IN PRAISE OF SUBMACULAR SURGERY

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IN PRAISE OF SUBMACULAR SURGERY (or, I was blind but now I see…)
	I'm a 44 year old independent lady, a secretary, active, and in good health. On Friday, November 13th, 1998, I suddenly could not read. I had lost the central vision in my left eye. It had gone from 20/20 vision to 20/400+ quite literally "in the blink of an eye" as a result of Wet Type Macular Degeneration - a disease which attacks some people slowly and insidiously, and others like myself, with absolutely no warning. It is painless - as long as you don't consider the agony of ignorance and confusion, and the looming threat of blindness. But I was very, very lucky. Here’s my story:
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November 13, 1998 - "I Can’t See What I’m Looking At!"
	I turned to my assistant and said "I can’t see what I’m looking at!" At first, she didn’t realize that I was serious. I found that if I closed my right eye and looked at her face, I could only see hair, mouth and chin, but eyes, ears and nose were completely obscured by a strange grayish blotch. It didn’t seem to matter much what I looked at, I could only see the OUTSIDE of it. If I closed both eyes, the blotch became a flourescent green spot. Coincidentally, I had been planning to get my eyes checked for new glasses on Saturday.
Within the first minutes of Dr. S’s examination, I knew I had a serious problem. I couldn’t even see that there was an eye chart, let alone the Big E. As Dr. S examined me more closely, his profound stammer emerged - he was clearly very upset. He managed to say, "I don't think we're concerned about new glasses here." He told me he could see a spot on the macula, and he explained the function of the macula, drawing a diagram of the eye to illustrate what he was talking about. He instructed me to go directly to Vancouver General Hospital's Emergency Room, and gave me a note to give to the ER doctor.
	Vancouver General Hospital was mercifully quiet that Saturday, but I was growing increasingly nervous, especially when the ER doctor arranged for the on-call ophthalmologist, Dr. B, to open up the VGH Eye Care Centre that very night, for me. Dr. B examined my eyes using a very impressive machine and some incredibly bright lights. Each time she swept that searing light across my eye, I could see a little black spot, and it began to look positively evil. I told her that Dr. S had seen a spot on my macula. She could see it too. She made arrangements for me to come in and see Dr. M very early Monday morning.
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November 16th, 1998 - VGH Eye Care Centre
At 7:00 a.m. Monday, when I arrived at the Eye Care Centre, there were 10 other people in Dr. M’s waiting room. A half a dozen of them were doctors. As I eavesdropped on their conversation, I could hear that they had come from the four corners of the earth to see him. Apparently, I was in very good hands, but the gravity of my situation was becoming very clear. During his initial examination, Dr. M asked me a very odd question: "Have you spent any time in the Mississippi River Valley lately?" (Uh…No…) I heard him murmur "Oh, dear, and at such a young age." (What the heck was that all about?) He pulled booklet from his shelf to show me an illustration of what he suspected. I took note of the title of the booklet - Macular Degeneration. That was the first I’d heard this term, and I certainly did not like that word "degeneration". Dr. M sent me across the hall for a flourescein angiogram, and asked me to return the next morning - by then, he’d know "what we can and cannot do".
	Flourescein angiophotography is fascinating. A dye was injected into my arm and photographed as it proceeded through my retina. The technician was very kind, and showed me the resulting computer images, and they looked exactly like the illustrations Dr. M had shown me in his booklet. The angiograms done, I finally went to work, but as hard as I tried, I could not concentrate. I needed to know more about this, and I was starting to panic.
I searched internet for "Macular Degeneration". Unfortunately, the first article I read said "... leading cause of blindness, incurable, invariably starts in one eye, and then proceeds to the other …" There it was in black and white extra large print - that word, "blindness". It was exactly what I feared but until that point had managed to suppress. Faint and nauseous, and on the verge of disintegrating into total panic, I ran to my family doctor. He couldn't give me any more information. Worse, he did not dispute the information I had. All he could say to me was, "Chin up, Dear. It's the pits, I know." Monday night was very long and difficult. As I reflected on all the data I’d gathered, I kept getting stuck at "...leading cause of blindness, incurable, invariably starts in one eye, and then proceeds to the other…" As hard as I tried, I simply could not imagine life as a blind person.
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November 17th - Diagnosis and Recommendation
By now, I’d spent hours in waiting rooms - Dr. S’s waiting room, the VGH ER waiting room, the Eye Care Centre waiting room. For days, I’d been trying to push away the fear, and it kept creeping back, and I couldn’t even distract myself by reading the magazines. As I waited in Dr. M’s waiting room on Tuesday morning, I steeled myself for his news. My appointment on Tuesday morning was the turning point. Dr. M showed me my angiograms and pointed out the spontaneous central choroidal neovascular membrane. To my profound relief, he did NOT recommend laser surgery, which I had read would leave a permanent black spot where I now had the gray blotch. Instead, Dr. M described a surgical procedure using forceps to remove the membrane through a tiny hole in the retina, and then injecting a gas bubble into the eye to assist the healing process. I would have to lie face down for 48 hours after the surgery - this part was crucial. The chances of a successful surgery were about 65%. While I would have preferred more favorable odds, I had nothing to lose that I hadn’t lost already. That was one of the simplest decisions I'd ever made. Surgery was scheduled for November 23rd, exactly 10 days after the onset of symptoms.
