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"macular pucker", and hearing loss
an interesting medical web page
Fluorescein and indocyanine green angiography Ed Thelen - firstname.lastname@example.org
Eye Sections: Prologue, Divergent Medical Opinion, Concurrence, Fluorescein Angiogram Torture, Good News, Final Checks, The Night Before, The Big Day, Days After, 1 Week Checkup, 2nd Week, Pathetically Grateful, 3 Week Check up, 6 Week Check up, August Check up,
March 2007 - Lets try again
Anesthesiologist, Lovely Operation, Afterward, 1 week exam, I Give Up, 2 Years Later
Ear Section: Ear Section
PrologueThe subject - my right eye - is a big deal to me - I have only two eyes.
Unlike some grade school teachers and parents, I don't have eyes in the back of my head :-((
and my right eye couldn't resolve the big "E" at the top of the eye chart.
The scar tissue that was distorting my retina has been removed and an artificial lens replaces my original lens.
Most of the stuff (I hope) has happened,
and unless I get an infection, will have a reasonably happy ending.
I don't like mysteries, life is enough of a mystery, we hardly know what light is!!
and I like happy endings :-))
Background: About 50 years ago, my father had an operation to repair a "detached retina". He stayed in the hospital, on his (back?) moving as little as possible for maybe 10 days. My mother stayed at that hospital, sleeping in my father's room, 24/7 to do what ever she could to help a successful outcome. - The operation didn't work, the eye was blind - and my father's left eye always looked a little odd after that.
Where to begin? About 4 years ago I was visiting my brother-in-law Bruce. He has a rifle, and we went to the local range (a not so modified sand bank) to shoot paper.
I couldn't see either the target nor the iron sights with my right eye, so had to shoot the right handed bolt action rifle left eyed :-| Bruce, being a good host, let me win - and I figured my right eye was having a bad hair day or something.
Divergent Medical Opinion
A couple of years ago I went to an oculist at the local Walmart - who informed me that my right eye was really bad - that I might have "macular degeneration" :-((
About then I got really irritated with the local hospital and joined Kaiser HMO. I visited Dr. Billie Knight in the optical department. She confirmed that I had macular degeneration and said that it was pretty much a one way street to loss of eye function. She gave me this eye chart to track the course of the disease
My left eye saw this as regular graph paper with a dot in the center.
My right eye saw this as wildly wiggly lines, from 16 inches away, near the center of vision, the wiggles were about 1 or more units wide and about 2 or 3 units long. There were wiggles that spread black lines wider and narrower, and wiggles that looked like pincushion camera distortion. When you try to draw it, you move your eyes and the wiggles all shifted around :-((
About a year later, I went to an outside ophthalmologist. He said that I did *NOT* have macular degeneration but had a film or scar growing over the macula (the high resolution part of the eye) that could be removed by surgery - but there are always risks ...
The value of a second opinion !! Macular degeneration is pretty much a one way street to blindness in the aflicted eye
- OK I guess - that can be fate.
But macular pucker is reversable - the eye can be useable again - but likely not 20-20, hopefully 20-30. :-))
My Kaiser GP had retired so I went in to interview Dr. Lim - early 2006. Dr. Lim doesn't let much grass grow, and when he heard of the divergent medical opinions, he hustled up an appointment with Dr. Walvick DO. Dr. Walvick had some fancy test that profiled the back of my eye - which clearly showed a much thicker something over my macula/fovea. Dr. Walvick said that he didn't do that kind of surgery, but that Dr. Lehmer does :-))
(2007) I haven't figured what to do about Dr. Billie Knight and her distressing mistake. An earlier correct diagnosis likely would have had an earlier, less difficult correction. As I face another operation (March 1, 2007) to correct an insufficient recovery of the underlying tisues, probably caused by longer stronger stress, ...
Dr. Lehmer (same spelling as the family of Berkeley mathematicians, but nothing close) said that the scar tissue was crumpling the back of my eye by pulling it together into little mounds and folds. He said that this often interferes with blood flow, and can cause its own form of macular degeneration due to lack of nourishment and oxygen from the restricted blood flow. He ordered an angiogram - I thought angiograms were of the heart, but in his business it checks blood flow in the back of the eye.
I talk with friends and read up on the Internet about macular angiograms. Friends said that with heart angiograms, "they" stick a catheter up an artery in your groin and direct it to the region of interest and release the dye local to the point of interest. OH YUK !! NO JOY !! I *HATE* stuff stuck into me.
The Internet did not mention catheters when talking about macular angiograms. Were my friends tormenting me??? The Internet did talk lots about lots of pictures, before, during, and up to 15 minutes after. The dye absorbs the laser light frequency and re-emits the energy (radiation for those who quake) at a different lower frequency. The camera system can filter out the laser frequency and the pass the re-emited frequency which shines brightly. Sounds simple and pleasant :-))
Fluorescein Angiogram Torture2006 vs 2007
A few days later I show up for the Fluorescein Angiogram. Careful asking yielded that they would inject the dye into a vein?/artery? on the back of my hand - just relax. OK. The eye drops of course, and the hypodermic are inserted (no dye yet). Just watch the little green dot - lets take some before shots - **DAMNIT THAT LIGHT IS BRIGHT** HOLLY BALLS!!
The operator says that the light has to be bright or the Dr. will complain. I complain that this is NO FUN AT ALL.
