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A Piece of My Mind
August 21, 2018

Blinded by Sight

Author Affiliations
  • 1DuPage Ophthalmology, Lombard, Illinois
JAMA. 2018;320(7):643-644. doi:10.1001/jama.2018.11125

It was some time ago when I first met her. She, like many other older patients, came to my office for her deteriorating eyesight. Aging gracefully, she was outgoing, pleasant, and articulate, and other than her blindness, she was in excellent health.

She sat in the examination chair, as she recounted her story. She had a happy childhood. However, as a teenager, she contracted a severe infection in both eyes, leaving her corneas permanently scarred and legally blind. She went on to finish high school, became employed, got married, and raised a family, but her blindness persisted.

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    4 Comments for this article
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    Similar cases
    David Snyder, MD | Private Practice
    In my experience, most patients who go from blindness to good sight are tremendously elated and grateful for regaining this most precious gift. However, I did have 2 cases which reacted similarly to Dr Lam's patient. One man whom I distinctly remember was 100 years old and he had hand motion vision for many tears due to cataracts. He ultimately decided to have surgery- mostly encouraged by his family. He regained 20/40 vision in both eyes and, paradoxically, he became my most unhappy patient. He hated his vision and failed to adapt to the world of vision. In fact, he was so mad at me that he actually took a swing at me on a follow-up visit- fortunately I could defend myself against a centenarian !
    There seems to be a very small subset of patients who are very happy and fully adapted to their world of blindness- they simply cannot or do not want to adapt psychophysically to having good vision- probably for many reasons. My patient was very unhappy because he couldn't handle seeing again- too overwhelming psychologically, and his 70 year old children tried to get him to live more independently.
    CONFLICT OF INTEREST: None Reported
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    Absurdity
    Peter Zloty, MD | Southern Eye Goup Mobile Alabama

    Your conclusion contradicts nearly thirty years of clinical practice. I am a reconstructive corneal transplant specialist who has restored sight to hundreds of long-term blind patients, many from childhood accidents and adult occupational injuries.

    These patients experience euphoria and delight seeing spouses and children and grandchildren for the first time. The only negative reaction has come from the mirror, which reveals age!

    Your article will be used by some to deny reconstruction to long-term blind people by government agencies and insurance carriers. 

    This patient needed counseling and perhaps antidepressants. Not darkness.
    CONFLICT OF INTEREST: None Reported
    Our Innate Biases
    Kevin Lavery, MD | Specialty Eye Institute
    Thank you Dr. Lam for the wonderful article. While not nearly as dramatic as either your or Dr. Snyder's experience, I once had a young patient in her 40s with a visually significant cataract who also had a coloboma of the iris which as you know is a large keyhole "deformity" of the iris. While we were discussing her surgical options I casually mentioned that I would also be surgically repairing her "iris defect" when she looked at me aghast. I was so pleased that I would be able to fix this for her I had no comprehension as to why she was looking so disturbed. When I inquired she went on to explain that her pupil was her pride and joy and defining feature. How dare I suggest to take that away from her and ruin her looks. It is very difficult overcoming our presumptions. It was an important lesson for me.

    CONFLICT OF INTEREST: None Reported
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    Agnosia
    John Niffenegger, MD | Retina Associates of Sarasota

    This patient 's experience of agnosia is similar to the case study of Michael May and has been referred to as Moluneux's problem, first described in 1728 by William Chesleden.

    REFERENCE

    1. https://ucsdnews.ucsd.edu/archive/newsrel/soc/sightregained.htm

    CONFLICT OF INTEREST: None Reported
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