Thomas Clinch, MD, and his dry-eye patient, news reporter Shannon Bream, manage her eye pain together.
Living with chronic pain often leads people to a dark place. Shannon Bream's 18-month ordeal with constant, searing eye pain left her exhausted, depressed and ready to give up on life. It was an unfamiliar place for a typically sunny person to find herself. The Fox News reporter managed during the day by keeping lubricating eye drops close at hand: her purse, car, desk, even in the shower. At night, she’d set her alarm every few hours to instill more eyedrops to keep the pain at bay.
Her doctors assumed she was suffering from dry eye, a common eye condition for women in their 40s. But she got no relief from prescription treatment. With no definitive diagnosis and no control over her pain, her days had become an exercise in survival. Eventually, she found an ophthalmologist who gave her the diagnosis she needed and the empathy she wanted. Together they became a team, working to manage her chronic pain and enabling Bream to regain her life.
"It pushed me to my limits, emotionally and physically, because I had no answers and there seemed to be no hope." - Shannon Bream
Bream's trouble began one night in 2010 when she awoke suddenly with a pain in her left eye "so searing it sat me straight up in bed," she said. A few weeks later, when it happened again, she called her doctor. He prescribed rewetting drops for dry eye, but the nighttime episodes continued. Another doctor agreed her eyes were dry and added Restasis, a prescription medicine that treats chronic dry eye. Restasis helped ease the dryness, but the incidents became more frequent; both eyes were now affected, and she was experiencing pain nearly all the time, often with double vision.
"I was living in a nightmare. I was desperate for sleep, but I knew that when I did, there was a good chance I’d wake up in pain," Bream explained. "It pushed me to my limits, emotionally and physically, because I had no answers and there seemed to be no hope."
When she described this struggle to her doctor, he diagnosed her as being too "emotional." That’s when she hit bottom. His words sent her spiraling into despair. Instead of doctors, she consulted Internet message boards, where she found others with similar symptoms and stories of being turned away from emergency rooms and doctors' offices. Some even spoke of ending their pain by ending their lives. Bream understood. The only thing that kept her going was thinking about how her family and friends would cope if she left them behind.
When she confided her dark thoughts to her husband, he vowed to empty every bank account and travel the world to get a concrete diagnosis and treatment. Turns out, they didn't even have to leave town. They found a world-class cornea specialist in Washington, D.C., Thomas Clinch, MD.
A Diagnosis At Last
Bream, pictured with her husband, is able to enjoy life again with the help of her ophthalmologist to manage her eye pain.
Dr. Clinch knew what she had as soon as he read her file – epithelial basement membrane dystrophy and recurrent corneal erosions. The cells that make up the outer layer of her cornea don't adhere well, so they easily tear or separate from the underlying cornea, causing a painful erosion. These erosions or tears can occur at any time, but people feel them most often while they sleep or when waking in the morning. That's because in deep sleep the eyes move rapidly back and forth across the eyelids. If the eye is dry, it can stick to the eyelid, which causes the painful tearing on the surface of the cornea. Nearly every time Bream went to sleep, she reinjured her eyes.
There is no cure. Instead she would have to learn how to manage her condition. Everyone is a little bit different. Dr. Clinch and Bream would start simple and figure out which treatments worked best for her. Several weeks later, as her eyes began to heal, Bream slept eight hours, the first time in more than a year.
Doctor Prescribes a Partnership
Bream's condition is the most common type of corneal dystrophy, affecting 2 percent of the population. Dr. Clinch sees patients every week who suffer from similar conditions that cause severe dry eye. It's not uncommon for these patients to come to him after seeing three or four other eye professionals. They're frustrated and ready to vent. Dr. Clinch has learned through experience how to manage this energy, steering the dialogue away from emotions so he can learn enough to treat their disease while making the patient feel heard.
"Thanks to a caring physician who met me halfway in a very difficult time, I feel the best I've felt in years." - Shannon Bream
Dr. Clinch and Bream successfully managed her symptoms with medication for several years, but eventually her condition deteriorated to a point that she needed surgery. Dr. Clinch performed a type of laser surgery called phototherapeutic keratectomy that removed the top layer of her cornea, leaving a rough surface so the cells can adhere better, making the cornea more resistant to tearing. After a painful recovery, she's doing better than ever.
"My eyes will never be perfect and totally pain-free,” Bream said. “But thanks to a caring physician who met me halfway in a very difficult time, I feel the best I've felt in years."
Why did she wait so long to find a new ophthalmologist? Simply the exhaustion and depression of living with chronic pain left her in a diminished state, she explained.
"It’s such a hopeless place to be, but I hope my story will encourage other people who live with chronic pain and don't have a diagnosis to find the right doctor," Bream said. "You must be your own fiercest advocate when it comes to your health. Walk away from medical professionals who dismiss your concerns, and don't quit searching until you find someone who will truly partner with you to find the answers you deserve."