Time to inject the dye - a kind of burning sensation on the back of my hand - nothing like that DAMNED LIGHT. This is the critical time - the movement of the dye (carried by the blood) into the eye. "Watch the little green dot". "I can't see any little green dot!" - "Open your left eye" "It is open" "No it isn't". I can focus to keep my right eye open in the face of that DAMNED LIGHT but can't keep them both open. The injector person holds my left eye open and I have trouble keeping that little green dot in the center of THAT DAMNED LIGHT.
It is over - I want out of this torture chamber *real bad* - both eyes dilated and the flimsy dark plastic sheet "glasses". The medical technicians who had been torturing me tell me that the dye will make my urine brightly colored for a few days. I imagine bright red urine as the color of the dye in the hypo seemed dark red.
I am in the car - can hardly see - but moving at 2 mph through the parking lot - escaping :-)) I have a dull brown shirt on, but seems glaring white under the edges of the dark plastic sheet "glasses". I know I shouldn't be driving - but I want out of here so bad!
I head for the haven of the 1401 restoration. I get there and get teased - about being a movie star. Soon I am dealing with transistors. I drop a little tray of 2N1303 transistors - painfully pick them up, and then drop that little tray again. I shoulda gone home - I am a menace to myself and others.
Soon I need to "void my bladder" - how about that for polite medical talk? The material in my bladder is very intense sunshine yellow - spectacular - I should have dyed my white socks - OK, so I think "out of the box".
In 2007, I had another fluorescein angiogram, from Kaiser. I was prepared to walk out if a repeat of the 2006 experience, and so told the operator. It turned out to be no sweat - the light was rather bright - but much much less bothersome than the 2006 episode, A different practicioner. Maybe the ladies of 2006 were trying an experiment? hated men? had no clue??
Monday morning the next week Dr. Lehmer calls me and says he has some good news - in a not good news voice. I wait for the "and some bad news." But there is no bad news - the back of my eye is good enough, he offers to operate on me. I still wait for the bad news - no bad news. He offers two dates the closest is next week Tuesday the 14th. We go over again the failure modes and percentage expectations again. The kicker in the background is serious infection that will ruin/destroy the eye - less 1/300, and the Internet quoted even less. Of course, these guys make a living selling "procedures", sound too bad, scare the patient, and you are out of business - interesting -
Even the bright side isn't all that great. Dr. Lehmer says that there is a 50% probability that my vision will improve by three lines on the chart or a little more - but will never be as good as in my left eye - now about 20-25. Since I can't resolve the big "E" at the top of the chart, I don't know where to start counting from.
Along the way, the Dr. has decided to also replace the lens in that eye. He says that it is a little cloudy, and the Internet says a side effect of this retinal procedure is a tendency to speed cataracts.
I check with my sister and my cousin - who have had operations (oops - procedures) and have circles of friends our ages. My sister says her daughter Linda had a cut cornea that had refused to heal - for months! - and to call her also. She says that the surgeon decided to really irritate the cornea which might kick it into healing mode. He made dozens of tiny pin pricks on the cornea (a bit like a tatoo with out the ink) and everything promptly healed. She said "go for it".
A "much older" friend of mine, Harlan Snyder, ERA-ATLAS-HSnyder.html, ERA-1101-documents.html, has had both lenses changed out. He can quote the mouth filling chemical name of the plastic used in the lens - I could not find it with google.
I did "due diligence" and a day later I called the good Dr. Lehmer's office back picking the earliest date. Of course one goes through cycles of "buyers remorse" but I stayed the course.
Final Checks - March 13,2006
The day before the operation is an appointment with the Dr. for final checks - another dilation and he finds a feature that appears to be a thick edge of scar tissue that will make an easy grab for the initial pull - or whatever. He is happy - if he is happy, I am happy.
I need to be measured for the new lens. A different medical technician :-)) The light is not so bright :-)) About five times a radial pattern to tiny red points appear - and she is busy adjusting some knobs. After a while she measures my left eye's lens power (the good one). I guess for general reference? I ask the power of the right lens - she says the resting power is 15.8 diopters.
- For those who have forgotten high school physics :-(( a diopter is the power to focus an object at infinity to a point 1 meter behind the (?center?) of the lens.
- A lens of 15.8 diopters will focus an object at infinity to a focus 1/15.8 meters or 2.49 inches on the other side.
- That lens, plus the effect of the cornea and the fluid to air interface at the front of the eye bring light to a focus on the back of the eye. :-))
Dr. Lehmer showed me images made at the fluorescein angiogram last week. Lots of 2 inch diameter images on a smooth paper. (A copy from Kaiser is illustrated below.)
- In some, the veins/arteries were dark and in some they were white (from the florescence of the dye)
- He showed me my normal eye and the blood vessels were relatively straight going in a directish manner.
- In the afflicted, there was a zone where the blood vessels went all squishy wiggly - he said that was caused by the invisible scar tissue pulling across that section of the retina.
Left eye Right eye Comments Color - before gray scale - before - The dark area near the center is the macula - fovia . gray scale #05 - about 20 seconds after the fluorescein dye was injected into the back of my hand
- The fluorescein dye flouresces and there is a filter to allow only the fluorescent color into the camera - so grey scale is appropriate, only one color.
. gray scale #07 - after . gray scale #09 - after gray scale #14 - after
the left image is my left eye about the same time
. gray scale #16 - After a ?15? minute wait for any leakage to show.
The gray areas near the black macula indicates leakage of the fluorescein dye from the strained capillaries.
- He seemed quite happy that one edge of the wiggly had a little whiteish half moon - he said that was a thick edge of the scar tissue - and that he could grab that more easily to start pulling off the scar tissue.
