Happy to say things are about back to normal again.
So, as I mentioned on Friday, my eye specialist called me in for an 8:45 appointment this morning. My vision had improved remarkably over the week-end, not 100% but much better than the previous few days had been. I was able to read once again.
Nonetheless, I went to see my retina specialist, Dr. Michael Fielden. He reviewed the scans I had done about 30 minutes prior, and I discussed the rapid changes in vision I had been experiencing over the course of the last two weeks. He used the analogy of a house that’s dirty inside that also has dirty windows. If the windows are dirty, you cannot tell that the inside is dirty. Once you clean the windows, the mess inside becomes evident.
Now that my dirty window had been cleaned, it was time to clean the inside of the house. This would be done using a drug called Avastin (bevacizumab), which would be injected directly into the eyeball. Avastin is a type of drug known as a biological response modifier and is also used in chemotherapy for certain types of cancers.
It acts by turning off a signal in the retina, usually turned on by lack of oxygen, that causes the growth of abnormal blood vessels. These vessels can leak fluid, leading to CSR. The drug acts almost immediately, and any accumulated fluid is quickly reabsorbed by the body.
It’s been about three hours since the injections, and my vision has returned to normal again, although it will take me a while to get accustomed to normal. I go back to see Dr. Fielden in a week to see how things are progressing.
Until then, I’ll get back on with things. I have a lot of work to get done, but if anything changes I’ll keep you in the loop. I want to thank all of you who kept me in your prayers. They helped. Meantime, get your eyes checked.
Sometimes things get worse before they get better.
Update: after posting this article I received word from my specialist’s office that I have an appointment at 8:45 Monday morning.
May 31st OCT scan of my right eye.
I just got back from seeing my eye doctor who, is only a couple of blocks down the street from me (score). She works out of Eye-Q Optometry on 17th Ave. S.W. and of the half dozen or so times I’ve been there, I have never had to wait to get in (big score).
As with my last set of scans, Dr. Sarah Freiburger was kind enough to email me a copy of the scan I had done today so that I could share it with you. So I’m going to give her and Eye-Q Optometry a shout out. Check them out for your next eye exam, which I am urgiung everyone to get immediately.
Fluoriscein angiography done prior to photodynamic treatment (PDT)
The reason I went to see (haha) her todaywas that my vision had suddenly changed again, for the worse. I underwent a round of PDT 2 weeks ago (see my previous posts on CSR for what that is) and I knew that I would likely be in for another change in my vision.
It started about a week ago when I noticed I could no longer see any straight lines. For instance, I went to light a cigarette one day, and when I held it up and looked at it, it looked bent and broken. “Well shit”, I thought. Then I saw it out of my left eye, my naturally weaker eye, and it was straight as an arrow again.
It was kind of amusing at first, kind of like a free ride on someones acid trip. Then, 2 days ago, I woke to yet another change in vision, only now the wavy lines, became a garbled mess. It’s now like looking through textured glass. It is no as dark as it was, but that really doesn’t matter at this point.
Like looking through textured glass.
Scan from a month ago.
The fluid is in fact draining from beneath the macula, but there is another pocket of fluid that has built up between the layers, the smaller bubble to the right of the larger one. Dr. Freiburger suspects this is the cause of the distortion.
A view of the surface relief also helps to explain things. My retina went from normal and smooth, to distorted yet still smooth, to distorted and resembling a crater. There is a small area with peaks and valleys on my macula, and until they all settle down, if they all return to normal that is, this is what I have to put up with.
It is what it is.
There is nothing that can be done at this point but wait. It is also possible that it will take multiple rounds of photodynamic therapy to resolve this. The risk of serious and lasting loss of visual acquity rises with every round.
I see the specialist again in two weeks, and I’ll keep you updated as things progress. As bad as this might be, and things could very well turn out in my favor here, there are far worse that could have happened but didn’t. But far worse things have happened to tens or even hundreds of thousands of people.
For the time being I’m going to be writing a little bit less, but I’ve been mulling the idea of utilizing video a little more than I have been. Recorded video and live steaming on FB and YouTube are platforms that others haved used to great effect. I’ll let you know shortly.
In the meantime, if you haven’t done so already, GET YOUR DAMN EYES CHECKED!!!
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.
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
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.
The Advocate-Equalizer 