Thursday, April 29, 2010

How I Spent My Wednesday

Today I'm taking a break from our usual focus on publishing in order to offer a sort of public service announcement (PSA). I had an experience yesterday that I want to share ... in the hope that someone out there will benefit from what happened to me.

Every spring, I schedule my annual exams: OB/GYN, ophthalmologist, and internist as well as my semi-annual exams: dentist and dermatologist. April and May are cluttered with appointments.

Yesterday was the ophthalmologist. Sarah, my tech, is a twenty-two year old single mother of a five-year-old, and I look forward each year to hearing how her precocious daughter is doing.

Midway through the exam, Sarah said, "I can't dilate your eyes."

I said, "Excuse me?"

She said, "Let me go find the doctor. I'll be right back."

My doctor, a lovely Asian woman who barely looks older than Sarah, came into the room and checked the results of whatever test Sarah had been running. She told me I had developed NAG--Narrow Angle Glaucoma.

This explanation of NAG comes from the Southland Eye Clinic website here:
A watery fluid is generated inside the normal eye. It circulates through the eye and drains out of the eye in the "angle" between the cornea (the clear window of the eye) and the iris (the colored part of the eye). Some people are born with narrow, slit-like draining angles. In such people, anything that further narrows the angle prevents adequate drainage and causes the pressure to build up. The patient then [may] experience/s an acute attack of Narrow or Closed Angle Glaucoma.
Fortunately for me, my visit to the ophthalmologist had preceded my having an acute attack. My doctor told me that she wanted to do surgery on one eye immediately and on the other eye within two weeks.

We agreed I would go on to work while her front office contacted my insurance company for an authorization to do the surgery. By 3:30 I was back in the office. Here is a description of the surgery:
In this office procedure, a small drain hole is created in the iris, the colored part of the eye. The hole is of microscopic size. The operation is painless.
Well, not totally painless. My right eye was deadened by drops. A lens was glued to the eyeball. The doctor then manuevered a laser which emitted clicking sounds while it cut through my iris. I felt a pinch and an immediate headache behind the eye. It took about three minutes for the doctor to cut through the iris and then to widen the hole to permit drainage. I had no bleeding at all although some people do experience a bleed.

Afterward I remained in the office for several hours while they checked my eye pressure and sight. I drove myself home and went to bed. When I woke up at 9:00 PM, the headache was mostly gone although my eye ached a bit. I have drops to put in the eye four times a day for the next five days.

I'm scheduled to have surgery on the other eye next Wednesday.

Here's the PSA part of this post. Narrow Angle Glaucoma (NAG) can present suddenly as opposed to the more chronic or Open Angle Glaucoma, which develops slowly over years. Here's the description of a NAG attack, again from Southland Eye Clinic:
An attack of this type of glaucoma is an emergency. Untreated, it may cause blindness in a day or two. Between attacks the eye pressure is normal and there are no symptoms. During the attack there are often eye pain, nausea and sometimes vomiting. The eye may be red, vision may be blurry and patients may see halos around the lights.

... people may delay treatment until it is too late because they do not recognize that they are having a glaucoma attack. They often think that they are just having a headache, or a migraine. Because they do not suspect glaucoma, they fail to seek treatment and damage to the nerve takes place. Once the nerve fibers are dead, the damage cannot be reversed.
I've known there was an issue with the shape of my eyeballs since I was in my late thirties and tried to get fitted for contacts because I was having trouble reading. The contacts simply would not stay in my eyes. I'd put them in and, within an hour, they would flop over and fold in half while still in my eyes.

My ophthalmologist told me my eyeballs were flatter than most people's (the only flat part of my body, I might add). I wear contacts that are the equivalent of coke-bottle-thickness glasses. However, no one ever told me the shape of my eyes put me at increased risk for NAG.

I was fortunate. My eye appointment permitted my physician to catch the condition before I suffered an acute attack. My ophthalmologist stressed that NAG attacks are often mistaken for migraines. She said hospital emergency rooms frequently misdiagnose the problem.

Once my left eye is operated on next Wednesday, I'll be free of the condition. In a few rare cases, the hole in the iris closes over, but my ophthalmologist will monitor for that possibility.

The entire point of this post today is to remind you not to neglect your eyes. Get regular eye exams. You don't have to have flat eyeballs to develop NAG. A friend of mine told me last night that her cousin developed it when she was only thirty, long before she needed glasses.

NAG and the more common form of glaucoma--open angle--are not the only conditions you need to be checked for. A friend of mine is gradually losing her sight from Retinitis pigmentosa. She is already legally blind and cannot drive. Her prognosis is eventual total blindness.

Imagine total blindness.

Take care of your eyes. I care about you.


Maria Zannini said...

I was on pins and needles waiting to hear how the surgery came out.

But now I have a million questions.

Did you have any clue there was trouble before you went to the eye doctor?

How is your vision today? Do you notice any difference from one eye to the other?

Was this a one time procedure or will you have to do it again?

I am relieved the first eye is done. Next week wouldn't come fast enough for me.

Take care, hon. Talk soon.

Peter L. Winkler said...

We care about you. Good that the condition was caught in time before serious damage occurred.

Judy Sizemore said...

Thank you for sharing this. I'm making an appointment today!

Maya Reynolds said...

Maria: Thanks. By the time I got home it was after 6 PM and I was exhausted--both from the emotional drain and the headache, which did not go away until I took that three-hour nap.


1) I had noticed that I was closing my right eye to read the computer. Since I have monovision (two contacts of different strengths) I assumed I needed a script for a stronger contact in one eye. But no other symptoms.

2) Vision today is fine. Again, my eyes are corrected to different strengths so my left eye always does the far stuff while my right eye does the close up.

3) Like any person with glaucoma, until I have the second surgery, I cannot take any decongestants which might increase the eye pressure. However, once I have the second eye done, the glaucoma will be gone, and I can go back to taking decongestants as needed. Fortunately, most of the stuff that makes me sneeze has already bloomed for this spring. The only potential problem would be if one of the holes in my irises healed. If so, I would have to have the surgery again. However, that is rare.

Thanks for your good wishes.

Maya Reynolds said...

Peter: Thanks so much for the kind wishes. I appreciate them more than I can say ... and I appreciate YOU.

Warm regards,


Maya Reynolds said...

Judy: I think of myself as being fairly well-informed when it comes to medical matters.

Part of my anxiety yesterday was that this just broadsided me. I had no warning at all. I guarantee you, if my eyes had gone into crisis mode, I would have assumed it was a migraine and not sought immediate medical help. I don't have migraines often (maybe one every two or three years) and they are usually a mix of things: allergies, stress, lack of sleep. I NEVER go see a doctor for one. The thought that I could have lost my sight over something like this is terrifying.

Thanks for commenting.



Sharon said...

This is important information. Thank you for sharing. Glad to hear you're doing well and sending good thoughts for a successful second surgery.

Maya Reynolds said...

Sharon: Thanks so much for the good wishes. Now that I've had the first surgery and know what to expect, I'm not as spooked as I was between 10:30 and 3:30 last Wednesday when I was pretty much freaked out.