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Visual Fields Test

david — Thu, 13 May 2010 05:58:43 +0000

My appointment with my glaucoma specialist went well, except for the fact that I was back to the 20/200 line and even that wasn’t as crisp as a my second PostOp appointment on 27 April (I also believe it was slightly worse than my unscheduled appointment with Dr. Ayres this past Friday.) I’m glad everything looks great, but that isn’t helping me see better. As per Dr. Pro’s (and Dr. Ayres’) recommendation, I’ve scheduled an appointment with Dr. Garg, the retina specialist I saw earlier this year. I have a feeling I know how that appointment will go too. Everything will look fine, but my vision will still suck. Call me Nostradamus. I’ll let you know how things go on 18 or 19 May.

Central Vision Visual Fields Test at Wills Eye

One of the problem I’ve noticed is that I seem to have more blind spots, especially in my central vision. When Eliz and I were working with Jane at softball, I noticed I had trouble following the ball when Eliz would flip the ball to me from three to five feet unless I looked to my right. I’m not sure what the above test indicates, but since I don’t think I’ve ever had this particular visual fields test I don’t think there is anything to compare it to.

Visual Fields Test Machine in the Glaucoma Dept. at Wills Eye

After my appointment at Wills Eye, Eliz and I walked up Walnut Street and stopped into the Associated Services for the Blind and Visually Impaired. I had contacted them just before we moved Salon Supplies + Interiors and ForYourSalon.com out of that disaster of a building (which has been condemned, by the way.) Between the move and setup of the business and waiting to see how things went with the surgery, I didn’t follow up. Looking back, that seems dumb. As it stands now, I don’t think things will improve dramatically, if at all. You may say I’m a pessimist, but I disagree. I would call myself a realist. Sure, I can hope and wish, but I’ve been doing that since I was a small child. Maybe I learn something and gain some confidence.

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Post tags: appointment, caption, central vision, Dr. Ayres, Dr. Garg, Dr. Pro, eye, glaucoma specialist, Jane, retina specialist, test, Walnut Street, Wills, wills eye

Going the Wrong Way

david — Mon, 10 May 2010 05:28:54 +0000

Since Wednesday or Thursday, I’ve noticed that my vision didn’t seem to be as good as it was earlier in the week. By Friday, after talking with Eliz, we decided it was probably a good idea to try and visit Dr. Ayres, the surgeon that removed the cataract (and performed the endothelial transplant in Dec. ‘08.) Fortunately, they were able to squeeze me into their busy schedule at Wills Eye at noon on Friday.

We didn’t have to wait long in the waiting room. I was very curious about reading the chart. The E was not a problem. I could see the SL on the next line, but it didn’t seem as sharp as my previous appointment about 10 days earlier. I could not read the OPLB line. That was a step backward.

When Dr. Ayres came in, I told him about what was going on. He took a look and said everything seemed about the same as my previous appointment. No signs of retina detachment, the new lens was still in place, and there was no signs of rejection on the previously transplanted endothelia. My IOP was at seven, which was down from 10 at my previous appointment. As he put it, the good news is that it is not a problem from the surgery, but that means I don’t really have any way of fixing the issue. He prescribed a non-steroidal eye drop just in case there was a little swelling that he didn’t notice. He said it was like Advil in drop form.

On Tuesday I have a scheduled appointment with Dr. Pro, who is my glaucoma doctor. I want to have a Fields test, because one of the things I have noticed is more blind spots, especially in my central vision. Hopefully, he’ll find something that can be corrected.

So, it seems I’ve missed my opportunity to go to the movies or a Phillies game. It might also be time to learn how to do things without much sight. I was waiting for the surgery before I tried anything new, but I think it is time.