- He also showed an image taken about 10 minutes after the dye had been injected, and faint little zones of whitish something were in the wiggly area. He said that was where the plasma was leaking out of the strained blood vessels. The normal eye did not have those little areas.
I asked about the scale of the pictures, that I had heard that the fovia is very small. He showed me the little black dot that was the fovea, and the "optic nerve". These are about 5 mm apart. The scar tissue, and the wiggly area were about 5 mm in diameter centered about the fovea. And indeed the fovea is about say 0.2 mm in diameter.
Searching with "cataract lens replacement plastic" got http://www.surgerydoor.co.uk/so/detail2.asp?level2=Cataract%20Lens%20Replacement http://www.eyeinstitute.net/cat-howsurge.html http://findlaw.doereport.com/generateexhibit.php?ID=12162
The written text in the Kaiser form 09032-033 (10-01)
"Request for operation, anesthesia, transfusions and medical services"
that I signed has - as best I can decipher:
(the medical assistant's writing is big and round, and when squeezed, as hard to read as we tease doctors about)
- phaco/iol and another reference phaco/iol
- membrane peel
- [looks like] "laser",
- kenalog injection right eye
The Night Before
So - it is midnight and I have quit eating, drinking, cussing, and other bad habits six hours ago :-((
At noon I will show up at Kaiser Hayward (map) and have a heart to heart with the anesthesiologist.
At about 1:30 I will hopefully be "totally out of it" and ready for Dr. Lehmer
I am told that normally a sedative, ("valium?")
and local anesthesia
"Local anesthesia eliminates any sensation of pain and prevents movement of the eye during surgery. "
and that I will be "fully awake".
I want to be totally unconscious,
- *NOT* have to focus my attention more than my usual seven second attention span!! - I don't want to listen to the good Dr. cussing out some assistant for some screw-up - or know that something screwed up
I just want to die in peace :-|
Apparently the "procedures"
- sounds less threatening than "OPERATION" like opening someone's chest with a saw -
take the following:
- 20 minutes for lens - 80 minutes for the pucker peel
I REALLY hope I sleep for the full 100+ minutes,
and don't say or do something stupid or upsetting.
I'm not afraid,
but I am seriously ready for childhood prayers and a religious conversion to any modern or ancient faith.
As Jackie Gleason used to say
"And away we go!!"
The Big Day - March 14, 2006
Son Edward mentioned that he likes to bring a book to ward off waiting worries -
I had a book - the cell phone manufacture's book how to operate that thing with far too many options
I had stripped and put on the gown - the correct way for a change - and stuffed my clothes into the Kaiser provided bag - and started to read. Someone came in and put the IV thing (I hate needles) into the back of my hand, stuffed the book into the clothes bag, and stuffed the bag into a locker around the corner.
A solid (like wrestler) Jake, the nurse anesthesiologist, introduced himself. I tell him that I do not want to be awake during the operation, that I might flinch or move or do something to screw up.
Jake explains that is exactly why they want me to be awake,
- sleeping people move unexpectedly, - conscious people can give warning.
OH GOD !!
He says that they will give me a quick acting sedative so that I won't worry too much. If I need to scratch or something, just wiggle my left hand and he (Jake) will tell the doctor and they will do what ever then let me scratch. Jake says that he will be sitting by my left knee during the whole operation, monitoring vitals and watching my hand.
I complain about the bright painful lights during a previous test. Jake explains that they will give me an injection into my eyeball and I won't be able to see a thing with that eye
Jake leaves - I am alone - no clock, no radio, no book, ...
Talk about helpless, captive,
- lost in a hospital mazeNurse Rose *finally* showed up to take me to the operating room. I had been laying on this ?gurney? for almost 1.5 hours and figured I would be wheeled. Nurse Rose suggested that if I *really* wanted to I could be wheeled but most people walked. So, she carried the IV bag and through the maze we walked. - no wallet, cell phone, friends (Betty was not permitted in)
If I had wanted to run, I might as well be wearing prison strips.
Imagine the dialog with a cop - well son - going some where? -- yeah, I want to go home to mommy! - and you don't have a dime for the phone? -- I don't even have underwear, can I borrow a dime?
There is a rumor that
- heroes die one death - cowards die a thousand
Well, I died a few more today laying all preped up for 1 hour, 25 minutes staring at the ceiling wondering if all this was worth it.
- I thought of pregnant women, about 9 months pregnant,
- about to go through "a real interesting time"
- I thought of the Iraqi torture cells in Kuwait,
- where body parts and eyeballs were scattered about.
- I thought of a Russian Jewish friend who had applied for emigration,
- - then came many visits from the KGB at 3 in the morning,
- - twisting his hands, encouraging him to withdraw his application,
- - and he had to go to work in a few hours to write and type
- - with those swollen painful joints.
- - again and again and again ...
We get to this large room with lotsa overhead adjustable lights.
It doesn't look or smell especially clean.
Various people are wandering in and out
- I think this is like the Mexican medical facility where BillBill went.
It is much cooler in here.
Maybe they use cool sanitary air to push out/block unsanitary outside air?
Steve is introduced as the "scrub" something - maybe nurse
Jake the nurse anesthesiologist is here
- there is a brief medium burning sensation on the back of my right hand - where the IV sticks in - I guess Jake is sedating me.
Nurse Rose tells me that Dr. Lehmer will be assisted by Dr. Lahey (a staff surgeon).
That they frequently work together as it speeds things along.
I see Dr. Lehmer, then close my eyes, keeping them closed for the next hour and a half - I don't wanna see nothing!!
