When Is It Better Not to Know?

Especially when it would save you money?

In 2014, I finally felt financially stable enough to get an eye exam, after putting it off for two years.

I knew I would be paying for the exam out of pocket, despite my health insurance. When I arrived the receptionist asked if I would like to pay even more out of pocket to get retinal photos taken, in addition to the usual air puff test and the rest of it.

I paid the extra fee and got my retinal photos. The optometrist examined my retinal photos and noted that it looked like my intraocular pressure was a little high, which could be a risk factor for glaucoma. He advised me to never miss an annual eye exam again.

So I went home, read everything the internet had to offer on glaucoma, and came back in a year. I paid for the exam, and I paid the extra fee for the retinal photos—after all, I needed them, right? Because of my intraocular pressure?

This time I had a different optometrist who looked at my photos and said my intraocular pressure looked fine. Which was good news—but I still wasn’t going to skip any eye exams, so I went back again in 2016, paid for the exam and the retinal photos, learned that my eyes were fine, and then went back again last weekend.

Now the slightly-elevated intraocular pressure was back. My optometrist pulled up the data from the past four years and I wanted to ask if intraocular pressure was related to stress, because the first thing I thought when I saw that chart was “wow, that looks like a diagram of my personal stress levels over the past four years.”

So yes, I might end up developing glaucoma in a few decades, or I might not. We really don’t know.

I also learned that I might be at risk for macular degeneration. Not now, and not for a very long time, but at some point in so-called “old age.”

It was at this point that I started wondering whether the retinal photos were worth it. Why was I paying an extra $45 on top of my exam fee to learn all of the ways my eyes might fail me, decades down the line?

Would it be better—not to mention less expensive—not to know?

Logically, I know that it’s better to get as many of these tests as possible, especially if they’re testing for something like glaucoma, which can be slowed down if caught early. (For macular degeneration, my optometrist advised me to eat a lot of leafy greens for the next 40 years.)

But if I hadn’t paid extra for that retinal photo during my first eye exam, I probably would have skipped years between eye exams, saving $200 for every year I skipped and ending up right where I am now, with eyes that are still doing fine.

Which is easy for me to say because my eyes are doing fine, and had there been something immediately wrong with them that could have been caught on a retinal photo, I would have wanted to know.

I feel like this is an early test of all the mammograms and colonoscopies to come, along with the other tests they will no doubt develop that will project certain types of health risks as accurately as these photos project my potential glaucoma. “You should come back, every year.” (And pay extra, every year.)

Maybe it’s just that healthcare is broken—and potentially going to be even more broken in the near future—and because of that we do not want to learn the ways in which our bodies might also break. The costs are high enough that it is worth it not to know.

But of course I’m going back next year, and of course I’m going to pay for the retinal photos again.

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