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Blind spot

After having my last check-up appointment at Moorfields cancelled at pretty much the last minute (https://rdramblings.wordpress.com/2016/04/03/q-whats-more-stressful-than-an-impending-eye-appointment/), I was more of a nervous wreck than usual by the time the hours, days, and finally three weeks had slowly dragged by until I eventually reached the rescheduled date.  After getting a few headaches I’d convinced myself that my pressure must be high, I was already terrified of the inevitable discussion of when surgery to remove the oil should take place, and to top things off I’d noticed a blind spot in my good eye (perhaps I should describe it as ‘better’ eye rather than ‘good’ eye) which had been freaking me out for a good few weeks.

I only noticed this during the course of my usual visual field checks at home.  One day I realised that when I sat at my table and stared ahead with my bad eye shut, I was unable to see one of the pictures on the wall across the other side of the room with my good eye.  Once I’d calmed down slightly from my initial panic of thinking, “****, I need to get to Moorfields first thing tomorrow morning”, I remembered that various people on the RD Facebook support group site had discussed suddenly noticing blind spots and it had turned out to be a result of laser surgery and they just hadn’t noticed them before.  So I told myself it could just be from the cryotherapy I’d had in that eye to mend the two tears back in April 2014.  Or, I told myself, it might be the natural blind spot which everyone has.  Or, I told myself, it might be a hole or a tear in the retina.  After telling myself all this and freaking out all over again as a result of the last possibility, I’d then try to calm my breathing down and stare at the blind spot once more, willing it to be a figment of my imagination.  It wasn’t.  I obsessively measured it each day (I’m not admitting to how many times a day) by using various visual markers so that I would be able to tell immediately if it got any worse.  I also started ‘looking’ for it when I was out and about.  This was not really a sensible thing to do.  Once, during a walk down the road, I managed to make an entire red telephone box disappear into the blind spot, which caused me to feel rather sick.  However, as the blind spot didn’t seem to be growing when measured against my set markers at home, and I wasn’t getting any other new symptoms, I gritted my teeth and attempted to plough on through my daily life as normal whilst desperately trying to quell the evil little voice inside my head that said “It’s going to be a tear, it could detach at any minute… you’ll end up at that appointment and they’ll whisk you straight into surgery”. 

We arrived at Moorfields in plenty of time – so much so that we even managed to nip into the cafe to get a cuppa to take down with us for the long wait in the clinic.  “What are you doing?”, asked my sister in aghast tones when I sat down with my cup of tea.  “I don’t want to go down to the clinic!”, I said, clutching my stomach which had been churning uncomfortably for most of the morning.  However, down we went, reluctantly.  We settled down for the long wait, briefly pausing in our important discussions of setting the world to rights to glare disapprovingly at one patient who obviously wasn’t accustomed to the NHS in general and eye clinics in particular as he proceeded to harangue the receptionist and demand to know when he would be seen.  We observed with disgust as he turned his back on her whilst she was still explaining that she would check where he was in the queue, and plonked himself back down inserting headphones into his ears as he did so.  Unfortunately, I’d already disposed of my banana skin, otherwise I’d have been sorely tempted to toss it under his heel and watch him go flying down the shiny corridor floor.

We didn’t have to wait too much longer before I was called in by one of my consultant’s team.  Upon asking if I’d experienced any problems since my last check-up, I told him about the blind spot and he said that he ‘hoped’ it was my natural blind spot, which everyone has.  Following the usual drill with each eye in turn (see https://rdramblings.wordpress.com/2015/07/30/a-grand-day-out-at-moorfields-eye-hospital/ if you’re interested to know what this is), he sat back and used magical words such as ‘okay’ and ‘stable’, as well as assuring me that the blind spot was indeed simply the natural one.  I quickly suppressed my urge to leap up and do a little dance as he then started talking about the dreaded subject of surgery to remove the oil.  However, even this ended happily as in answer to questions, he said there was no clinical need to remove it immediately and it would be fine to wait for another few months.  Of course, I’d still like a miracle, but while I’m waiting for this to be arranged, I’m more than happy with the outcome of today’s appointment.