I sure don't wanna see folks fooling around in my eye!!
Something is apparently stuck into my right eye, (just a slight pressure - no pain) and soon that eye is dark - the left eye lid transmits some light, the right eye is black.
I have no idea what is going on - just fine.
I am oddly comfortable and at peace :-))
- I do not worry - - The padded clamp holding my head fixed seems reassuring.
Soon there is a strange vibration - they must be destroying the lens
so that they can suck it out through the small hole the Internet mentioned.
Soon one voice says "Hmmm - we better start here instead"
There is a steady succession of snipping noises.
Soon the doctors and staff are talking about I-Bonds, E-Bonds,
treasuries, diversification, ...
Things must be OK if they are making chitchat.
Time goes on endlessly (like this story)
Then I feel something covering my right eye and being taped on.
Then a voice says "OK, All set, Just fine".
I still keep my eyes closed as I am wheeled out I come to a stop - and decide to open my eye(s?)
Then there is Betty, and Dr. Lehmer
Dr. Lehmer says every thing is fine that my eye cooperated very well. "The only surprise was that the little ridge of apparent scar tissue to start to pull on, was a fold of retina." They had to find another starting place - and did just fine. "Come to my office tomorrow and we will remove the patch and check out the eye." Betty goes to the pharmacy to get two kinds of eye drops
I stay in recovery for an hour - the specified time
Betty goes to get the car,
I am wheeled (I told them I could walk) to a loading zone "And Away We Go" :-))
Day00-Tuesday. I have survived. The anesthetic is still active. The mild scratchy feeling has not started. (The doctor said that if there was pain to take a non-aspirin pain killer - there was never any pain. But that eye sure wept a lot - especially if I got tired.
BillBill gave me that hat from Paris:-)) He wants to upgrade my image :-| Maybe I should also get my teeth whitened?
I take three types of eye drops (Betty does it.) Four, three, and two times a day. Schedule that!
Days After - March 15, 2006
The day after, I went to the Dr.'s today to get that big patch off.
In preparation to see the doctor, a medical technician, removed the patch to measure the eyeball pressure.
My first glance out was startling - water hose size blood vessels on a field of straw yellow
What the heck
- how did that come to be?? - oddly, light passes through - blood vessels - a bed of nerves - the bodies of the nerve cell on the way to the actual photo receptors - - exactly backward to what you would think!!
Within 30 seconds, this view was fading out,
and the expected view (but very blurred) faded in.
The technician first wanted to check my vision
- I could just make out the top "E", so no loss of old vision :-)) - and could make guesses about the next row down :-)))
The technician (a real chick!) then put in some numbing drops.
- these guys do not use the air puff method of measuring eyeball pressure. - the contact gauge registered 26 units, I have no idea what a unit is the usual is about 18 units.
The chick technician wrote this down, and left -
About 20 minutes later Dr. Lehmer came in -
I asked about the 26 units, he said that is a little high, normal for just after the operation, but just incase the pressure is going up instead of down, he prescribed an eyeball pressure lowering eyedrop medicine.
That makes three eyedrop medicines with deliveries,
4 times a day, 3 times a day, and 2 times a day. :-|
My eye will be teary and a little uncomfortable for a while
- it will slowly (a month?) get better .
While at the pharmacy, I noticed an odd thing,
when looking with my right (bad) eye at a guy's cane, THE CANE WAS STRAIGHT !! for several years that eye had seen straight lines as wildly wiggly!!
It hit me - THE OPERATION WAS A SUCCESS !!!!!!!!
Now if we can just keep infection out --
(Actually, Dr. Lehmer says my right eye will never be as good as my left eye
- but we didn't screw it up worse :-)) )
If you are into pharmaceuticals, here are the drops what I am taking: (text from internet)
Prednisolone acetate (microfine suspension) 1% optht drops 4 times a day
Topical steroids - For moderate to severe inflammation - Because it is an acetate suspension, prednisolone acetate is optimally suited for penetrating the cornea and the anterior chamber. This makes it effective for treating anterior chamber inflammation and remains the drug of choice in treating anterior uveitis. Dexamethasone/neomycin sulphate/polymyxin B sulphate optht drops 3 times a day
Dexamethasone- a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It often is used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma.
Neomycin sulphate - bactericidal in action (kills bacteria). It does this by causing the bacteria to produce defective proteins which are essential for their growth.
Once the bacteria have been killed, tissues can be repaired by the normal healing process. Neomycin can be used as eye drops (in combination with the antibiotics polymyxin B sulphate and gramicidin) to treat bacterial infections of the eye, such as conjuctivitis
Polymyxin B sulphate - drug of choice in the treatment of infections of the urinary tract, meninges, and blood stream, caused by susceptible strains of Ps. aeruginosa. It may also be used topically and subconjunctivally in the treatment of infections of the eye caused by susceptible strains of Ps. aeruginosa.
Timolol Maleate 0.5% optht drops 2 times a day
(This was prescribed the day after the "procedure" when my eye pressure was 26 somethings rather than 18 somethings - non-selective beta-adrenergic receptor blocking agent. Timolol maleate, when applied topically on the eye, has the action of reducing elevated as well as normal intraocular pressure, whether or not accompanied by glaucoma. Elevated intraocular pressure is a major risk factor in the pathogenesis of glaucomatous visual field loss. The higher the level of intraocular pressure, the greater the likelihood of glaucomatous visual field loss and optic nerve damage.
The following few days
Day02-Thursday - I am sleeping 15 hours a day - basically sleep 5 hours, awake 3 hours, ?like a baby?
