for Christy and walk with her through this chapter?

Because Christy has keratoconus, her vision is impossible with glasses; she must be fitted in specialty contact lenses. Due to her diagnosis, she was in for a massive and aggressive treatment with the most toxic and noxious chemicals, which might not kill her but that would kill cancer.

Unsurprisingly, these nasty chemicals make their way into the tear film and have been seen in meibomian glands (Eom et al, 2017). Knowing that Christy was most likely going to have the worst dry eye of her life, we went on overdrive to come up with a plan. Otherwise, she would have to suffer with no vision or uncomfortable contact lenses.

I called Christy a week after her diagnosis. She was still numb, but was able to process an aspect of her health care that she knew: her eyes and her specialty contact lenses. I explained that we were going to be proactive, but that much of our treatment would be done via telehealth and that she was free to text or call me anytime.

Although she was only six months into her current scleral lenses, we elected to order another pair for her to switch over to within the next few months. These lenses would have a polyethylene glycol (PEG)-based coating on them to keep them as “slippery” as possible, and we would use a conditioning solution that restores the PEG coating on them weekly or biweekly, depending on her comfort.

I scheduled Christy for a thermal pulsation treatment as soon as she could get into the office to pick up her contact lenses and told her that we would do another treatment three to six months later as a proactive treatment to flush her meibomian glands. She went on an immunomodulator that she used two to four times a day, and we explored a lipid-based drop and a gel-type drop that could be used as needed. A warm compress heating device was dispensed as well.

The Gift of Sight

A year later, Christy has completed her chemotherapy, but she is not out of the woods. She has had multiple surgeries and is scheduled for additional treatments. She is alive and has become the most gracious and grateful person. Christy wears her scleral lenses daily because she says, “I cannot imagine a day without sight.” She has mentioned that it gives her a moment of gratitude.

Learning about other health implications requires us to go the extra mile beyond normal protocols to help someone through the trauma they are experiencing. Patients like Christy are in your office and mine. She reminds me that life is precious, and the gift of sight that we can give our patients cannot be sacrificed during the worst of times. CLS

For references, please visit www.clspectrum.com/references and click on document #317.