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Post tags: appointment, central vision, Dr. Ayres, Dr. Pro, eye, eye drop, Friday, phillies game, problem, retina detachment, vision, wills eye

A Long Day

david — Sat, 16 Jan 2010 06:41:21 +0000

It has been a long day. It started off with a trip to the retina specialist at 8:30 am. We were a few minutes late, so only had to wait about 10 minutes in the waiting room. Eliz had a cup of tea from the Senseo (or similar) machine, while I brought my own (my favorite Teavana mix: Queen of Babylon and Rose Garden Rooibos.) I was called back into the first exam room, where I would (try to) read the eye chart and go over my eye issues. Kelly asked about any of my eye problems and then noticed we were from Media. She said she grew up in Wallingford. When Eliz told her we did as well, she mentioned that she graduated from Strath Haven in 2002. I told her I graduated from Nether Providence and Eliz from Strath Haven and Kelly asked if I went to school with her mother since I was born in 1954. I laughed and asked if I looked 55… I guess if there’s going to be a mistake, that one isn’t bad at all. She corrected my birth year to 1964 and we moved on to the eye chart.

Again, I was unable to read any of it until I flipped the pinhole cover down. Like magic, the E appeared. I then said I know the next line is S and L, but I can’t see it. She told me I was wrong. What!?! It’s not S and L. Now I had to know. I moved the pinholes all around until it was as clear as it was going to be for me. I guessed O for the second letter. Try again. D!, I said next. That was it. The first letter (don’t ask me why I don’t read them in order) looked like it could be an O, G, or C. I guessed G in hopes of it being the GD line. No such luck. C was my next try and that was it. Kelly mentioned that this chart is made up mostly of similar letters that repeat often, so my usual deduction that I’ve got a one in 26 chance which increases with every letter doesn’t work. I’m actually going to have to read them.

Once I was finished with the eye chart, Kelly took us to another waiting room, where Eliz read me the story of the Penn State mascot in a recent addition to ESPN magazine. Before we could finish, we were called to see the doctor. Dr. Garg asked me about my issues and mentioned that he had spoken to Dr. Pro about me. He explained that even though my right eye doesn’t do much he still wanted to check it out. Since my cornea is really cloudy and I have a pretty mature cataract in it, they would use an ultrasound to have a look. He also explained a test they’d run on my left eye, to check for changes in the macular pigmentation. Dye is injected via an IV (that’s iv, not roman numeral for 4) and pictures are taken. After he mentioned the dye, I remembered that I had this test before. The images are wicked. Unfortunately, I didn’t have a flash drive on me to get the images.

I went into another exam room to have the ultrasound and then back to the second waiting room to wait on the angiography. After a 10 minute wait, Tom called me back to have the angiography. He took a couple of images of my eye before putting the dye in. The dye made me feel nauseous for about a minute. Tom took more images and left to give someone an OCT scan (which took him all of five minutes — about 1000x faster than mine took on Monday.) He then came back into the room I was in to get two more pictures.

I waited in the angiography room for a few minutes until they called me to see the doctor again. He explained what he thought was going on. He increased my use of one drop to three times per day and added another drop to try and get the swelling down in the retina and cornea. He suggested that I wait on having the cataract removed until I see him again in six weeks.

After three hours, we were out of there. We headed down City Ave to pick up Jane from school. She called me just before the ultrasound and said she wasn’t feeling well, which I knew when she left for school. I also knew we’d be right down the street from her and could pick her up after the appointment if she couldn’t last the day at school.

After I spent an hour, or so, at home (at which time I found out my mom had gone into the hospital — more on that below,) we headed over to Viva Salon in Springfield. They’ve been having a problem with a hydraulic base that was still under warranty. We swapped out the bad base for the good one that has been in our car since the move and headed to my next eye appointment.

I had scheduled this appointment with John Ruffini, another NPHS alum, to talk to him about the cataract surgery (and before I knew of any retina issues.) He had a look at my still dilated left eye and we discussed my options and the problems that could arise from taking out the cataract. He also thought it was best to see how the eye reacts to the increased drops and new drop. I have put off scheduling the cataract surgery because of moving the business and the fact that it could undo the partial cornea transplant. My left eye has endured seven operations over the years, with another one imminent. I’m tired of going through these procedures and the recovery with mediocre success. The risk/reward factor isn’t great, though I would do anything to preserve any sight I still have.