If I stay awake longer, the eye really tears up and feels scratchy and puffy -
I sleep with the patch on to reduce hazard.
Day03-Friday - All the medical people stressed keeping shampoo and water out of my eye.
But Betty says I either shower daily or sleep on the floor - think, think, think - and look at this :-))
Day05-Sunday - I was up for 12 hours in a row Saturday. Betty wanted to go to some shindig in San Mateo Saturday night, and wanted me to drive.
1 Week Checkup - March 20, 2006
It is now Monday - next check up - appointment at 3:15 :-|
I'm feeling confident that things are somewhat better than before.
BUT - it is evident that there is some distortion remaining.
I can definitely read the left letter below the big "E" on the eye chart. Its rather wiggly - but definitely a "Z" :-)) I can only guess the other two letters. The technician numbs and dilates my eye, says my pressure is 17 (good).
Then I wait an hour. Dr Lehmer comes in but can't log in. Gets a message with a big red "X". "What is this?" He calls to the guy who has been walking up and down the hall for the past hour, who is apparently Software Services or something, installing something. After a few rounds of experimenting, the software guy says "I don't know what is going on, but always click "YES". and leaves.
Betty and I can't figure what that orange flare in my right eye is. The pupil is still a little dilated, but both eyes and camera see it.
Day06-Monday - Dr. Lehmer examines my dilated eye - and says "Good". He says "You are ahead of schedule I ask how to keep ahead of schedule. He says "Listen to your body, don't get too tired. Take your drops. Protect your eye.
I have an appointment for Thursday April 6th 3:15. Dr. Lehmer says I should be seeing even better then as my retina relaxes and flattens. :-))
2nd Week - March 27, 2006
Well - Monday again - getting lots of sleep - all seems getting better - can see things like many of the vertical fins on a wall ventilator - the rest blur - Still taking all the eye drops (thanks Betty), and wearing the protective patch at night - I don't want to screw up! Two things seem interesting:
The friend of mine who had both lenses replaced had mentioned that he finds driving at night difficult and distracting. I will ask about his "internal reflections".
- Variability of seeing - vertical lines now seem quite straight - but there is one wiggle when looking at a horizontal line - right in the middle of where you want to focus - seems to get worse when tired - except for that, I think I could read large print.
- Internal reflections - telescope and microscope makers go to some pains to paint the inside of the instrument black, and add baffles, to reduce reflections from off axis bright light sources.
I now appreciate their problem. - In a dark room, if there is a night light about 60 degrees to the left of where I am looking, I see a thin ring of light about 30 degrees to the right of where I am looking. The length of the ring is about +- 15 degrees about the axis of where I am looking.
Even in normal light, I get the feeling that an eye lash is hanging to the left of my field of view. I am getting used to it - wonder if I should inform the doctor or if this is a standard "side effect"?
I've always figured the worst thing would be to lose a child, or drive along and have someone else's child dart in front of my car.
Having the mother of my children wander off turned out to be not much fun either.
So when I was diagnosed with macular degeneration (basically my right eye was on a one way trip to nowhere) I could almost cheerfully say that it could be worse. Just hoped that the right eye would continue to track with the left eye so I wouldn't bother others, and that the left eye would hang in there.
Since then, other doctors said the problem was "macular pucker" and could largely be corrected. Operation about 3 weeks ago, with much progress since.
Woke up a few minutes ago, and noticed that the eye chart distortion could be described with a single pincushion distortion function. The multiple crazy swirls had slowly become less, and were now almost nil. As a test, I can play a solitaire using only my right eye and get the cards right with out too much effort. I might not be legally blind in that eye - the state might let this old man drive for a few more years - if my brain and other parts hang in there.
I thought of the old pictures of weeping women, with mouths agape, bodies and arms stretched forward, thanking a doctor or other miracle worker for saving their child. Boy - can I relate! - I'm sitting here with tears streaming, wishing to thank the doctor for giving me back my now less screwed up eye.
I know he was only doing his job - but god its wonderful !!
I visit the Dr. for a checkup tomorrow (April 6) - hope I don't make an idiot of myself.
But guys usually don't make idiots of themselves in that way. - - OK, I'm kind of recovering even now -
3 Week Check up - April 6, 2006
A bit of an anti-climax. Went to Kaiser for check up. Got numbing and dialating drops. Contact gauge said 14 mm mercury eyeball pressure. Medical aid said that was in normal range - apparently 11 to 24? I could guess the second line of the eye chart better - and even tried the third. Looking through the multi-pin hole mask helped even more. She then photographed my right eye with a machine showing a cross of tiny laser looking dots.
Dr. Lehmer came in - looked in my eyes with another machine and a hand held light and with said things were coming along nicely. At my next appointment, April 29th, he would fit me with glasses. We discussed eye drops, the 2 times a day drop, cut back to once a day, and all others three times a day. I asked to get a copy of my macular angiogram, and was directed to the Medical Secretary to make the request. Should arrive by mail in 2 weeks.
Next appointment April 29th, glasses??
6 Week Check up - April 29, 2006
I showed up, got dialated, pressure checked (17mm), OCTed (a depth scan of the retinal area), and Dr. Lehmer came in. Apparently there was still too much swelling at the macula to prescribe glasses. :-| We discussed the eye drops. Reviewed the frequency - to be the same, except the antibiotic has run out - not to be renewed. A new appointment for Fri May 26th - at 8:00 in the morning - I thought only bakers went to work that early - but the scheduler said that lots of folks are at work by then.
