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Tuesday, July 15, 2014

The Eyes Have It

1957 BMW R50
"Diabetic retinopathy," they call it.  It is a common complication of diabetes.  It used to be the No. 1 cause of blindness in the adult population.  I cannot explain its bio-chemical mechanisms, but its effect is to make the retina produce lots of fragile new capillaries that, at first, tend to become microaneurisms that burst, releasing blood into the eye's vitreous gel, creating black (or, rarely, reddish) floaters that swirl and undulate like lava lamps, blocking portions of the vision in the affected eye. Usually the unaffected eye can form a clear image, and the amazing brain can adjust one's perception, so that the diabetic can continue to function normally with the floater.  Fortunately, this blood is eventually resorbed into the body, so the floaters abate in a few days' time.  But, left untreated, the retinopathy gradually worsens, and causes retinal separation, leading to blindness.

Your humble blogger is a Type II diabetic who has been treated for diabetic retinopathy for over a decade.  My doctor is the chief of retinal surgery at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire.  For most of these years, he has treated me using laser surgery, at first zapping (cauterizing) the microanerisms, and then by using a technique known as "gridding," in which up to 20% of the retina is killed using tiny laser burns, in a series of dots covering most of the back of the eye.  Hence, I have received over 2000 laser hits in each of my eyes.

Other than a slowing of my eyes' ability to adjust to changing levels of light, those laser treatments have worked well.  Up until recently, I have maintained 20/20, or at worst 20/30 vision in both eyes, while wearing glasses.  My doctor tells me that I am fortunate, for had I been born even ten years earlier, I would long since have gone blind.

But diabetes is a progressive disease, that will have its way with us. Over the past several months, my eyes have developed some edema in the area surrounding their maculae.  Too close to the center of vision to be treated with lasers, this problem is being addressed with injections of swelling-reducing chemicals only now being applied to ophthalmic cases.  I have had to sign releases to permit their use. One is called Avastin, the other Lucentis.  The injections are not fun, but less annoying than were the long laser sessions.  I can report that my left eye is still seeing at 20/25, corrected.  But, in the right eye I am down to 20/80.  Hence, reading and writing have become difficult, as my brain is having to accommodate two very different images.  If I close my left eye, faces become narrow caricatures of the persons in view.  Even when using both eyes, letters disappear in the middle of words on the page, or on the screen.  I hit wrong keys even more often than I used to.  For one who teaches online courses, this difficulty in reading is a worry, and is forcing me to contemplate immediate retirement, although I have one year left on my half-time retirement transition program at Plymouth State University.

The treatments are ongoing, so I pray for improvement over this summer.

Back in 1964 I made a promise to God, when I caught myself riding my 1957 BMW R50 like the testosterone-crazed youth that I was, that if He let me live to see 21, I would live to be 100.  So, I must hang tough, and go for Centurian.  God willing, I will do so with my sight intact.  Amen.

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