After leaving John Ruffini’s office, we made a delivery in Holmes and stopped by a salon in Milmont Park to look at a styling chair that needs replacing. We returned home at about 4:00 pm and had an alarm company tech waiting to convert our system. It took him about two hours (the whole story will have to wait for another time.)

We were finally able to head to Riddle to visit my mom. She went to the hospital at around 8:00 am this morning because she was having shortness of breath and chest pains. The doctor wanted to keep her overnight for observation. She seems to be okay, though uncomfortable because of the shingles. We are hoping to pick her up and take her home tomorrow.

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Post tags: 1964, C. I, cataract, chart, congenital glaucoma, cornea, Dr. Ayers, Dr. Garg, Dr. Pro, Dr. Ruffini, Eliz, espn magazine, eye, Holmes, Jane, John Ruffini, Kelly, L. Now, Media, Milmont Park, nether providence, Penn State, penn state mascot, Providence, Queen, queen of babylon, retina, retina specialist, Riddle, room, Rose Garden, Springfield, Strath Haven, StrathHaven, swelling, Teavana, Tom, Viva Salon, Wallingford, wills eye

Time to See a Retina Specialist

david — Thu, 14 Jan 2010 06:47:48 +0000

I received a call from Dr. Pro late this afternoon regarding my OCT scan from Monday. Before the call, Dr. Pro talked with Dr. Ayers to discuss the scan. They both agreed that there is swelling in the retina. Dr. Pro told me that sometimes this occurs when the IOP is low, which mine has been since my trab in 2003. He didn’t think it would come on all of a sudden from low IOP though. My IOP has been between five and seven at just about every eye appointment I’ve had since spring or summer 2003 (except for that dramatic increase after the partial cornea transplant when it rose so quickly it made me vomit multiple times on Friday, 5 Dec 2008 — the day after the surgery.)

Dr. Pro recommended a couple of retina specialists at Wills Eye, who also have an office at the Pagoda Building in Bala Cynwyd. It was too late in the day to get an appointment today, so I’ll call them tomorrow and set something up. I’d like to get something quickly to stop further decrease in my vision. I already have an appointment with my local ophthalmologist, John Ruffini, on Friday and will discuss the scan, my options, and the cataract (which was the original reason I made the appointment.)

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Post tags: appointment, bala cynwyd, call, cataract, congenital glaucoma, cornea, cornea transplant, Dr. Ayers, Dr. Pro, Dr. Ruffini, eye, iop, John Ruffini, late in the day, retina, ruffini, swelling, wills eye

Image of My OCT Scan

david — Tue, 12 Jan 2010 17:53:51 +0000

Just a quick update to add my OCT image. I’ve added here and to last night’s post (so you can compare mine with the normal one posted on the Vitreous Retina Macula Consultants of New York website.) I kind of think mine looks like two people laying on the beach on their bellies and seeing just their backs and butts. I’m hoping to hear from the doctor today or tomorrow.

My OCT scan from 11 Jan 2010.

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Post tags: bellies, butts, caption, cataract, cornea, Dr. Pro, glaucoma, image, mine, New York, OCT, pagoda building, retina, update, vitreous retina, wills eye

OCT Retina Test

david — Tue, 12 Jan 2010 06:36:14 +0000

What an adventure today at the Pagoda Building at 100 Presidential Ave. After a few minutes in the waiting area, we were called back. I followed Irene into a very dimly lit room, stumbling slightly on one of the stools. I sat on a stool that seemed to be a bit too high for the machine I was supposed to put my chin in while pressing my forehead against the bar. The device that was going to take the images and measurements of my retina looked similar to an older (circa 1998) surveillance camera. Inside the lens was this cool blue light, slightly lighter than the blue light on the machine that reads your IOP, that looked similar to something in a sci fi movie with a thin red line across the horizon that looked like a laser.