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November 23, 1998 - The Surgery
	I was too squeemish to ask what they would actually do to me, although I learned later the procedure wasn’t as ghastly as I'd been imagining. I was given a choice of local or general anaesthesia, and I opted for general. The surgery took place at 2:30 in the afternoon and by 5:00 I was back in the hospital room where I would spend the night. While it was not exactly a comfortable night, my biggest complaint was having to sleep on my stomach.
When Dr. M visited me early on Tuesday to admire his handiwork, it took every bit of courage I could muster to open my eye. Dr. M waved his hand in front of me and asked how many fingers I could see. I saw a red blur. He seemed satisfied with my blur, patted me on the hand, and sent me home. My parents came to stay with me for a few days, and I really needed their help. First, I had to remain face down for 48 hours. I was only allowed to roll over long enough to have eye drops administered or to have the patch changed. Besides, I had no idea how to administer the four different types of eye drops, four times a day! On Wednesday, I finally got up enough nerve to look in the mirror and was surprised to find that it wasn't horrible, just a little swollen and bloodshot. By Thursday, I finally mastered eye drops so I released Mom and Dad to return to their own lives. I still had frequent twinges of pain and headaches but Tylenol provided enough relief. My gas bubble bounced and rolled around and compounded the vision difficulties, but it would only last a short time. It grew smaller by the day. One day it split into two, and then into many, and finally, after about 10 days, it disappeared altogether. Now I was looking through a rather coarse and dark veil of lace, but I could almost see through it. The eye was a little weepy after the surgery, and the dressing needed to be changed frequently. I wore a patch for about a week, but when I developed an allergic reaction to the adhesive tape, Dr. M said I didn’t really need it anymore, and I was glad to be rid of it. Dr. M had recommended that I take a month’s leave from work to recover from the surgery, and it was indeed a month before I was able to return to work on a full-time basis. I tried to work half days, but found that within a few hours, I’d develop a whopping headache, and a new symptom began to manifest itself - nasty flashing lights - if I became tired or stressed. December 19th checkup - the eye is healing nicely, but still no big E.
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January, 1999 - Progress Report
	The post-operative discomfort was gone by Christmas, but the gray spot remains - less solid, with the lower half more like a gray smudge than a blotch. Using both eyes, I see life through a slight blur. Other symptoms are distortion of line, flashing lights, slight double vision (a result of each eye seeing something slightly different), and now I have an annoying little floater. But it’s healing, and all will soon be well.
I can drive with confidence. Reading is made easier using magnifiers bought at the neighborhood drugstore. The pair that work best for me don’t have much magnification, but the difference is profound. My company has kindly provided me with an extra large monitor. Even so, proofreading my work is not working very well - those typos used to practically pop off the page, now they literally disappear. January 19th check up - a remarkable improvement! I finally saw the Big E! Not only that, the images of the other lines on the chart are almost penetrating the smudge, but I can't quite read them yet. Dr. M tells me to keep my fingers crossed. And, although my left eye is still vulnerable to recurrence, he feels the likelihood of my losing the vision in my right eye is remote. He recommends that my diet include spinach, kale, egg yolks, zucchini, kiwi fruit, red grapes, apricots and carrots 2 to 3 times per week. I’m to take Lutein pills 2 times per week, and Ocuvites on alternating days.
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My Mission
During the Christmas break, with two weeks to go before my January checkup, I was anxious for information about MD in general, and my surgery in particular, so I waded back into internet.
	This time, I surfed into a marvelous resource enthusiastically providing the most current, comprehensive, clear and positive information and advice, but also warmth, fellowship, and hope. During my first month with the MD People support group, I watched with interest as several others joined the group, and I became aware of another unifying factor, aside from our shared affliction: We were all searching because we were in the dark, even in this, "The Information Age"!
While our doctors should have armed us - at the time of diagnosis - with information about the many support systems and resources that are available to us, the truth is that they’re just too busy. So let’s help them. Let’s show them we’re organized and available to assist their new patients so that they don’t have to suffer as we did.
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The Future
Whatever the outcome of my surgery with the passage of time, I will be forever grateful to Dr. M and the VGH Eye Care Centre for restoring my vision - yes, restoring my vision - I was blind, but now I see! Okay, so my vision is still a little smudged, but it’s early days, yet. Besides, this is a matter of degrees, and I’m watching continued improvement.

A Message to Other Submacular Surgery Candidates
Don’t even hesitate! I wish you the very best of luck, too. Linda1958 Vancouver, BC February 6, 1999

To read the December 23, 1999 update on my vision, click here.
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