The requested angiogram has arrived. Look here.
Here is an e-mail dialog with my doctor - :-)) Sent via a log-in method.
From: THELEN,EDWARD S
Sent: 5/2/2006 12:52 PM
To: Office of JEFFREY MARK LEHMER MD
Subject: unable to get copy of "angiogram" of my eye
On April 6th I requested that I get the Laser fluorescent image of the macular region of my eyes. This seemed to be called an "angiogram" even though it did not involve X-rays and the heart.
The medical secretary (MaryAnn 510-675-xxxx) says that "angiogram" is not the correct word - but in any case there are no round gray scale images of my retina in my file. She does have the OCT of Jan 13th, but nothing more recent.
What can I do? What should I call it? Help :-))
To: Edward S Thelen
From: JEFFREY MARK LEHMER MD
Subject: RE: unable to get copy of "angiogram" of my eye
Received: 5/2/06 3:33 PM
Dear Mr. Thelen:
The study you are asking about is called a Fluorescein Angiogram of the Retina. It does NOT involve laser or x-rays. It involves the injection of a fluorescent yellow vegetable dye called fluorescein into the arm vein followed by flash pictures of the retina over a 10 minute time sequence using a digital camera called a retinal fundus camera that uses special filters to capture the fluorescence of the dye as it passes through the retinal blood vessels.
If you are wanting the actual photos (as opposed to a written report based on the photos), then you may need to pay for a special photo processing fee to obtain them, but you should still be able to obtain them since they are a part of your record. You may print this e-mail out in order to present it to the person or persons you are speaking with regarding obtaining your records. I hope this helps.
Jeffrey Mark Lehmer, M.D.
The requested angiogram has arrived. Look here.
Pre operative OCT scan
Post operative OCT scan
The left image is preoperative. I am guessing that the black line in the thickness chart is my macular thickness, and the green zone in the usual.
The right image shows the macula as the usual recessed region or dip in the average surface
August 10th Check Up
Sorry about the break in reporting - The ability to see with my right eye reached a plateau. Dr. Lehmer did not seem satisfied that the "macula" had reduced enough in swelling. So June 30th he suggested two options:
a) increase the eye drops to two kinds 4 times a day, - prednisolone acetate 1.0% - voltaren - diclofenac sodium 0.1% b) a shot of some cortisone or steroid in my right eye Disliking getting shots *a lot* (I don't accept shots for most dental procedures) I chose a) above.
The August 10th visit yielded
June30-OCT - Dr. Lehmer wishes to get the number in the center bulls eye down toward 250 (nanometers) (typical) from the 352 shown. He also pointed out the little black spaces near the macula as suspected pockets of fluid - apparently contributing to the thickness and swelling? August10-OCT- a little better - 337 down from the previous 352 - but it is so slow that I accepted his suggestion of a shot of cortisone or steroid or ... in the right eye - which is likely to speed reduction of swelling.
We discussed the likelihood of infection and other complications. I asked if it was his eye in this circumstance, would he choose to have the injection. (I don't think he likes this kind of question.) He kind of mumbled that he thought so.
So - more drops and some antithetic swabbing of the eyelid area, he drew out some of the fluid that he had put in in March to make room for the drug which he now put in.
After that procedure, I broke out into a cold sweat and felt light headed while sitting. We had a fun talk about my heart rate going way down that being a more suitable reaction after a tiger tore off my arm. The lowered blood pressure would ease the bleeding, and if I didn't get eaten, my chances for survival would be increased. We also discussed antithetics vs. "biting the bullet" of the Civil War, - and - whiskey vs the current preoperative sedatives :-))
Soon I recovered and fled the area, after a good bye hand shake.
It is fun - the doctor thinks like I do - what is the Darwinian survival improvement of - you name it - skin color, hairy vs. little hair, ...
March 2007 - Lets try again
Well folks - I still can not read a book (or monitor with average font size) with my right eye - although I can now make out the big E at the top of the chart, and fake it down a couple of lines. :-))
This is a late January OCT (Optical Coherence Tomography) scan. Things of interest to Dr. Lehmer seemed to be:
The thickness of the retina (red) of my right eye The flatness of the area to the right of the macula/fovea (the little dip)
Dr. Lehmer has tried all his tricks, and waited for effects. So he called for another Fluorescein Angiogram which looked boringly similar to me but very interesting to him.
1. There was still leakage from some of the little capillaries, likely mechanical stress 2. An array of faint tiny parallel capillaries indicated that the retina was still wrinkled.
He said that likely the "internal limiting membrane" (separates the retina from the vitreous) under the previous scar tissue has not flattened back to normal but has creased crossway to the previous stress - He said that if he removed this membrane, the rest of the retina might revert more to its previous unwrinkled state - He said the chances were good - and the risk no greater than the previous operation.
He reminds me that there has been some permanent damage to the sensor cells in the macula. (I believe this occured because of Dr. Billie Knight's mistaken diagnosis of macular degeneration - and the delay permitted the increasing pucker to cramp the capillaries reducing nutrients to the macula and harming the cells.)
Since the images from my right eye are more of a distraction than useful, and if something happens to my good left eye ...
Lets go for it ...
Even though he already had me sold, he continued on, saying that the technology had improved since last year. This year he would be operating through a # 25 needle, instead of the thicker # 20 needle of last year. Since I don't like needles of any size, I get queazy, until he said that the needle is so thin that they don't need to even take the one stitch of last year. The hole is so small that the eye white membrane would just close it over - similar to taking a blood sample. And the patch can come off after a day instead of a week :-)) Dr. Lehmer shows me a catalog from DORC (Dutch Ophthalmic Research Center) - look for "Catalog", then "Vitreoretinal Instruments: ", then 25 gauge instruments.
