Yet another eye update

It seems like a good time to catch up on the state of my eye health. 2017 was a year of such ups and downs for my eye, but the good news is that it is over and my eye seems to be pretty stable now.

I ended up having three surgeries last year to try to slow down the vision loss from secondary glaucoma. Surgery #1 at the end of July involved implanting the new Xen Gel Stent. That didn’t work. Surgery #2 at the end of September involved implanting a more traditional Baerveldt valve. The surgery met expectations for regulating my eye pressure, but had resulted in some issues with my pupil. I went back in early December for another surgical procedure to correct the adhesion of my pupil to my cornea. (Without that procedure I could have further damaged my cornea; the surgeon was also able to slightly reshape my pupil so that it looks a little less goat-like.)

I’m happy to say that in 2018, I don’t expect to have any eye surgeries! I will be going back to the surgeon next month to have the final stitch removed, and then I should be done with regular visits to the glaucoma specialist in San Francisco. I’ll keep seeing the local ophthalmologist for regular check ups and care.

Vision in my right eye is fair. I’ve had several visual field tests in the past three years that have documented the extent of vision loss from the glaucoma. Below is my most recent visual field test on my right eye. The darker the areas note either complete (black) or partial (gray) vision loss. I’ve lost quite a bit of peripheral vision from the areas closest to my nose, but the vision in the center and outer portion of the eye is still OK. d3yI9eRrSvuG9Cs4ZyoMgA

In practical terms, when looking strictly through my right eye, items in my visual field appear blurred, even with corrective lenses. The ophthalmologist said this could either be from the vision loss or from the cataract that is forming in my eye. Early cataract formation is an unfortunate side effect of all the eye surgeries I’ve had. The local eye doc did have a great suggestion to help me get the best vision possible from my eye, though. He urged me to try a rigid gas permeable (RGP) contact lens.

I found a local optometrist to consult for a fitting and he recommended I try a scleral lens. Inserting and removing this lens is a little tricky, but I’m getting the hang of it. Insurance should cover the full expense since I can’t achieve a very good correction with eyeglasses due to the irregular shape of my eye.

Over the past year or so, my brain has slowly retrained itself to use my left eye as my dominant eye, and this has helped, too. I can see well enough to drive, although night driving is a little more challenging so I try not to do too much of it. I won’t regain the vision I’ve lost to glaucoma, but I’ve staved off full vision loss for now. And that’s as good as it gets.

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More medical fun

I’ve been pre-occupied lately with more medical stuff. Some of it is the same old stuff with some new developments, and some of it is new.

First, the old stuff. I had to go back to the gynecologist for a check on all the shenanigans earlier this year. The timing was fortuitous, since after I had set the appointment I started bleeding again and could talk to her about that odd occurrence. With my levels of estrogen and progesterone being pretty much non-existent when tested in April this was unexpected, so now I get to have the endometrial biopsy. Hooray (not). At least this doctor believes in good drugs. I took some misoprostol last night to “prep the area,” and was instructed to take a hydrocodone before I arrive at the office. My neighbor and friend is driving me to the doctor’s office, so I won’t be a hazard to anyone on the road.

I don’t expect that there will be any problems found with the biopsy, but it’s recommended to make sure my bleeding isn’t caused by something bad. When I told the doc that I haven’t had any hot flashes in a couple of months, she said it was likely my ovaries produced some extra estrogen for a while, which is why this happened. Sadly, the hormonal pendulum seems to be swinging back the other direction because I’ve started having a few little hot flashes during the night and evenings. (I wonder why they happen so much more often in the evening? I’ll have to ask the doctor.)

The really shocking thing I’ve been working on absorbing is that I was diagnosed with a form of glaucoma called angle closure glaucoma. This all came about when I went in for what I thought would be a routine eye exam not quite two weeks ago. I had been experiencing some redness in my right eye, and had noticed that the eye was looking a little odd, but I didn’t imagine it was anything serious.

The optometrist told me that the intraocular pressure in my right eye was very high, that I needed to use some drops over the weekend to reduce the pressure, and to come back on Monday when another doc could evaluate me for glaucoma. I tried not to worry about it over the weekend and used the drops as prescribed. When I went back on Monday the second doctor repeated all the tests and referred me to an ophthalmologist, where I was seen later that day. Two doctors examined me there and that’s when I was given the diagnosis and told I needed laser surgery to correct it. The drops were working to reduce the intraocular pressure, so I needed to continue those for another week until the surgery could be scheduled.

Yesterday was the big day, and after a laser peripheral iridotomy, I now have an extra hole in my iris. It’s been amazing how quickly the procedure has worked to get my eye looking normal again. Due to the pressure, my pupil was distorted and the iris looked bigger in my right eye than my left. Within a few hours the pupil shape and iris were looking closer to normal again.

Unfortunately, I’ll never regain the vision I lost in the eye. The vision loss seems to be mostly peripheral, and I can’t say I really notice it very much. I’ve apparently had this angle closure issue for “a while” now, so the vision loss has happened slowly enough that it never triggered any alarms for me. After the laser procedure yesterday the doctor told me that the reason I have the angle closure issue is that I have plateau iris syndrome: the shape of my iris makes the drainage angles in my eyes very narrow and easily blocked. If the iridotomy alone doesn’t work, I’ll need another laser procedure to widen the angles. I’ll also need to get the left eye fixed, too, so I can minimize any vision loss in it.

I’ve been getting my eyes examined every year since I have a vision plan as part of my employer benefits. However, this issue of narrow angles is apparently only recognized when there is a special exam called a gonioscopy — which isn’t part of a standard eye exam — performed. I’m making a list of questions to ask the doctor during my follow-up visit, and I’ve also already let my sister know about this since plateau iris and glaucoma seem to run in families.

The lesson here is to get your eyes checked every year. And if you have any history of glaucoma in your family, you may even want to request a gonioscopy to confirm if you have narrow angles. If I had been diagnosed with the plateau iris condition sooner I could have had iridotomy years ago and perhaps saved more of my vision.