“Eyes But Cannot See”

Along with trying to make Mom young again, the next target was her eyes.  I’d taken her to a local ophthamologist who has a very good reputation.  She did a complete examination.  Her recommendation was that it would be of no benefit to give Mom a new prescription for her glasses, as she had a cataract in the left eye (one was removed from the right about 5 years previous) and macular degeneration in both eyes.  Her suggestion was that Mom see a retina specialist in Grand Junction as well as a cataract ophthamaologist there (one would think there are absolutely no other competent doctors of any kind in the Roaring Fork Valley.).  After those issues, cataract and macular degeneration, were addressed, an accurate prescription for glasses would be more likely.

I realized what a nightmare this was going to be as we were leaving Dr. Cecil’s office (she’s the lcoal ophthalmologist we’d just seen.).  They gave Mom the cardboard glasses since they’d dilated her eyes and sunlight or any strong light would damage them in that condition.  The glasses absolutely were the weirdest thing Mom had ever encountered – “What are these for?”  “I can’t keep these silly things on!”  “I don’t need these”.  With each outburst I would patiently try to explain the importance of wearing them.  But she either didn’t understand or the explanation wouldn’t stay in her short-term memory long enough for her to realize she had to wear them.  (Later, after talking to my brother in Michigan where she was staying when she had the right eye cataract removed, I understood the futility of all my attempts.  He literally followed her around and every time she took them off he’d tell her to put them back on.  Finally, my meek and mild Mom turned and faced him.  With her finger jabbing at his face she exclaimed “You stop telling me what to do!”) 

I got Mom home, and finally was so frustrated I convinced her to take a nap.  I reasoned with her (or lied, whichever) that the type of exam she’d had required rest afterwards.  She complied.  It’s funny – if napping is her idea she’s all over it.  But if it’s someone else’s she’s sure we’re just trying to “get rid of her”.  When she got up I sat her in my room with the shades pulled down and let her watch T.V.  Finally the 4-6 hours passed and I quit worrying about it.

Since new glasses weren’t going to help because of the macular degeneration  I was in a fugue about “what in the world is macular degeneration?”  I had heard of it and knew it could cause blindness (or thought so anyway).  So I was confused, upset and ignorant.  I made an appointment in Grand Junction with both specialists.  Fortunately the first was the retina specialist for the macular degeneration.  But to diverge a moment:

The thought of more dilation for Mom was alarming.  How in the world would I keep sunglasses on her in the “always sunny” Grand Junction?  I had a couple strategies.  One was we’d check into a hotel close to the doctor’s office and close the drapes and sit in the dark for hours.  Also I decided when we started the trip we’d have matching sunglasses and I’d convince her it was the new fashion statement.  In the meantime, I asked my friend Dianna if she’d like to go; I was paying for hotel and dinner and she could do some shopping while Mom and I sat in our cave.  She jumped at the chance for a getaway.  I got a suite so Mom and I could be in the room with the bathroom as Mom gets quite familiar with whatever bathroom she’s close to (including all the restaurant, mall, gas station, families, and miscellaneous restrooms within the radius of her world.)  Our bedroom was the back room of the suite and had a king-sized bed in it.  Dianna’s was the front room with the kitchen-ette and the main door to the hall.  I sat in the tiny front room with Dianna working on my computer, while I got Mom comfortable in bed with “Law & Order” on (needless to say, her favorite show.  I’ve seen so many re-runs, I can speak along with the actors word for word.  I’ve alerted my family that I’m qualified for any legal questions that might arise after so much digestion of the legal system on Law & Order.)

On to Mom.  The rooms were dark enough we didn’t have to worry about glasses anymore, but Mom couldn’t get it straight which side of the bed was hers.  I had her side all pulled down with the pillows  “in position” and my side made up as left by the cleaning service.  Still, it wasn’t clear to her.  I kept explaining, Diana and I estimated about 25 times an hour, her side was the one next to the bathroom and with the covers ready for her to tuck into.  When we all went to bed, I snuggled into my side close to the wall and promptly put my ear plugs in as I knew between Mom’s shuffling (which can be quite loud and annoying) to the bathroom, her hearing aides ringing all night and her snoring like a drunken sailor – sleep would be illusive.  I felt unselfish and self-satisfied that I’d given Diana the “good” room – away from all the nightly activities in my room.  She could close the door in-between and forget we existed.  Happily, and unexpectedly, I slept like a baby.  But my poor friend!  Twice through the night she heard noises at the door and got up to find Mom wandering in the hall!  Each time Mom said, “I’m looking for the bathroom” (which was directly across from her when she got out of bed.).  Patiently Diana led her to it both times.  After the second time Dianna got up when Mom was done (which could have been as much as a half an hour  later!), turned the bathroom light on and closed the door all but an inch or two so that hopefully Mom would see it next time.  That must have worked, because she was never found in the hall again.

The verdict from the doctor wasn’t what I’d hoped.  She has the “dry” degeneration in both eyes and a cataract in the left.  He said removing the cataract won’t help her vision, as that eye is pretty damaged by the degeneration.  But happily the right eye isn’t and with a new prescription he felt her vision would be significantly better. 