OK - the stitch last year didn't feel scratchy all that much - just do a good job ;-))
So March 1st 2007 I visited the Kaiser Hayward Anesthesiologist's office and three friendly crisp ladies, one a Nurse Practitioner and an other an MD., gave me a going over - EKG and all - that I thought sufficient for a heart transplant. My goodness - the game is that I will be sedated (and the eye anesthetized), but I am again to retain consciousness so that I will not toss and roll my eyes at a bad time.
So, - Wednesday March 7, 2007 I have a preop with Dr. Lehmer,
- March 8th, the operation at 9:30, - post op and patch removal Friday March 9th.
(With the # 20 needle last year, and the stitch, the patch came off after a week.)
I ask the doctor if he likes using the # 25 needles, I would rather have him use familiar tools rather than just not take a stitch and its longer recovery. Dr. Lehmer says that he prefers the # 25 equipment - that he uses this in his practice and has been try to get Kaiser to adopt such. He says an additional advantage is that if there is a problem - (eye movement or such?) - the smaller equipment will do less damage. (I like folks that can talk straight up about risks and problems.)
It is the fateful day - March 8th, Thursday, I've had a lovely operation.
It is now 6 hours later and still comfortable - and hopeful ;-))
- Even before the relaxing drugs, I am so relaxed - not tense and frightened as last time.
- Unlike the local non-Kaiser hospital, they didn't lose track of my records during treatment -
- A link to that experience.
- Friendly staff, (they even kid with me), - Thanks Agnes, Jackie, Sue, and several others
- A whole new view of the operating room, - look at that massive Leica microscope with two stereo viewing stations and camera. The mounting structure seems massive and stiff - and they will swing that over me? I wonder what portal in my eye they will look? What power is needed to see what is going on?
- Seemingly more effort to keep drafts off of me, and they have placed a folded blanket under my knees to relieve that tenseness.
- This time the eye being operated on is not blacked out. I can see the operating needle with its little jaw/grabber-things sticking out. I see it moving about and opening and closing - I have no clue what it is doing, It does not seem to be grabbing/cutting anything - In is just a black tool on a white background.
Dr. Lehmer had shown me a catalog from DORC (Dutch Ophthalmic Research Center) - look for "Catalog", then "Vitreoretinal Instruments: ", then 25 gauge instruments. He said that Bausch & Lomb Instrument Division also makes a line of similar instruments.
- A very smooth seeming operation. Dr. Lehmer seems to be talking (to students?) who must be seeing images. The talk is very non-specific - "look over here" "now I will cut"
- I wonder why I don't have to worry about not moving my eyes - they just stay put - no tendency to move or look around. I don't have to try to "look at the little green dot. I am so relaxed and comfortable.
- Once I feel a little pressure (at the back of my eye?), and report it in a dreamy voice. Dr. Lehmer says "just fine" and the little pressure goes away.
- Toward the end of the procedure, there are reflections? of a green light moving around. Later I ask Dr. Lehmer what that was. He said that was a laser to tack the retina (to the back of the eye?), as as a prophylactic for detached retina.
A nice time in the recovery area,
- Please excuse the cell phone camera image :-((
And very comfortable at home with out even an aspirin. No apparent worry about a scratchy feeling from the stitch that wasn't needed with the # 25 instruments.
The day after - March 9th - visit to Dr. Lehmer at 9:00
The cutest technician took off the bandage and gave me numbing drops and measured the eye pressure at 10 mm mercury, she said that was just fine. (The pressure for me is usually about 17, and if it goes above say 26 for a long time you risk serious permanent damage.
The view of the eye chart was no fun - focus was bad and there was a fixed pattern obstructing part of the chart. For the several years, wildly shifting distortions had made the eye basicly useless. (Say you were looking at some squares - the slightest involuntary shift of focus would wildly shift the wiggly distortions and you really couldn't discribe nor draw what you saw.
Now there is something fixed long enough to describe and roughly draw - well a change anyway - and I think the wiggles are mostly? gone? Anyway, if you are focusing on the middle letter of this "eye chart", this is roughly what you see. The right hand side of what you are looking at is obstructed by that black funny thing, and to the lower left is another odd thing.
Cutie - really neat! - bags up the metal eye protector and suitable tape and says that I should sleep with the eye protector taped on for the next week. Just think, a couple of generations ago I was so shy!! The cutie leaves and I read my book. Dr. Lehmer comes in and looks through the usual (I have no idea what to call it) machine and seems very satisfied. I ask about the fixed occlusions and he says that is ?kelvar? sticking to the retina, and will soon dissolve. He says that things should be out of focus but improve over the coming weeks as the swelling of the retina goes down. He seems happy, and if he is happy, I am delighted!
Dr. Lehmer then gives me a copy of the angiogram as I had expressed that I had been getting quite a run-around this time about getting a copy. It seems that someplace else must be the correct place to get the pictures. Dr. Lehmer explains that I should advise the Medical Secretary in Building A about his giving me the print, and gives me a note about what to say. I go the the Medical Secretary window, (by now I could probably find it in the dark) and the person there looks at the note and pictures and says that he knows how to pass requests to Doctors, and does not know what to do with this. He asks another person in the office and that seems no help - and hands the material back to me. I feel that I have done my duty and exit stage left.
