Thursday, November 16, 2017

THE EYES HAVE IT



Somehow retirement generates so many projects that things get dropped out.  I had intended to write a list of concerns for the new eye doctor I’ll visit at the end of the week, but didn’t get around to it.  So maybe I can double-up by posting the list to this blog.  It will be a relief from politics.

GLAUCOMA

I have several danger signs in my situation, things that are often associated with the development of glaucoma in later years.  Basically they come from all the systems diminishment of aging.

“Although there are several types of glaucoma, the most common is open-angle, which accounts for roughly 90 percent of all cases. This form of glaucoma occurs when the drainage canals in the angle formed by the cornea and iris become clogged. The blockage causes a gradual buildup of aqueous humor, the transparent fluid occupying the anterior chamber of the eye. When too much fluid accumulates inside the eye, subsequent pressure on the optic nerve causes the fibers to degenerate. Open-angle glaucoma develops slowly and sometimes without noticeable vision loss for many years. “Glaucoma has been referred to as ‘the silent thief of sight,’" Dr. Assil says. "It’s all about early detection of the fiber loss."

Associated precursors:
  • Extreme near-sightedness
  • Optical disc that connects the optic nerve to the retina is a bit off center
  • Mother had glaucoma, controlled with meds
  • High blood pressure
  • Diabetes

THE FRONT OF THE EYE

Replacement of the lens when it is clouded by cataracts in old age is almost like the craze for tonsillectomy was in my childhood.  Docs here specialize in it and claim universal success, but I hear quiet complaints now and then.  It is also possible to transplant corneas which can restore the sight of those that scratches or infection have clouded.  An aged Blackfeet friend whose sight was damaged by trachoma in the great epidemic of the early 20th century was able to see again.

We have learned that past middle age, as we lose muscle strength everywhere, the tiny muscles that pull the eye lens to change focus also get stiff and slack.  Then we need reading glasses.  I use “computer glasses” which are set permanently by prescription to a distance of 18” and also have a blue tint meant to protect against damage from the constant exposure to the light of computer screens.  I don’t know how scientific that is, but it doesn’t interfere and seems like a good precaution.

Direct sales of Chinese eyeglasses has been a bonanza for me.  (I’m very fond of round lenses, like Harry Potter.)  My last optometrist-provided variable-focus spectacles cost close to $400.  Now I buy from zenni.com and don’t bother with variable focus because the glasses are so cheap that I can keep a basket of them, color-coded for near or far.  I’m on the computer or reading or sewing almost all the time, but I keep an old-fashioned variable-focus eyeglasses in the pickup that is tinted yellow for better perception in low light or snow dazzle.  

DRY EYE SYNDROME

To work properly eyes need to be continuously wet, which is a problem when staring at a screen, because the lids are like reverse windshield wipers spreading the tears over the eyeball.  If one is not blinking, as is the tendency when watching a screen, the surface of the cornea dries out.  Another case is when driving in a car with the heat blasting or the window wind hitting the eyes.  Montana wind sweeps eyes when outdoors.


A few years ago I had red sore eyes and what felt like grit in them.  I was alarmed because when I first met Bob Scriver in 1961 (and the reason I was drawn into his life so quickly) was that he was suffering from herpes simplex keratitis, which is to say that herpes virus had attached to his corneas.  If it burrowed as far as the vitreous fluid, he would lose his eye.  If it continued up the optic nerve to his brain, he would die.  At the time the only remedy was to scrape the cornea and pour iodine into it.  Three times a week.  In the end he was save by iododeoxyuridine, an experimental drug meant to address cancer.  

This has made me extraordinarily alert about eye symptoms.  So I forced myself into the schedule of the opthalomist in Great Falls.  He was stumped.  I had stopped wearing eye makeup years earlier.  I refuse contact lenses.  We finally blamed field burning.  A year or so later I returned for a “checkup”.  This time he asked if the little scaly patch on my quite pink cheeks was rosacea.  It was.  I had ocular rosacea.  No one knows what the cause is specifically, but it’s at least partly hereditary.  It’s part of dry-eye syndrome, treated with drops (otc or specialty), warm compresses, and ultra-cleanliness for the lid area.  

My cousin, who also has rosacea (we’re red-heads or were before we turned white) uses an upscale cream.  I found a little tube of stuff called “Prosacea” which is sulphur-based, but then discovered that a similar tube called “Psoriasin” which is coal-tar based, works better.  In fact, the scaly patch of cheek is gone now.  I still have pink cheeks, sort of like Prince Harry.  (It’s very common among Brits.)

This affliction appears to be halfway between allergy and anti-immune disorders, so “Flonase,” which is a glucocorticoid, seems like a good influence when it’s allergy season.  A little crust of alkali-like stuff forms along the edge of the lids, in the lash-line, which prompts some to theorize that the teeny-tiny microbes that live there have something to do with it.  But we’re all sort of stuck in old-fashioned microbe/germ theory, not quite convinced that inanimate molecules can be so active.  Anyway, the little crust tastes like tears, so I suppose it is tears evaporated.

RETINA

This is the really scary stuff, the light-sensitive film at the back of the inside wall of the eyeball.  When it tears a bit and bleeds, the clots form the “floaters” in the vitreous fluid that keeps the eyeball round.  Or individual neurons can go a little crazy so that there are “flashers.”  If the vitreous fluid dries and shrinks a bit, it can create suction on the retina that makes the neurons flash, esp. if the suction pulls bits free from the film.  Sometimes it looks like lifesavers, circles. 

The notorious toxoplasmosis parasites like to cruise around in there.  I didn’t take that seriously until at animal control — where I had researched them objectively — I talked to my counterpart in Seattle where her daughter complained of passing shadows in her eye, which turned out to be “mitos”.  In a healthy person, they will simply die and be absorbed, but in people with challenged immunity, they might not.  

When I was in Saskatoon, thinking I would have health care provided by the government, I was naive about the gatekeeping meant to keep the hypochondriacs out of the system.  I began to see grids and colored patterns and went to the intake doc.  He mocked me, asking if I ever saw pink elephants.  When I was living in Montana again, the eye doc diagnosed ocular migraine — malfunction of the fluid feed around the eye — both blood and lymph, which made the tissues swell and shrink.  In fact, the mechanics of this had caused tiny holes in the retina which he sealed with a laser.  The seals have held and no more holes have appeared.

When I thought about it, I remembered that in childhood where my near-sightedness was not recognized for a long time, I saw those same patterns at night as well as the sensation of a vortex sucking me down, down, down.  I woke screaming.  These were probably not produced by ocular rosacea or ocular migraine so much as the ocular centers of my brain trying to figure out the blurs I saw, imposing possibilities from their own sorting structures, which are quite mathematical.


I read as much of this stuff as I can find on the internet and then digest.  I look at macular degeneration, tear film osmolarity, diabetic macular edema.  And soon I will begin to move from print to sound on the computer — pod casts.  Just in case I go blind.


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