My good fortune was that the machine was brand spanking new and both Irene and Todd had not yet mastered it. Irene couldn’t get a good set of images and kept asking me if I was diabetic, which I am not. She then said that the cataract in that eye must be really dense, because they couldn’t get a clear image. She then decided to dilate my eye. (This test was only for the left eye. The right is waiting for the Six Million Dollar Man eye and I haven’t spotted those at Radio Shack yet.) Dr. Pro had asked that the eye be dilated, but Irene thought it wasn’t necessary at the beginning. While my pupil was dilating, Irene stepped out of the room. Todd, Eliz, and I talked about the machine. I asked Todd a question and didn’t get a response. Eliz then answered for him. Seems he didn’t realize I couldn’t see him and he nodded yes to answer my question. After about 10 minutes, Irene walked back in, but Todd wanted his turn on the machine, so Irene coached him. He couldn’t get a good image either. Irene’s turn again.

After about 10 to 15 minutes of trying, we were asked to go wait in another waiting area. We only waited there a couple of minutes and then it was back into the hot seat for me (and I didn’t stumble in the room this time since my eye was dilated…) Finally, Irene was able to get the correct images the doctor ordered. I asked if I could have one put on my flash drive. Irene said no, but said she’d print one out. As she looked through all the images, she realized that they weren’t that good. She asked if she could try again on getting a good image. At this point, either Eliz or I mentioned the Endothelial transplant from December 2008. She then said that might be why she couldn’t get a good image. Whatever. She got some images she was happy with and printed one out for me… In black and white! The doctor will have a look in a day or two. I’ll call on Wednesday to see what the story is.

I’ve got a scanner issue that is stopping me from uploading the image. Hopefully I’ll figure it out tomorrow and have the image up here then. I know it doesn’t look like this image:

OCT demonstrating normal retinal architecture.

My OCT scan from 11 Jan 2010.

So now I have to wait to hear from the doctor. My image is a bit more “hilly” than the image above. I’m hopeful this is the reason for my latest issue. I also hope this can be fixed.

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Post tags: adventure today, caption, cataract, cornea, Dr. Pro, Eliz, eye, glaucoma, good fortune, image, Irene, machine, OCT, retina, room, surveillance camera, thin red line, Todd, waiting area, wills eye

New Challenges

david — Sat, 09 Jan 2010 06:18:06 +0000

Our holiday season officially ended yesterday with the celebration of Jake’s 16th birthday and my dad’s 92nd birthday. That is one long stretch, though some years it is longer. It starts with Chanukkah (I’m jewish,) continues to Christmas (Eliz is catholic,) then on to Jane’s birthday (2 Jan,) and finally to Jake (and my dad to a lesser extent.) This year’s holiday season was pretty subtle because Eliz and I have been busting our rear ends (and in Eliz’s case, her arm too) to get out of mold. I’m hopeful of a more joyous season this coming December.

So the holidays are over. We’re out of Folcroft and restocking the shelves in the new space and we’re starting to make local deliveries from the phone orders we’re taking. Just when it looked like things were starting to settle down, a couple of new challenges have emerged. My mother hasn’t been feeling well since her fall about three months ago. Eliz has been taking her to various doctors over the past week, with another appointment on Monday. One doctor thinks she may have shingles. It has worn my dad down. He feels helpless since he can no longer drive and his vision and memory are starting to slip. We’ll know more on my mom on Monday.

The other challenge is me. I’ve noticed that my vision has deteriorated over the last six months and has really started to nose dive in the past few weeks. (I got a new HDTV for my birthday and hooked up the HDMI cable about four weeks ago and was wowed that I could notice a difference in the picture. Watching the news tonight, I couldn’t make out many of the graphics that said where the story was taking place and the reporters/interviewee’s name.)

