Throwback Series: Learning to read the patient, not just the eye

In celebration of Ophthalmology Times’ 50th anniversary, leaders revisit a memorable “throwback” case from earlier in their careers. In this special series, they reflect on how evolving knowledge, techniques, and technologies have transformed the way such cases are managed today. Join us as we look back at pivotal moments in their professional journeys—and explore how far the field has come.

This episode focuses on a retinal detachment case that took an expected turn when an expulsive suprachoroidal hemorrhage occurred mid-surgery. The experience underscores the importance of remaining acutely attuned to the patient—not just to the operative field. For the ophthalmologist—Deborah Ristvedt, DO, of Vance Thompson Vision in Alexandria, MN—a moment of crisis forever shaped her approach to patient care and intraoperative awareness.

“I had a patient on the table. We were doing a retinal detachment repair, and she started coughing, and she ended up having an expulsive suprachoroidal hemorrhage,” Ristvedt said. “And if you've never seen that, it's so scary. We didn't know, actually, where the blood was coming from. It happened so fast.”

The experience, though alarming, became a pivotal learning moment. “But the one thing that I learned from that situation is to constantly be mindful of listening, listening to the patient's breathing, listening to body movements, listening to anything that could give you that indication that that patient may not do well under sedation or elsewise,” Ristvedt added.

Her mentor’s guidance reinforced a broader awareness beyond the operative field. “I remember my mentor saying, ‘Okay, Deb, what if this patient started coding, just a different situation, what would you do?’ And all I'm thinking about is the eye. She's like, ‘No, you pull off the drape and you start CPR.’”

That conversation—and the moment in the OR—sparked a shift in how she approaches every patient encounter. “I think learning how to read the patient early on has given me just such a better knowledge of how patients are doing comfort wise, how I can make their experience better, how I can take care of them more if an unhappy patient is coming in the door, watching their breathing, their body language, being able to get them to a level where we can have a conversation and listen,” Ristvedt said.

“It kind of all started from that experience with the expulsive hemorrhage being like, I've got to be aware at all times when I'm in the OR as well as the clinic, and in tune with my patient,” Ristvedt added.