Saturday, December 13, 2008

Looking at you, kid

Arrgh! I'll keep an eye on it!

My father's right eye is somewhere in a University of California medical lab. It came into their possession after a surgeon extracted the blind orb and set Dad up for a glass replacement. He's been a one-eyed man for several years now, though he has yet to find the land of the blind in which he could be king.

Did the UC med school find anything interesting in my father's eye? I'm more than merely curious these days, especially since last year, when my ophthalmologist told me that the retina of my left eye was scarred. (Dad's right eye. My left eye. We're as opposite as can be.) The eye doctor opined that the likeliest cause of the scarring was a leaking blood vessel, but there was no indication of leakage into the vitreous and I could not report any significant incidents that would have confirmed such an episode.

My ophthalmologist decided that no immediate intervention was indicated, but that we should “keep an eye on it.” I dutifully laughed at what I assumed was an eye doctor's favorite joke, but her advice seemed reasonable enough. She referred me to a retinal specialist for a second opinion, who quickly concurred with my ophthalmologist's recommendation:

“I think she's right. No intervention is indicated. We could zap it with a laser, of course, but the potential risk outweighs the likely benefit at this point. You should let us know immediately, of course, if there are any significant changes in your vision, but otherwise it should suffice to check your condition every six months or so.”

I was perfectly happy to accept the opinion of the two ophthalmologists that it was not necessary to shoot a laser beam into my eye. The semi-annual checkups seemed quite adequate, thank you very much.

Six months ago, the checkup proceeded without incident. This month, however, there was some additional excitement. The ophthalmologist ushered me into an examining room that sported an imposing piece of electronic scanning gear.

“It's brand new,” she told me. “We can now do better and more detailed scans than ever before.”

I sat down in front of it with my blearily dilated eyes and followed her directions to stare into the bright lights. A few seconds later, the color inkjet printer attached to the equipment spit out a detailed scan of my left retina.

“See that?” the ophthalmologists asked me chirpily, obviously still enjoying the novelty of her new diagnostic gear. “It shows you as clear as could be that you have an accumulation of fluid behind your retina. I'm going to refer you to the retinal consultant again and you can show him this printout.”

I was not as bubbly about the bubble as she was—in fact I was unnerved—but I dutifully agreed to see the retinal specialist the next week. In the meantime, I noticed that the scan was labeled with xy coordinates to identify the location of the cross-sections: 272 for the x coordinate on one graph, 8 for the y coordinate on the other. That, of course, captured my attention.

On the day of my appointment with the consultant, I put a brave face on things and shared the eye scan with my calculus class. The students were duly impressed (or at least were kind enough to pretend to be) by this example of xy coordinates at use in the real world. They passed the scan around and commiserated with me. One of them asked what was going to be done.

“Oh, I'm just going in for a consultation and second opinion. No one has decided yet to shoot a laser into my eye,” I finished, a bit weakly. The students favored me with sickly smiles.

I reported to the retinal specialist's office and endured the customary two-hour wait till it was my turn to see the man himself. I gave him the printout from my ophthalmologist.

“Oh, yes,” he said. “Yes, yes. That's quite a bit better.”

The bubble is a good thing?

“Huh?” I said, articulately.

“The fluid pocket is shrinking,“ the doctor replied. “That means we made the right decision in not intervening. Your problem is taking care of itself.”

“Um,” I said, suavely. “The bubble was already there last time?”

The consulting ophthalmologist seemed just a bit puzzled. “Hmm? Oh, yes. But this time your eye doctor was able to give me her own scan. Last time you were here I had to do it myself.”

And somehow managed not to mention it to me.

“This fluid pocket is definitely smaller than the one we saw a year ago,” he concluded.

“Oh,” I said, brightly. “That's good news.”

“Yes,” agreed the doctor. “Just see your regular eye doctor in another six months and we'll continue to watch your progress.”

The bubble was not new. The bubble had been there a year ago. The bubble was smaller now. I was happy. Sort of. I was also muttering a bit to myself as I left the consultant's office and walked out into the overcast afternoon. To my dilated pupils the sky was as bright as a laser blast, but I put on my Joe Cool sunglasses and headed home.

It was a good day, I told myself, so stop grousing.

By the way, after I showed my calculus students the scan of my eye and the utility of xy coordinate systems in medicine, I returned to the math offices and found one of my colleagues at his desk, his office door left incautiously open. I could not resist sharing with him an account of what I had just done. He perused the eye scan judiciously, his lips pursed and his head slowly nodding.

“That's very interesting,” he said. “Nice job. I'm sure your students were impressed.” He paused for a beat, then looked up at me. “I think I have some good news for you,” he continued. “My wife volunteers some time each week at a local animal shelter. When you start wearing an eyepatch, she should be able to get you a parrot to wear on your shoulder.”


The Ridger, FCD said...

It's always a good day when they don't have to shoot a laser into your eye.

Jens Knudsen (Sili) said...

You shoulda asked for the old scan and then had the students integrate the bubble areas.

Captcha: "dacksted" - where the Bumsteads have their Summerhome.

llewelly said...

I recommend you get that eyepatch and parrot soonest, Dr. Z.

We've got to do everything we can to fight global warming.

Theo Bromine said...

About 7 years ago, I was diagnosed with a "central serous chorioretinopathy" (aka a bubble of fluid behind the retina). The symptoms were a small area of blurriness in the center of my field of view. It was diagnosed at the time by an ophthalmalogist, after the use of anaesthetics, pupil dilation, staining and visual inspection using a magnifier in contact with the surface of the eye. (It resolved on its own after about 9 months.)

A few months ago, I visited my optometrist for a routine checkup and new glasses (presbyopia). All they needed was dilation - no stain, no anaesthetic, and lo and behold, there was a 15" picture of the inside of my eye (showing the slight scar that was all that was left of my "bubble").

The bad news was that the optometrist then said that I was at risk for narrow-angle glaucoma, and sent me for a folowup consultation for a potential prophylactic trabeculectomy, but fortunately the 2nd opinion was that there was no need for me to have lasers shot into my eyes either.