At Wills Eye today, my glaucoma doc, Dr. Pro, told me he didn’t think the issue was glaucoma related. My cornea doc had previously told me that he didn’t think it was cornea related. Dr. Pro mentioned today there were two other possibilities: the cataract or a retina problem. He said while the cataract might be the cause of some of the issue, he said it wouldn’t lead to the significant vision loss I have sustained over the past weeks. I couldn’t read the big E on the chart with or without the pin holes. The E is the 20/400 at the very beginning of the eye chart. I was able to count fingers at about three feet. This, of course, was in my left eye, the “good” one. As usual, I could tell when a light was off or on using my right eye, so there’s no excuse if I leave a light on in a room…

This development is troubling to me, though not unexpected. My whole life I knew the chances were good that one day the lights would fade. Maybe this can be reversed. I’ll know more on Monday after I have an OCT (The technique of optical coherence tomography (OCT) produces high resolution, high speed, non-invasive, cross-sectional images of body tissue. from the University of Miami) test. Hopefully, I’ll have some images to post and some good news to deliver. Funny how last April and May I was trying to find a way to be able to have a catch with Jane to now just trying not to walk into things or find items on my own.

As usual, there is never a dull moment with me, especially when I do walk into something. I end up cursing like a drunken sailor with turrets even when I don’t hurt myself. The frustration gets hold of me for a minute or two. Sometimes it does actually hurt…

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Post tags: 16th birthday, birthday, dad, Dr. Pro, Eliz, eye, Folcroft, glaucoma, hdmi cable, HDTV, holiday, holiday season, Jake, Jane, joyous season, rear ends, season, University of Miami, wills eye

Wills Eye Tomorrow

david — Fri, 09 Oct 2009 04:34:03 +0000

Okay, I’m going to try to keep this short… I’m scheduled to see my glaucoma specialist tomorrow. His name, fittingly, is Dr. Pro, and he is… It was at an appointment with him late in September of last year that he noticed the clouding of my left eye and recommended me see a cornea specialist, which I did within a month. That led to the December surgery. I guess I’m hoping for lightning to strike twice. As I’ve mentioned in previous entries, my vision has been giving me additional trouble over the past few months. Dr. Ruffini noticed a slight fold in the cornea that was not there the last time I saw him. Is that the problem, or is it something else? I am hopeful that Dr. Pro will spot something, and if he does, I hope it can be corrected. If not, my last bit of hope will come at the end of this month when I see Dr. Ayers, the cornea specialist that put in the 69 year old endothelia and gave me a black eye in the process (don’t worry, I forgave him for the shiner…)

I had also hoped to stop by ASB (Associated Services for the Blind and Visually Impaired – asb.org) tomorrow, as they are just across Walnut Street from Wills Eye. I didn’t hear back from them, so I don’t know if we stop in. I don’t get a chance to get out of the store too often, so we’ve got to make the most of it. Jane and Margaret are covering for Eliz and I tomorrow, by the way. I will post tomorrow or over the weekend on how he appointment goes.

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Socks

david — Thu, 24 Sep 2009 21:11:40 +0000

After I posted the Glaucoma Study entry, Eliz said that I should have talked a bit more about the socks task. At the school where Eliz used to teach and our kids went, they would call this the Socks work. It was work for me. Here’s how it worked… There were seven socks pinned to a board on a wall at eye level. There was a table that was 30 x 60 up against the same wall that you could spread the 10 socks out on. You then had to place the sock on the table under the correct match that was on the wall.

The first time I did this task, I was given the ground rules: I couldn’t touch the socks on the wall, I could get as close as I wanted, and, there was no time limit. Most people had to this (and all the other tasks in the study) three times. First time with both eyes, the second time with one eye covered, and the third time with the other eye covered. I only had to do it (and all other tasks) twice since I have only the slightest vision in my right eye. Believe me, 2x is enough.

I verified the ground rules with Maryanne before we started. The last time I did this task the observer seemed to have a problem with the way I did this task. She then started the clock and I began the task with my right eye covered. It was covered from the last task and both Maryanne and I forgot to remove it. I spread the socks out on the table, looking for the one I knew had no match. It was easy to spot since it had cream or gray colored stripe near the top of the sock. Now I just had to find the correct seven of the remaining nine and match them up. So I hopped up on the table and zeroed in on a lighter gray sock on the board. I found two socks that were similar in color and held them up close to the one on the board. I could feel a pattern on one of the socks and knew that wasn’t the correct one. I placed the other on the table beneath its mate. This went on for about 18 minutes. I missed two or three.