This is "the eye" one day after the second operation - so much better than 1 week after the first operation. Of course, this time the lens wasn't jellyfied and removed and a rolled up plastic one inserted.
The above is the good news - now the problem -
Betty got the prescriptions, Neomycin sulphate - three times a day Polymyxin B sulphate - once a day
see descriptions above
and I read the packaging. NEVER DO THAT!! You scare your self silly. No reason to get all up set. Just close your eyes and do what the Dr. says. Everything is dangerous. I live in a state where every store should have the sign posted "WARNING - This facility has chemicals know by the State of Kalifornia" (did I spell that right?) "to cause cancer or birth defects." I think buildings owned by the state are exempt - because they contain only paper and hot air?
Anyway, I read the warnings - and my eye feels so good - why risk a good thing. Still wondering if I should obey instructions or "be safe". Really - a dilemma -
While writing this, I notice the occlusions noted above are no longer black, but light grey - but I cannot see through them to read.
1 week exam March 15, 2007
The pressures in the eyes are 16 and 17 mm, I forget which for which. The pressures are completely normal - OK.
The eye chart a little better (20-50?) but the funny black/grey stuff in/near the center of focus remains. Dr. Lehmer says they will go away slowly.
The Dr. says to stop taking drops from the little bottle, and use the big bottle - Polymyxin B sulphate - 3 times a day.
I Give Up - The End - May 1, 2007 - Ed Thelen - email@example.com
Well, I give up -
The wrinkling field of view is coming back, and the wierd black pattern (above) largely remains, but turning gray.
I have canceled the follow-up appointment for May 7, 2007 and am resigned to my previous fate. Still having fun, hope the left eye hangs in there.
Signing off maintenance of this web page.
2 Years Later
Stuart G. of Sherman Oaks, CA e-mailed wanting to talk on the phone - didn't think e-mail would do it for him.
Turns out he had the same thing (even a Kaiser surgeon and outside surgeon), same eye, same worries -
He pointed out that the above section sounded rather negative to the success of my operation.
Indeed, I was feeling somewhat negative at the time
- HOWEVER - I am now glad I went ahead with the treatments available at the time.
- The eye has not gotten worse, which folks predicted if I didn't have it treated
- I have gotten comfortably used to the status quo - the right eye can't read but can find stuff -
- Both eyes track just fine, it never did and doesn't go cross-eyed :-))
- There appears to be continued progress with macular pucker, even while I was involved, the introduction of the # 25 needle technology in the second operation made recovery much faster. (In the grand scheme that isn't much, but progress is nice.
Folks have sent e-mail, which I answered,
but then I remembered that folks like to read mail-bags - so now put some here
----- Original Message ----- From: David Sent: April 02, 2007 Subject: your eye surgery > Ed, > I just came across your website after searching for information > on Macular wrinkle and the OCT test I had done. > I hope everything is going well. > It sounds like you have been through a lot. Well - it was interesting - mostly self imposed If other folks had not said that they had eye surgery and gotten better, I think I would have pulled out that IV and walked out of the hospital no shoes, no pants, no wallet, 10 miles from home (Actually the wife was somewhere in the hospital waiting for me, with keys. I suppose I would have found her.) But - the operation was not so bad, actually not bad at all - > The first doctor I saw diagnosed me with Macular degeneration, > I decided to get a second opinion and he diagnosed a large wrinkle. I think it is weird - it can't be that hard to separate the two! Macular degeneration is currently such a one way street to blindness in that eye that one would think doctors would use considerable care before announcing such a finding - As best I can figure, separating macular degeneration from a wrinkle should be a piece of cake - - blood flow completely different if nothing else - - and the wavy lines in a known square grid - > The center and surrounding areas of my right eye were > between 328 and 334 on the OCT image, the left eye ranged from 225 > in the center to 252 to 284 in the surrounding area. > Seeing that RED mark on the OCT sure concerns you. > My vision is at 20/50 and they are not suggesting surgery > at this time, but those wavy lines sure drive you crazy. Well, I guess I had unconsciously turned off my right eye - I don't even remember seeing wrinkles until the miss-diagnosing "doctor" gave me the square grid chart to track the "macular degeneration". > I have a macular hole in the other eye (left) > which they are doing surgery on next tuesday. "Enjoy" ;-)) Hope it gets better Ed Thelen > Dave ...
and "David Jenni" Jan 3, 2011
-------- Original Message -------- Subject: Your eye blog From: David Jenni Date: Tue, January 04, 2011 11:13 am > Hi Ed, > Thank you so much for your web site. I am 49 years old > and have been informed that I need to have the surgery on my left eye. > This is my best eye or was. I had amblyopya in my right eye as a child > and it has never been quite right. > My left eye is my dominant eye for sight. > I am a bit worried about the operation. > Has your sight improved at all since your last entry on the site? > Thank you > David I just checked my ability to read normal sized text with my right eye - nil, nada, no way, can't even guess - The whole center section where you read with, is hopelessly scrambled - like scrambled eggs - I can use it to navigate just fine - There is the door handle, curb, ... keyboard, space bar, ... but read normal or print twice this size silly to even try - Even reading 1 inch size letters at say 20 inches is slow work - bobbing head or eye about trying to make out is that a "D" or "B" Good luck - Ed Thelen
Ear Section: Audiometry
So I got another "ear tube" in my left ear.
and it worked
But they work to the edge of the ear drum and fall out. So I got another "ear tube" in my left ear.
and my left ear works.
The "ear tube" in my right ear fell out, but the ear still works :-))