When a ‘Regular’ Eye Exam Is Anything But Routine


Jobson’s Dennis Murphy (center) enjoys his return visit to
LensCrafters / Cosmopolitan Eyecare, where doctors Eliza
Yaghoubian and Deeba Chaudri first alerted him to potential
serious health concerns following what was assumed to be
a routine eye exam in June 2017.
There’s quite a bit of debate today around the concept of an eye exam, and even what qualifies as an “acceptable” exam. Without getting too deep into the weeds on this complicated issue, we thought nonetheless that this story, which begins with a routine appointment for an eye exam at a New York LensCrafters and turned into a trip to an ophthalmologist and eventually under the knife of a noted vascular surgeon for Jobson’s own Dennis Murphy, would be a great way to start to the holiday weekend. Spoiler alert, the story, thankfully, ends on a very happy note for everyone involved.

(By the way, if you are relatively new to the optical world and want to know more about what goes into a comprehensive eye exam, check out this explanation on All About Vision.)

Now, here goes the story: About a year ago, early June 2017 to be exact, our Jobson colleague Dennis Murphy, a vice president with both Vision Monday and 20/20, visited a LensCrafters location on Sixth Avenue in Manhattan. Murphy, a 36-year Jobson veteran, and a few other longtime Jobson executives were ostensibly on site at LensCrafters to get a closer look at “Clarifye,” a relatively new, proprietary digital eye exam that “lets your doctor gather five times more information about your vision,” according to LensCrafters.

The eyecare office at the Sixth Avenue LensCrafters is overseen by Deeba Chaudri, OD, of Cosmopolitan Eyecare and her staff includes Eliza Yaghoubian, OD, among others.

Dr. Yaghoubian was the OD who performed Murphy’s exam that day, and in addition to the Clarifye process she reviewed his medical history and also performed a retinal-imaging test using an Optos device. According to Dr. Yaghoubian, the review of a patient’s medical history is crucial first step to a comprehensive eye exam.

“The comprehensive examination process opens with a preliminary medical history that a staff member collects from the patient,” she told VMAIL Weekend. “This is a way of prompting the doctor on issues to be aware of prior to beginning the exam.” She noted that Murphy did have 20-20 vision at the time, but his history indicated that he also was seeing a cardiologist.

Dr. Eliza Yaghoubian
Dr. Yaghoubian used an Optos device to record an image of the back of Murphy’s eye. This is an alternative to the dilation process. “When we put in drops and dilate the eye, we get a full view of the back of the eye,” she explained. The Optos device is “a great replacement for dilation for those who cannot be dilated on the same day.” The Optos image provides results similar to dilation for the peripheral, or full retina, and in Murphy’s case the image showed some red spots, or hemorrhages, on the peripheral retina.

The “bleeding” around the outside of the eye indicated to Dr. Yaghoubian that there was something systemic present. Dr. Chaudri, the proprietor of the Cosmopolitan practice, noted that red spots on the peripheral retina are a symptom that typically would not be noticeable to a patient. It also indicates the important role retinal imaging plays in a comprehensive eye exam. “This is part of our job,” she said.

Murphy recalls what happened next: “After we came out, Dr. Yaghoubian asked me to come back into the exam room. She called me in and said, ‘Mr. Murphy, I need to let you know that I am seeing red dots on the outer edges of your eyes,’” he said. “She said this could be a sign of a blockage and that I should probably go to an ophthalmologist and have it reviewed.”

“We had a good patient history and also Mr. Murphy was very forthright about his overall health,” Dr. Yaghoubian said, describing how she determined her recommendations. “He knew what treatments he had undergone and what medications he was taking.”

Dr. Yaghoubian referred Murphy to a retinal specialist/ophthalmologist who specializes in diagnosing issues found in the back of the eye. “We can’t always tell with just a picture of the back of the eye,” she explained. “It just didn’t look like [the red spots] should be there after the [previous] surgery that he had had.”

At the ophthalmologist’s office, Murphy was told the initial diagnosis was “exactly right,” and the ophthalmologist recommended further follow-up with a cardiologist or general practitioner to review the findings and investigate a possible carotid blockage.

In quick succession, a round of doctors’ visits and more tests, and Murphy discovered that he had not one but two carotid arteries that were blocked. “They always say the doctor will call you,” Murphy recalled after a subsequent test. “He called the next morning and said, ‘You have about 90 percent blockage in your left carotid artery.’ And I remember being floored. How can I have a 90 percent blockage? Why am I not dizzy? The previous weekend, I was playing basketball with my nephews, and doing pretty well. I wasn’t any more out of shape than they were.”

Dr. Eliza Yaghoubian (front),
who performed Murphy’s eye
exam, with Dr. Deeba Chaudri
of Cosmopolitan Eyecare.
About a week later, Murphy visited Dr. Michael Marin, the chair of vascular surgery at Mount Sinai, who examined him more thoroughly and confirmed two blocked arteries. He was scheduled for surgery in one of the first openings in Dr. Marin’s schedule a few days later. A second surgery was performed—with some juggling around the summer wedding of Murphy’s daughter—in October 2017.

Overall, the process that began with the eye exam in June and leading up to the first surgery spanned about three weeks. The longest waiting period was finding a spot on the surgeon’s schedule, Murphy said.

“It all went well,” he recalled. “My daughter got married, I had the first surgery in June and the second one in October. I went back later and Dr. Marin, the surgeon, was kidding me about now having the carotid arteries of a 15-year old.”
Yes, what Dr. Yaghoubian found in June 2017 is more the exception than the rule, but it also goes a long way toward supporting the idea of the necessity for having regular comprehensive eye exams.

“I just consider myself very, very lucky,” Murphy said. “I was the classic walking candidate for a stroke, with no symptoms. And if I had gone for a regular vision screening—like they do with many children in schools—none of this would have been noticed. But because I was getting a thorough eye examination with a retinal image and they had such great diagnostic equipment at LensCrafters, they were able to discover this.

“And I am lucky enough to have been able to go back and thank Dr. Yaghoubian. To be able to go back and say to the doctor, ‘I’m a lucky guy because of you’ is a big reward. A bigger reward for me, but a big reward for her, too. She’s really doing her job as a skilled optometrist.”

Dr. Yaghoubian, and other ODs, would agree that this kind of story, and its result, is an often-overlooked role that optometrists play in the delivery of health care today.

“Most people just assume that if they can see well, then everything is fine,” she explained. “If anything systemically is going on, [however] a lot of times, depending on the stage of the disease, we can see earlier signs of it in the eye.”

She added, “I was touched to be part of the whole process.”