 Looking on the
“bright” side of the sight issue, at least I won’t be making numerous trips to Grand Junction.  My plan had been to get it all done quickly, before winter sets in the and roads get tricky.  Plus the hotel, eating out – the entire routine – is time consuming and expensive, as well depleting any reserve of patience I might have in dealing with Mom’s confusion.

In retrospect, this entire ordeal would have been easier if I’d been educated about the issues involved.  So I’m going to share some of what I learned about macular degeneration:

Mom has age-related macular degeneration, AMD.  Light rays enter the eye through the cornea, pupil and lens, then focusing on the retina.  The retina is a light-sensitive tissue lining the back of the eye.  It has two areas, the peripheral and macular.  The peripheral gives us wide-angle vision, seeing things to the side.  The macula is a small area in the center of the retina, allowing us to see details clearly, pinpointing them. It enables us to drive, read, or recognize a face.   Age-related macular degeneration is one of the leading causes of vision loss in people over 65.   There are two types, atrophic, dry and exudative, wet.  AMD can cause blurriness, dark areas or distortion.   Of those with AMD, 90% have the dry variety.

The retina is made up of layers sandwiched together into a smooth surface.    In dry AMD  the Retinal  Pigment Eptithelium (RPE – I could live with acronyms for everything!)  layer is disrupted by deposits called drussen or other age-related problems.  Most discover they have AMD when they notice their vision starts to seem abnormal and they go to their doctor.   Often it’s discovered during a routine eye exam.  

Dry AMD can increase in those who have intermediate AMD in both eyes or advanced AMD  in one eye.  Dietarty supplements C, E, zinc, and beta  carotene  can decrease  the advancement of AMD in 25-30% of those affected.  It doesn’t appear to be beneficial as a preventative treatment or for those with minimal AMD.

Early detection is crucial in the treatment of wet AMD.  An Amsler Grid is recommended for monitoring both types of AMD.   It should be used daily, and is a 5″ by 4″ graph or grid.  The directions for its use are printed on it.  An abnormality will cause the lines of the grid to appear wavy, blurry or dark or even blank.  I’ll be using it with Mom (and will comment if that proves challenging, interesting or even humorous) daily.  I’m to contact her doctor if there are changes, as early detection of wet AMD is crucial in controlling it (the good news is that this is the local doctor!).

Wet AMD occurs with the growth of abnormal blood vessels in the layers behind the macula.  They further distort or blurr central vision by leaking  fluid.  In folks with dry AMD, 10% develop the wet form.  Early detection is critical.

It’s impossible to tell if Mom will develop the wet form of AMD (or if anyone with the dry form will).   When wet AMD is suspected, there’s a diagnostic technique called fluorescene diagnosty.  Flouristein dye is injected into the  arm which travels to vessels in the eye which then can be seen by a special camera.  Treatments can stop further development of wet AMD, but not cure what’s already happened.   If the wet AMD isn’t in the center of the macula, lasers can stop the progression of blood vessels, which if left untreated can cause further loss of vision.  In most cases, vision can’t be improved, but can be preserved.  I’t s likely that for those who have the laser treatment, 50% will need re-treatment within 5 years.

For some with wet AMD  the laser treatment isn’t an option because it would damage the macula.  That’s the case when the damage caused by the unwanted blood vessels are under the center of the macula.

 If  the (nasty, leaky) vessels are under the center of the macula there is another possible option other than the standard laser treatment.  It’s called photodynamic therapy or PDT.  A  photosensitizer and low power laser are used together.   A photosensitive chemical is injected into blood vessels and attaches to cells which are fast growing, typical of the abnormal cells growing in the central macula.  A low or cool-powered laser is focused on the abnormal vessels which activates the chemical and destroys the vessels.  Folks having this treatment must be extremely careful to avoid strong light after the treatment.

Another option may be an anti VEGF drug (I won’t even attempt to spell this.).  This targets the chemical VEGF which contributes to abnormal vessel growth beneath the retina.  This drug can slow leakage of the vessels, thus slowing vision loss.  VEGF is inserted directly into the eye with a very fine needle and may be done numerous times over several months.  It may also be combined with some of the other therapies.

People with wet AMD can learn to “see again” with visual aids and with the vision they still do have. 

AMD runs in families and those who smoke or have high blood pressure may be more susceptible to AMD. 

Mom’s ophthamologist put her on vitamins enriched with lutein.  Lutein is an antioxidant which protects the eye from free radicals (environmental toxins, poisons, etc.).  It and zeaxanthin are the only carotinoid pigments found in the macula. They’re not made in the body, so can only be supplemented externally.  They’re plentiful in red, leafy vegies – think red lettuce, spinach, kale.  I found a variety of brands of vitamins that have these two supplements in them:  Bausch & Lomb Ocuvite, Ocuvite Nutrition for the Eyes, Solaray Lutein Eyes, and I Caps which is what I’m currently using.  There are many more out there, just be sure they contain the two supplements mentioned above (if you want to stay up on current research!). 

 

 

This entry was posted on Monday, November 16th, 2009 at 5:50 pm and is filed under Caring for Mom. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

3 Responses to ““Eyes But Cannot See””

  1. ostrov Says:

    Thank you,
    very interesting article

  2. avva Says:

    Dear Author iamthebologna.com !
    Yes well!

  3. Prescription Retin-A Says:

    Prescription Retin-A…

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