Monday, June 30, 2014

Vision is a Precious Thing

“Hey Dave, would you mind if Ben looks at your corneas?”

“No. Of course not.” I saw Ben as I was coming into the Ortiz Eye clinic. He was going around to the back, texting as he walked, while I was coming in the front. Ben’s tall. He’s a basketball player who just finished his freshman year in college. Ben is Tim Ortiz’s son. Tim is my eye doctor.

“I’ll be right back,” Tim said.

Lots of people have looked at my corneas. While I was studying for finals my junior year at ISU, pulling all nighters, it became hard to read. I had to cock my head to make the letters clear up. It was frustrating. That was 1972. I’d been wearing hard contacts since 1968. My high school coach thought contact lenses would improve my peripheral vision. I was a pitcher. When I went to the stretch and looked at first, I couldn’t see what the runner was doing out of the corner of my eye. They’d steal on me. I’d worn glasses since third grade and my eyes were fairly bad. Coach thought the contacts would move with my eye and I would see more clearly. He was right. It helped me on the basketball court too.

Tim came back to the exam room with his son. Ben is taller than his Dad. He adjusted the stool in front of the slit lamp. I put my chin in the little tissue covered cup and my forehead against the bar. His face got close to mine. A bar of light moved slowly in front of my eyes.

“See the button?” Tim said.

“Yeah,” Ben said.

“That’s the grafted cornea. Dad referred him to Dr. Noth. When did Dr. Noth replace your corneas Dave?”

“1990 for the first one, 91 for the second.”

“Wow that was 24 years ago,” Ben said.

“Yeah, and look how clear they are Ben. Tissue donation. Accident victims usually, and they only take younger corneas.”

“Yep, I said. “I may be 63 but my corneas are still in their forties.”

When I went to my eye doctor at Gailey Eye clinic in Bloomington after finals were over he was immediately concerned. He needed an auxiliary lens on the machine that measured the curve of my eye.

“I’m not sure what’s going on with your eyes Mr. McClure but I want you to go home and leave those contacts out for a full week, and then I want to re-examine you.”

“A week? I can’t do that. My glasses stopped working a long time ago. They’re useless. Way too blurry. I wear my contacts all the time. I have to work and stuff.” I worked at Bloomington’s newspaper, the Daily Pantagraph.

“Tell your employer you have a medical emergency. If needed I’ll contact them. It’s very important you leave those lenses off your eyes so we can see them in their normal state. It must happen that way. This is a serious matter and nothing to fool around with. Do you understand?

“So he had them replaced why?” Ben said.

“Kerataconus.” Tim and I said it at the same time.

“I’m not sure what that is,” Ben said.

“You explain it Tim.” Ben wants to be an eye doctor. He’s helping Chris Ortiz, his cousin, an optician in the dispensary; fitting, adjusting, fixing glasses and generally learning about lenses for the summer. He has to do really well in the sciences as an undergrad. With hard work, he’ll make it to Optometry School like his Dad, his Grandpa, and his Great Grandpa, and come out an eye doctor. For now, Ben’s just learning.

“The cornea begins to change shape. No one is sure why. In Dave’s case it could have been complicated by those old hard contacts. Anyway, the cornea becomes cone shaped and irregular. It warps. As it stretches it scars. A kerataconus patient can have distorted vision, poor night vision, blurred vision, all of that. How am I doing Dave?”

“Fine,” I said. “And for years after my corneas were replaced I wore glasses with a very simple prescription. But over time my eyes affected the shape of these new corneas. So I’m back to severe astigmatism. But clear corneas. No scars. If your Dad does his job right, I see just fine. They change often, my eyes do, and my prescriptions, but they continue to be correctable. I pass my driving test. That’s what counts most.”

“We’ve got him now in a SynergEyes contact lens,” Tim said, “but he’s no longer getting the wearing time he needs. We’re fitting him with a new Bausch and Lomb lens just out that’s a specially made soft contact for kerataconus patients. He’s one of our first fits.”

When I first heard the word, when Gailey Eye clinic diagnosed me with kerataconus in 1972, I was terrified. I assumed I would go blind. It’s easy to be fatalistic when you’re young. It’s easy when you’re old as well. They had another doctor confirm it. That doctor asked if his intern could look at my eyes. That has just continued. They dismissed the intern and both doctors took me into an office and talked to me for long time. I was twenty.

“We’ll refit you with contacts that should be more comfortable and improve your vision. They won’t be particularly comfortable, although you don’t seem to be especially sensitive to eye pain. They’ll have a center touch that will hold your contact back, sort of force it to a manageable curve. You’ll have to see us, or another eye care professional, at least annually and immediately if you have a problem or think your eyes are changing. You’ll have to be careful about keeping them clean, about limiting your wearing time, and especially vigilant about abrasions. You’ve had abrasions I assume.”

“Yeah.” They were hellish. Light killed me. I stayed in a dark room for days.

“So what happens when you can’t correct my vision with special contacts anymore?”

“Well, there are cornea transplants. But the procedure is not where we want it to be. Patients recover by lying flat with their head between sand bags for extended periods of time. There are good results but not as often as we believe they should be. Let me just tell you this. The longer you can wait before you get transplants, the better that procedure will be. They’re doing amazing things. But they need time to perfect the procedure and put it into practice.”

That was good advice.

“Weren’t they different procedures Dave? Tim asked. “One eye from the other? I think I remember my Dad saying that.”