Now it was time for me to do it with both eyes. It seemed silly for me to do it with both eyes, but at one of the other tasks I had done better with both eyes than with just my left, so I was up for seeing if it made a difference with this task. I asked Maryanne to mix the socks up so that it would be a fair comparison. She did and then started the timer. I found the striped sock again and discarded it. I hopped back onto the table and began matching. This time it only took me about 11 minutes and I got ‘em all! I think that was the first time in the study that I matched them all correctly. I was happy until I realized it took me about a minute and a half to match a pair of socks.

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Post tags: colored stripe, congenital glaucoma, Eliz, eye, eye level, glaucoma, glaucoma study, legally blind, low vision, Maryanne, Socks, table, task, time, visually impaired, wall, wills eye

Glaucoma Study

david — Wed, 23 Sep 2009 04:47:56 +0000

My latest Fields Test done at Wills Eye during a glaucoma study.

Over the past year, Eliz and I have taken part in a glaucoma study at Wills Eye in Philadelphia. I was asked if I’d be willing to participate and when they realized that Eliz would be bringing to each session, she was asked to participate as part of the control group. Fortunately, Eliz doesn’t have glaucoma! The study included a (torturous) visual fields test, IOP and vision check, a questionnaire on how glaucoma affects your life, an obstacle course, spotting different size boxes around a room, dialing a “telephone,” reading in varying lighting conditions, spotting objects moving on a computer screen, and, my favorite, matching socks. It takes about three hours to complete and we had to go in four times within a year. Last Thursday (17 Sep) was our last session.

We were compensated $20 (total) and had our parking validated at each visit. At the end of the study, we are each to receive $160 (which is due in the mail in the next week or two.) To get paid to get a fields test is AWESOME! It’s like getting paid to be water boarded… The fields test is so exhausting to me, because I have trouble just looking at the dot in the center of the machine. I only get the test done on my left eye, as my right eye can barely tell light from dark (I can tell light is shining on it by waving my hand between my eye and the light source, about 10 inches from my eye. If I see a shadow, I know there’s light and six more weeks of winter. Of course, I could always just open my left eye, but I like to know what I can see with the right eye.) For those that haven’t taken a visual fields test, as you look at the center dot, a series of lights, ranging in size and intensity, flash all around the inside of the machine, one flash at a time. You have button in your hand that you press if you see the light. It’s kind of like being on a game show. I would hope that I would hit the button more if I were on a game show… I’ve posted my my fields test from that day so you can see the results, they weren’t pretty.

One of my concerns that day was the eye chart. I could only see the big E at the top with my left eye (the “good” eye.) That is the 20/400 line. I was able to see the E on the 20/200 line, but only with the pinholes. I have noticed over the past few months that my vision seemed to be slipping (again.) I have also noticed some double vision, especially on lighter objects with a dark background. This is extremely frustrating, because it has really effected my reading on the computer. I have a local ophthalmologist appointment next week, a glaucoma specialist appointment the following week, and my cornea specialist appointment in mid-October. Hopefully, one of them will be able to find the problem and fix it (though I’ve been waiting my whole life to have my problem fixed, so I won’t hold my breath.)

I was asked at the glaucoma study if I would be interested in participating in more studies. I told them I’d be happy to so. It upsets me when I see a young kid at Wills Eye to see a glaucoma specialist. I know what is ahead for them and it isn’t fun. I also know what you are now thinking, ‘With technology and stem cell research, they’ll be able to take care of that problem…’ I hope so, but pardon me for not being as optimistic. Those same things have been said to me over the years, from the time I was in middle school to the present day by friends, teachers, coworkers, employees, and others. I’m still waiting.

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Post tags: caption, double vision, Eliz, eye, Fields Test, glaucoma, glaucoma study, lighting conditions, obstacle course, ophthalmologist, Philadelphia, size boxes, study, test, vision check, wills eye