In the meantime, if anyone’s wondering, let me just explain the sciencey bit about the blind spot, which all of us have.  Light enters our eye through the pupil and hits the retina at the back.  The optic nerve then carries this information to the brain.  However, the optic nerve is kind of ‘plugged in’ to the retina itself, which means that this part of the retina is in effect redundant, thus creating a blind spot.  Most of the time, the other eye will see what’s in the blind spot, but if the person is only looking through one eye, the brain just fills in the spot by taking information from the surrounding area.  So, for example if a picture on a green wall falls into the blind spot, the brain will fill in the blind spot with the green colour of the wall and it will look as if the picture has just disappeared.  This is what was happening in my case at home, doing my visual field checks.

To demonstrate this, have a look at the picture below.  Close your right eye and look at the cross on the right.  You should still be able to see the dot on the left, but don’t focus on it.  Keep your eye on the cross and move your face slightly closer to the screen, and then further away again.  At some point, the dot should disappear.  At this stage, you have found your blind spot. Do the same with your left eye, but this time focus on the dot and move around until you see the cross disappear.  The same should happen if you use a different coloured background, but your brain will fill in the colour of the background.

blind-spot

 

The dreaded removal of the patch

I’m not sure whether it’s a consequence of being plagued once again by pre-appointment paranoia (see https://rdramblings.wordpress.com/2016/01/24/pre-appointment-paranoia/ if you’re wondering about this) due to the fact that my next appointment at Moorfields is rapidly approaching, but the other day I found myself remembering the various dreaded occasions of eye pad removal following surgery.  I suspect that removal of another kind of iPad is likely to cause similar fear in some people; but anyway I digress…

The first time it was like a cross between a horror movie playing in slow motion and a miracle of literal enlightenment.  I was still in a state of shock following the emergency flight back to the UK from Berlin following my macula-off detachment and I could barely stand up upon waking from the general anaesthetic at the Royal Surrey County Hospital.  For this reason, I wasn’t quite as horrified as I’d normally be by the fact that I was taken down from the ward to the eye clinic in a wheelchair the morning after surgery.  However I was somewhat embarrassed to be seen wearing the dressing-gown I’d had since I was about 15 years old (which still fitted me at the age of 38, as I was then).  It had always seemed like a sensible idea to keep my comfortable old dressing gown at my mum’s house for emergencies, but clearly I hadn’t forseen this particular emergency.  Gone was the no-nonsense surgeon with the comforting Irish lilt, and I was seen by a Greek surgeon, who removed the eye pad and did a fair amount of peering into my peeper (I now know that he was checking my pressures, although at the time I hadn’t a clue) before he proceeded to put the fear of God into me by instructing me firmly, “You must be very careful not to get any infection – your eye is an open wound.”  Not being one to shy away from gore, I managed to shuffle to the toilet once I was back on the ward, and there held onto the hand basin for stability and peered gingerly into the mirror.  An angry red slit with yellowish crusty gunk smeared around it was visible where my right eye should have been.  Yet… and here comes the miraculous part… whereas a few hours previously I had seen mainly black through that eye, at that point I could actually see light.  I couldn’t make anything out, and I felt as if I was about to topple over at any moment, but at least the light was better than the terrifying black abyss of the detachment.

Eye pad removal following surgery number two was more a case of “I-can’t-believe-that-this-is-happening-again-someone-please-wake-me-up-from-this-nightmare-pleeeeeeeeeaaaaaaaaaaassssssseeeeeee!”  However, on the plus side, I’d been able to actually get dressed first thing in the morning so that I wasn’t seen in my childhood dressing-gown for a second time; and on the even more positive side it was the Irish surgon who came to remove the patch, and check out my buffeted and sleep-deprived eye.  This time I’d had silicone oil inserted, which was better than the gas in that I could actually see, but everything was incredibly blurry and I couldn’t read anything out of that eye.  Of course, there was also the return of the stabbing stiches pain, the constant aching, and the redness and disgusting eye gunk.