“Yeah. In 1990 on the first eye Dr. Noth did something like sixteen separate loops each with a knot. In 1991 he did a running stitch, like a spiral notebook, with one knot.” In 1990 I was in the hospital overnight. In 91 it was outpatient. I made the kids breakfast and when they came home I was in the recliner with a patch on my eye.

“How did it go Dad?” Dean said.


“Great.” He turned on The Simpsons and settled in front of the TV with a box of Cheerios. His sister joined him.

“Does it hurt?” she asked.

“Not much.”

“That’s good.”

In 1988 I was on an eye care mission in Mexico with Phil and Tony Ortiz. Tony is also my brother in law. Tony, Phil’s brother and a former optician at Ortiz Eye Clinic, was my roommate. We were getting ready to go to clinic the first morning and he saw me feeling the dresser top with my hands.

“What are you doing?”

“Trying to find my contact case.”

“Jesus Christ. Can’t you see it?”

“Not without my contacts.”

“You better see Phil.”

I saw Phil when I got back and he spent a long time with me.

“What do you think?”

“Well, you’re case is pretty advanced. Your contact fit is not bad but I think we can do a lot better. They’ve developed gas permeable lenses that are going to allow more oxygen to those poor corneas of yours and probably give you more comfort and maybe more wearing time.”

“What about glasses? I wouldn’t care so much about the contacts if I could have glasses that I could see with. Just see fairly OK around the house you know? Even if I couldn’t drive with them.”

“That’s just not going to happen. We’ll do the best we can do, but you have to understand some things. The reason the contact works is that it holds your cornea back in a more normal shape and that improves your vision. But when you don’t have contacts in your eye the cone comes back, distortion occurs, and glasses can’t accommodate that. But I think you’ll soon be a candidate for cornea replacement. And when that happens we’ll refer you to someone good. The transplant procedure has gotten a lot better. I think you’ll be fine.”

Within a year I renewed my driver’s license, or tried to, and flunked the eye test. That is not a hard test. I flunked it in a pretty big way. When you do that they require you see your eye doctor for a more complete examination, and he or she can determine if you see well enough to drive.

“OK,” Phil said. “I’m going to sign this form allowing you to drive, and you can drive after we give you new contacts. But you have to promise me you will make an appointment with Dr. Noth. Good young ophthalmological surgeon in the suburbs. He’s doing these surgeries all the time and having great results.”

In 1990 Dr. Noth was getting corneas regularly from an eye bank in Michigan. His office staff gave me a beeper. When the cornea became available I had to respond to the beeper and accept it within two hours. If I turned it down, couldn’t have the surgery for some reason, it went to another of his patients. I was on the list. The beeper went off in about three weeks. Eighteen hours later I had a new cornea. In 1991 he got two corneas every Wednesday. They just looked in the book and scheduled me for an upcoming Wednesday. Outpatient. Slick.

“What made these operations so much easier?” Ben asked. He stayed behind the slit lamp a long time looking at my eye.

“Amazingly thin suturing thread,” Tim said. “And great magnifying instruments. It’s all about the tools.”

I thought I was cured after the transplants. However my eyes have required lots of prescription changes. I’ve gone through countless corrective lenses. Phil retired. Tim became my doctor. At one time or another I came to Tim with various complaints.

“Look, Tim, I talk to groups of people. If the light’s not good, or sometimes when it is, I can’t see the expressions on their faces. I cannot talk to people if I can’t see what they think of what I say by the look on their face. It’s impossible. I don’t know whether to change what I’m saying or not. It’s like speaking blind.”

“My wife and I took my daughter to the airport, there’s a big banner hung across the corridor, and I can see the right side of the banner fine and the left side is blurred out. So I close my left eye and scan it with my right, moving my head like I’m watching ping pong. It’s a pain in the ass.”

“It’s getting harder to read. When I read at night, with a lamp beside the bed, it makes my eyes really tired. And sometimes the letters on the page just fly apart. The words on the left side jump up above the words and letters on the right. That’s never happened before. It’s driving me crazy.” Tim listened closely every time. His response to my last concern went something like this.

“So here’s what’s happening Dave. Your eyes are changing in different ways. One eye is now very different from the other. That thing you’re describing when the letters on the page suddenly go out of focus? That’s your brain being unable to compensate any longer for the different images it gets from your two eyes. I’ve been surprised for some time that you’ve been able to accommodate the difference I find in your eyes. What you’re telling me is evidence that we’ve got to do something else. You may have to go back to contacts.”

Not long after that Tim and his staff fit me with the lenses I’m wearing now, a hybrid lens with a gas permeable center and a soft contact skirt which improved my vision dramatically. With them I see better than I’ve seen since 1992. And we hope for a similar result, with more comfort, from this next generation of soft lenses. The technology is amazing. It’s what keeps me going, driving, living a normal life, seeing the letters as they pop up on this computer screen right now.

But it’s not just the technology. It’s having eye doctors who understand eye disease. It’s going to a stable clinic that knows me and my history, keeps well trained staff, stays current with the best new products available, and takes the time to make sure I get what I need and understand how to use it. It’s like being taken care of by family. I feel blessed. When I realized by being part of I Care international’s Central American eye clinics for twenty five years how rare such eye care is in the world, for so many people, I feel humble. We take so much for granted. Vision is a precious thing.

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