When the vision of his left eye suddenly clouded over, a 57-year-old man was launched into a maze of hospital testing, imaging, and examinations until—days later—an in-depth eye exam revealed the startling and life-threatening cause of his partial blindness, Lisa Sanders writes for the New York Times Magazine.
Blindness, headaches, and chest pain
In September 2020, the patient realized while washing his face that he could no longer see correctly—while his right eye seemed fine, an "impenetrable gray cloud" hovered over the upper half of everything he could see from his left eye, Sanders writes.
The patient's wife immediately took him to Bridgeport Hospital, where a physician took down all his symptoms: blurry eyesight, a throbbing headache, and pain on the left side of his chest.
Immediately, the doctor ordered an EKG and a blood test in case of heart attack, but the tests came back normal. So did a round of additional tests—an CT scan, an MRI, and more blood tests—that the doctor ordered to rule out a potential stroke, tumor, or temporal arteritis, a disease that can destroy arteries in the brain and eye.
The doctor hypothesized the blindness could stem from a migraine, but even after the patient's headache finally cleared up, his partial blindness lingered.
A life-saving eye exam
The hospital had ruled out potential causes of blindness stemming from the brain or the area between the brain and eye—but it didn't have the technology to do an in-depth exam of the eye itself. For that procedure, the patient was sent to Jay Wang, a retinal specialist at Yale New Haven Hospital.
After several hours of testing and imaging, Wang identified the problem: While the vessels in the patient's right eye were "perfect," the vessels of the left eye were irregular. Some were brightly spotted in the imaging and others nearly invisible—including the artery that supplies blood to the fovea, a section of the retina that is integral to clear vision.
As Wang explained, the imaging indicated that the man had suffered a stroke, with tiny clots of blood travelling through his bloodstream before lodging in his eye, where they had irreparably damaged his vision.
But the man's medical mystery was by no means solved, Wang cautioned: They had to find out where those clots had originated from, or else it could happen again.
Wang sent the patient to Yale New Haven's ED for an echocardiogram. While there, a fourth-year medical student shadowing the case, Joshua Hyman, asked the patient if he could do an initial scan before the official echocardiogram just as a learning exercise. The patient agreed.
But when Hyman placed the ultrasound probe between the patient's third and fourth rib, he didn't see what he should have seen: "the light gray muscles of the two chambers on the left side of the heart squeezing around a dark center of black that is the blood," Sanders writes. Rather, Hyman saw a kiwi-sized "bright ball zooming back and forth across the screen with every heartbeat."
'It's not every day you get to save a life'
Hyman immediately shared the results with his attending physician, Karen Jubanyik, who confirmed his suspicions: The patient had a myxoma, a rare type of slow-growing tumor, often found in the heart. The tumor had likely been developing for 20 years or so, and the tumor's rough surface provided a haven where blood could pool and eventually form clots—clots that could be launched any time tumor lurched side-to-side.
According to Hyman and Jubanyik, the patient was lucky. Tumors like these, they explained, often presented in cases of stroke or heart attack, but sometimes can grow large enough to block the blood's ability to flow out from the heart, causing sudden death. So far, the patient had only lost some of his vision, they explained, but he needed immediate surgery to excise the tumor before further damage could be done.
Three days later, the patient underwent a successful surgery, and today, he says he feels healthy enough to exercise. While his vision isn't perfect, the patient added, it seems better than it was when the symptoms first hit.
Wang, who had followed his patient's journey, said he was amazed by what the providers in the ED had discovered and grateful the operation went well. "As an ophthalmologist," he said, "I'm used to saving vision. It's not every day you get to save a life" (Sanders, New York Times, 2/4).