Weirdly, I can’t remember anything at all about eye pad removal number three, but the third surgery was performed at Moorfields and I do remember feeling a heck of a lot better upon waking up from the general anaesthetic.  Amazingly, there was also considerably less eye gunk, which was a massive plus and more than made up for the fact that I could have easily been mistaken for Frankenstein’s Creature a couple of days later when the bruising started to appear.

Eye pad removal following surgery number four still makes me shudder.  That was the surgery under local anaesthetic to remove the silicone oil, but as small detachment was found in the operating theatre, I ended up with gas again.  As the surgery was very early in the morning and done under local, I was packed off home the same day.  The following morning, my sister came to help me take the eye pad off.  I rapidly spiralled into nervous wreck status, quivering like an idiot in front of the bathroom mirror as I attempted to peel a bit of surgical tape off with shaking fingers.  “Do you want me to do it?”, asked my sister helpfully.  I just stared at her, nervously.  “Sit yourself down”, she instructed capably, indicating the toilet seat.  I obeyed, and sat in trepidation as she gently peeled away each piece of tape and removed the pad.  Foolishly, I took this from her and inspected it.  “Euuuuww!”, I exclaimed in disgust, before she retrieved it and placed it firmly in the bin.  I then busied myself with the task of examining my eye.  “Where’s my bottom eyelid gone?!”, I wailed, peering into the mirror in horror.  Weirdly, it had kind of turned in on itself, but fortunately a few wipes with cooled boiled water seemed to retrieve it.  Initial panic over, I was back to the by now familiar drill of redness, stabbing stitches, deep aching, and my old friend the gas bubble.  Oh, and posturing, of course.

Exactly two weeks later, I found myself sitting in Moorfields for yet another dreaded removal of the eye pad after further emergency surgery and another lot of silicone oil following the particularly devastating detachment number five.  This time, it was the nice Irish nurse who removed the pad.  I cautiously opened my eye to discover that the bizarre visual effects of the last detachment had thankfully disappeared, along with the remains of the tiny gas bubble.  However, I had developed horrendous double vision.  “This has never happened before!”, I cried in alarm, whilst pointing into the air and explaining, “I can see one of you here, and I know that’s the real you, but I can see another one of you there as well!”   “Don’t you worry – the doctor will check it in a minute”, she said calmly.  “How does it look?”, I asked her, hopefully.  “It looks a bit dirty, but I’m going to clean it up for you.”, she said cheerfully.  True to her word, she cleaned it up to the extent that by the time I managed to stagger to a mirror, although Frankenstein’s Creature stared back at me once again, he had at least had a good wash.  Fortunately, a few hours later I only had one sister again rather than two, and I was back to oily blurriness with considerably reduced peripheral vision, yet very thankful to be able to see out of that eye at all.      

Marching for Moorfields: limbering up

Just incase my sister and I were in any danger of forgetting the fact that we’d signed up for the fourteen mile Eye to Eye sponsored walk on 13 March, Moorfields Eye Charity have been sending us weekly emails.  “Seven weeks to go!”, announced the first one, triumphantly with air of excited anticipation.  Shortly after receiving it, a somewhat more panicked missive pinged into my inbox: “Aaaaaaaaaaaagghhh!”, wrote my sister, “Seven weeks to go ’til Eye to Eye!”.  “Oh don’t worry”, I assured her, “there’s still plenty of time!  Have you done any practise yet?”  It transpired that she hadn’t really done much practise at all because – irony of ironies – she couldn’t walk too far with the dog.  Now, in the dog’s defence, he is now eleven years old and has a touch of arthritis which causes him to limp if he walks too far.  My suggestion that she take him for a quick meander then return him home and go out again herself for a longer walk was greeted with a gasp of horror, “Oh no, I couldn’t do that – I’d feel too guilty!”

