CSR Treatment Options

Photodynamic Therapy

Fluorescein angiography image.

I went back to see the eye specialist this morning. The Southern Alberta Eye Centre is home to some of the best specialists and surgeons Western Canada, in a state of the art facility complete with operating rooms for day surgeries. As I approached the building I couldn’t help but notice how everyone out front had their sunglasses on, even though it was in the shade. My inner dark comic was wondering where the tie-ups for the guide dogs were.

I was headed for the second floor and Calgary Retina Consultants. There, such conditions as macular degeneration, detatched or torn retina, CSR, and a host of others are diagnosed and treated. As could be expected, most of the patients are seniors.

After a round of three different eye-drops which will numb them and dilate my pupils, the pressure in my eyes is checked and then it’s off for a new OCT scan. It doesn’t take long and only involves one quick flash of bright light, but that’s okay, because if you like bright lights flashing in your eyes, there are plenty more to come.

Back to the waiting room a few minutes and then it’s in to the next room, where I will wait for the doctor for no more than about 5 minutes or so before he walks in. He looks at the scan, it looks like it has gone down a little, but there’s still a lot of fluid built up. So, I’ll have an angiogram done to see if the vessels are still leaking, and if there is still some leakage then I will get treatment right away.

Fluorescein angiography

Yes, this is my angiogram. The area of leakage is the white area near the centre.

An angiogram is a picture of the blood vessels, usually performed on the heart and brain to check for blockages, leakage, or vessel deformity like an aneurysm. A dye, in this case fluorescein, is injected into a vein and after a few minutes the vessels will show up on the scan. It takes about 15-20 minutes to do the tests and you can expect multiple bright flashes in your eyes throughout the duration of the test. Like I wasn’t already having problems seeing before the test. I thought I was going to have to ask for a dog.

Photodynamic therapy (PDT)

Of the available treatment options PDT is really the only way to go, at least as far as I’m concerned. That’s what the doctor thinks anyway and, after doing my own research beforehand, I’m glad that he does. The bottom line is that it’s a safer procedure with fewer side-effects and fewer risks to permanent vision. There will be a risk in ANY procedure you have, it’s just a matter of whether or not those risks are acceptable to you. If they aren’t then don’t do it.

I wasn’t quite sure what to expect as I sat in the patient’s chair in yet another room. A nurse came in and explained the procedure to me and read me the requisite list of warnings, interactions, and instructions and had me sign at the bottom. I was then prepped for an injection of the drug verteporfin, and it’s not like she could just stick a needle in a bottle and then jab it into my vein, believe me.

I watched as she pulled out two vials, transferred a very measured amount into another vial, shook it, and injected that into a small IV bag of saline solution. Once mixed together well it was put into another syringe which was put on a pump with a timer on it.

A short while later after being weighed and having my height measured, the dosage depends on body size. the nurse began to infuse it intravenously. The dosage had to be delivered using a pump because it has to be infused very slowly, over a period of 10 minutes.

About five minutes after the syringe had emptied its contents into my veins, the doctor was back, this time to treat me. Vertporfin is a light activated drug, and the doctor uses a “cold” laser of very low levels to activate it. It has to be done for 83 seconds, so a special contact lens in placed on your eye that will hold it open. More freezing drops were put in so it wasn’t really a big deal. Normally I hate having my eyes poked and prodded, but it didn’t seem terrible today for some reason.

Oh, about those side effects

As I mentioned above light activates this drug. The laser is focused directly on the spot of the leak, and the drug then destroys the blood vessel in that location, sealing the leak. New vessels will grow to replace those destroyed.

It also makes you photosensitive for a period of 48 hours, so you have to stay out of the sun entirely or you could get a sunburn. Any bright lights at all could activate the drug so certain types of lighting are to be avoided as well, such as dental lamps. You’ll have to wear a paper hospital-type bracelet for that period as well in the event something happens to you, that way first responders and medical personnel know some critical information in an emergency.

Follow up in a month.

I’ll go back, have another OCT and see if everything is all good. In the meantime all I can do is wait for my vision to clear up, and the sun to set so I can go to the store and get a pack of cigarettes.

One final note

Mefloquine-associated dizziness, diplopia, and central serous chorioretinopathy: a case report

Manish Jain,1 Remington L. Nevin,2 and Iajaz Ahmed

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088661/

While searching for source material I found an academic article co-authored by Dr. Remington Nevin which examined a potential link between mefloquine and CSR.

Conclusions: It is proposed that central serous chorioretinopathy be considered a potential ophthalmological sign of mefloquine central nervous system toxicity, and for this effect to potentially indicate susceptibility to other neuropsychiatric effects of mefloquine intoxication. Treating physicians should be aware of the potential for acute and chronic ocular effects resulting from administration of mefloquine and other quinoline antimalarial drugs.

Jain, Nevin, and Ahmed

Every veteran should get a check-up, including your vision and hearing, a little bit more than the average person. Because of your experiences, the places you’ve been, or the things that may have entered your body during those times, regular and routine medical checks.

As for the quinheads out there, if you haven’t already, see your eye doctor. If you don’t have one, get one. And then make an appointment and see them. Trust me, you don’t know how much you read on a daily basis until you can’t.

D.B.

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