is this treatment wrong?

[Tony.]

so, im reading different ophthalmology books before i begin school, but i practically laughed my butt off when i read the "treatment" in the following case, can someone please explain this to me!

Case 10 from Dr. Newell's Principles and Concepts

55 y.o professor noted flashing lights in the periphery of her visual field several times each month. the lights are present in both eyes and with the eyes open or closed. at the onset the lights are so slight as to be almost unnoticeable, but then they become brighter, larger, and interfere with reading. they disappear over a period of 15-20 minutes. they are unrelated to activities and are not followed by headache or any other ocular or neurologic disturbance.
EXAMINATION: visual acuity w/ correction: od and os 20/20
EXTERNAL: ocular movements, external eyes: normal. pupils react promptly to light.
OPHTHALMOSCOPY, OCULAR TENSION: normal
DIAGNOSIS: Visual hallucination
TREATMENT: Reassurance.

Reassurance? the poor woman is having a transient ischmic attack.... is it common to "reassure" patients?

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[Redhawk]

Why do you think this is a TIA, especially with the lack of neurological symptoms? It sounds more like an acephalic migraine (visual migraine without headache) to me.

If you're just curious about using "reassurance" as a treatment, it's not uncommon. If she were having TIAs, though, (transient slurred speech, weakness, confusion etc.) then reasurrance would obviously be insufficient.

 

[Andrew_Doan]

Diagnosis is visual migraine. This is classic for march and build-up seen with visual migraines. The symptoms start as small positive visual phenomena and then expand. The symptoms subside after 20-30 minutes.

Reassurance and education about visual migraines are indicated.

 

[Tony.]

i dont know,
i guess using "reassurance" as a treatment is a little strange to me.....

I remember last summer i had an internship working with an optometrist and a patient came in with floaters and she was told that there is no treatment for her floaters (unless surgery is performed and something artificial is inserted instead etc.)
could that be considered a form of "reassurance"? Im pretty sure she didnt feel reassured after what she had learned.


p.s Dr. Doan, what is "march" ?

 

[Redhawk]

Patients present all the time with complaints that cause them concern, which really aren't anything and only require patient education and reassurance that they don't have cancer, a heart attack, strep throat, etc. If you do an ER rotation, you'll have patients come in all the time that have "chest pain" which is due to any number of causes other than a heart attack (anxiety, chostochondritis, etc.) and simply need to be reassurred that nothing is wrong (after whatever appropriate testing may be necessary). Unfortunately, some patients are less able to accept such reassurance and continue to worry. All you can do is try your best.

 

[Andrew_Doan]

i dont know,
i guess using "reassurance" as a treatment is a little strange to me.....

p.s Dr. Doan, what is "march" ?

I think a better way of reassuring patients about floaters is to explain to them that they are normal and that everyone has them. Then they should be educated about the signs and symptoms of a retinal tear or detachment (e.g., photopsias, metamorphopsias, curtains, and showers of floaters). It should be emphasized, however, that their visualization of small floaters is not related to a retina problem.

March is the movement of the expanding visual phenomenon seen with visual migraines over the visual field.

 

[Tony.]

thank you both, my fellow clinicians !

I learned something from the both of you

 

[GeddyLee]

I have this condition. Funny how it never worried me, even before I learned what it was. It's mostly just annoying.