Not to be defeated, during my next visit to Surrey I suggested a spot of Eye to Eye practise.  It was quite a family outing as my mum came too, along with both dogs.  Sure enough, our canine companions didn’t seem to grasp the concept of ‘marching for Moorfields’ and seemed to be under the impression that it was ‘having a good sniff at every post for Moorfields’ instead.  Unfortunately, I suspected that we wouldn’t be able to boost our fundraising total very much by adopting their approach, and we were also likely to get some very funny looks along the way.  We continued as best we could, but I couldn’t help thinking that the short distance we managed (I reckon it was only about a mile and a half) wasn’t going to help us an awful lot in preparing for our fourteen-mile trek.  On the other hand, it was actually pretty good-going that my sister was still ploughing ahead with Eye to Eye after an unfortunate incident several weeks back when one of her toenails fell off.  “Whaddaya mean, your toenail fell off?!”, I demanded in dismay mixed with incredulity when she told me.  Apparently it had been feeling a bit odd for a while before giving up the ghost and falling off completely, at which point it became very sore.  Matters weren’t improved by our aunt informing us darkly that toenails take AGES to grow back.  Hmmm.  So that would be longer than the few weeks we had to go until Eye to Eye then!  😮

Shortly after the toenail incident, our spirits were raised by Moorfields Eye Charity’s “Six weeks to go!” email, which announced that they had selected us as their ‘fundraising heroes of the week’.  My sister had already been aware of this, as they’d ‘phoned her to ask if they could write about us in the email, but it came as a complete surprise to me!  Needless to say, it gave us both a boost, as did the fact that we made it past our target of raising £50 for every mile we’ll be walking.  We’re hugely grateful to everyone who has donated so far, and every donation we receive gives us a little boost to continue and try to raise as much as we can for Moorfields Eye Charity.  The money we raise will be used to support sight saving research into retinal conditions.  For further information on the Eye to Eye walk, please go to: http://www.moorfields.nhs.uk/content/eye-eye-2016, and if you’d like to sponsor us in our walking challenge please do so at: https://www.justgiving.com/emseyes.  Alternatively, you can donate by texting: ‘LOOK48 £5’ (or the amount you wish to donate).

eye to eye practise in Pirbright

 

Under Pressure

Note: Appropriate musical accompaniment to this post can be found here: https://www.youtube.com/watch?v=a01QQZyl-_I

Normal eye pressure (or intraocular pressure, often referred to as IOP) ranges between 12 and 22.  Throughout my eye dramas I’ve had a few issues with high pressure, mainly because oil in the eye can cause high pressure as can the steroid eye drops prescribed following surgery to treat the inflammation and redness.  In the couple of weeks following each of the first couple of operations to insert silicone oil, the pressure has increased to 30.  The first time it happened, this was treated by switching me to a lower dose of steroid drop which did the trick, and the second time I was prescribed drops to bring the pressure down in addition to the steroid drops.  So, after my third lot of oil was inserted, I was expecting the pressure to go up again.  The morning after the surgery, the eye pad was taken off and the surgeon checked my pressure in the usual way.  ‘What is it?’, I asked.  ‘Six’, he replied.  ‘Six?!’, I repeated in consternation.  ‘It’s never been that low before – why is it only six?’  Apparently this was because of the surgery and nothing to worry about as my eye was ‘well formed and not collapsed’.  I stared at him again, with mounting horror.  So low pressure could make my eye collapse.  Great.  Just another minor thing to worry about then.   He did nothing to reassure me by telling me that he’d be worried if the pressure was five.  ‘FIVE?!’, I almost shouted.  ‘But five is only one lower than six!’  He remained unperturbed by my rising panic and explained that he’d be more worried if the pressure was too high as that would mean having to remove the oil, and the steroid drops would probably make the pressure increase anyway.  ‘So you’re not worried then?’, I asked him.  ‘No’, he replied firmly.  Well, that was that then.  It didn’t stop me from staring at my eye in the mirror regularly for the next few days, for signs of imminent collapse.

He was right when he told me not to worry.  At my next appointment a week and a half later, the pressure was 22.  I breathed a sigh of relief, only to realise the following day that this meant my pressure was going up fairly quickly.  A quick call to the hospital, and I was advised to get it checked at the opticians and ring back for advice if it started getting up towards 30 as happened previously.   I know a pressure of 30 isn’t actually that bad.  It was once described to me as being ‘like driving at 40mph in a 30mph zone’.  I’ve also been told that the retina prefers a slightly higher pressure.  But after talking to my eye buddy who had horrendous issues with high pressure to the point where the agonising pain made him physically sick and it took weeks to resolve and settle, I’m anxious not to let things get to that point.

The last time I went into the opticians just to get my eye pressure checked, I rang first to explain and was told to just call in at any time.  So in I went and explained to the receptionist that I was there for a pressure check.  He looked blankly at me as I’d spoken to him in Russian, and didn’t even seem to realise that there was such a thing as eye pressure.  A Janet and John style explanation and a few minutes later I’d had the pressure check done by a cheerful lady who told me she’d need to get the results checked by an optician to see if they were okay.  She didn’t seem to believe me when I told her there was no need for that as I knew what the normal limits were and that she could just let me know the figures.

Anyway… this latest pressure check at the opticians was decidedly easier.  The puffs of air were administered, figures recorded, and then crunch time.  ‘What are they?’, I asked.  She peered at me over her posh designer frames and enquired suspiciously, ‘What are they usually?’  I suppressed a sigh and the urge to snatch the piece of paper from her hand so that I could read the figures and instead explained that they vary considerably as I’ve now had five retinal detachments.  ‘Five?’, she gasped, mirroring my reaction to the retinal surgeon a couple of weeks ago.  I nodded, and she obviously took pity on me as she gave me the pressure readings without further ado: 28.  Darn it.  I called Moorfields back and they told me to go to my local eye clinic to get the high pressure checked and treated, and this was how I came to be back seeing my original consultant at the Royal Surrey County Hospital a few days later.  Quite frankly, I was surprised he didn’t turn tail and flee when he saw me sitting in the waiting room yet again.  Instead he was quite interested to hear what Moorfields had done, and upon hearing that I’d had my previous two operations under local anaesthetic, his eyebrows shot up as he praised, ‘That’s very brave of you, Emma!’.  ‘I know!’, I agreed with alacrity, abandoning any attempt at modesty in my continued amazement at having got through not just one but two rounds of eye surgery under local.

He cracked on with the business of checking my eye pressures.  This involves putting numbing drops in (ouch, they sting a bit), followed by more drops which makes everything suddenly turn yellow (this can be a bit bizarre sometimes), and then the part where I have to rest my chin on the contraption and stare straight ahead, eyes wide open, watching the tiny blue glowing disc travelling towards me and knowing that it will come to rest on my cornea so I really need to keep my eyes open.  One ophthalmologist told me once in answer to my question, ‘Yes, it does touch your eye, but I don’t usually tell patients that because it makes them freak out and blink alot.’  Unsurprisingly, the pressure was up.  So my drops were adjusted and I was told to go back in two weeks.  I’m not even going to start talking about the complicated logistics of getting from Kent back to Surrey.  It’s only complicated because I don’t feel safe enough to drive long distances at the moment, but this does make things tricky.  Two weeks later, and my pressure was down to 14.  Yay!  But because of continued inflammation I was told to continue with the drops and return for another check in a week’s time.  Arrrgh!  But hearing the words ‘stable’ and ‘flat retina’ is enough to enable me to keep going for now…