How my sight was saved
Seventy-nine year-old Denise Mann (not her real name) is often the designated night driver among her friends.:“ I see very well. I had very good eyesight,” she boasted, “and I can still read without glasses. I see at night and drive my friends. I play golf and bridge and can read the score cards without glasses. My friends say they cannot see them so I read their score cards for them.”
Yet were it not for a recent medical discovery, Mrs. Mann quite likely would have lost her sight almost completely. She has macular degeneration - an erosion of sorts of a delicate portion of the inner eye responsible for sensing light. It is the light receptors in the eyes that enable us to see.
Agreeing to a treatment that had not been approved by the US Food & Drug Administration Mrs. Mann flew to the Lahey Clinic in Massachusetts last year for her first shot.
Macular degeneration most commonly affects the elderly.
In the US about 10 percent of those 66 to 74 years of age and thirty percent of seniors 75 to 85, develop the condition. It can be gradual and often those affected do not detect it for some time.
Mrs. Mann said she knew she was at risk because her father suffered with the disease. “He was left with only his peripheral vision - you don’t go totally blind,” she said. “He could see, but he had to use strong magnification and a lot of light.”
Mrs. Mann said her parents ran a small hotel in England where her mother did the cooking and her father did the bills.
“Doing the billing was frustrating for him because of the lack of vision,” she said.
Not strictly a hereditary condition, studies show that people who have something called drusen in their eyes are more likely to develop macular degeneration.
A yellow fatty deposit, drusen presents an increased risk for macular degeneration when the deposits are large or plentiful.
Mrs. Mann knew she fell in this category and said her local ophthalmologist, Dr. Leonard Teye-Botchway, had given her a special grid to periodically check her vision at home. She was to stare in the middle of the grid and notice if there were any areas she could not see or if the lines began to wiggle.
Having this grid at home helped save her sight.
Discovering she was losing her sight
“Last year during the week leading to Cup Match things didn’t look as sharp as they normally did,” she said.
“I thought I had an eye infection and I got some antibiotic drops to try and clear it up.”
When her vision didn’t improve right away Mrs. Mann said she felt it was because the antibiotics simply needed a bit of time to work.
“Then on one of the Cup Match days I was in the kitchen and noticed the chart Dr. Botchway had given me to test my eye,” she said.
“I thought ‘I haven’t done that in a while’ so I did it and that’s when I noticed a brown circle in the middle of the vision in my left eye. It was about an inch in diameter. I went straight to the Emergency Department.”
Her ophthalmologist was away at the time. The attending doctor told her she had some bleeding at the back of her eye and to wait about a month and her body would absorb it. The news was unsettling for the senior and she fell into a serious depression.
“I was going on holiday in September so there was some urgency from my point of view in having it looked after,” she explained. “ Because I didn’t even have an appointment as I began to wait I got very concerned and went into a deep depression. I had to go to my GP because I wasn’t eating because I was so depressed.”
The mother of a doctor in England Mrs. Mann called her MD son and explained her upset.
“He called Dr. Botchway right away and an appointment was made,” she said. “ I saw Dr. Botchway on Thursday August 24 and he said: ‘I’m sending you to Boston for treatment.’ I left the following Wednesday. Although blood was still in my eye when I went, it didn’t matter. “
The treatment was short consisting only of a shot to each of her eyes. Three days later Mrs. Mann was back in Bermuda, giving her more than a week to prepare for her September 12 overseas holiday.
- Wed 30th arrived at the clinic
- Thurs Sept 1 injection
- Fri Sept 2 observation
- Sat Sept 3 back in Bermuda
- Holiday Sept 12
Mrs. Mann is immensely grateful that she is able to take advantage of the recent medical discovery that Bevacizumab, a drug designed to combat colon cancer, has an application in treating macular degeneration.
Wet macular degeneration - the type that Mrs. Mann has, is characterised by an overgrowth of blood vessels on the lining of the inner eye - the macula.
The drug works by cutting off the blood supply. This prevents the overgrowth.
A drawback is that a shot of the drug does not fix the problem for good.
Mrs. Mann says for the rest of her life she’ll have to have the shots every six to eight weeks.
The visit
On her first visit to the Lahey Clinic’s Peabody branch in Peabody Massachusetts, Mrs. Mann stayed an extra day for observation.
She’s had about three treatments since then and usually goes up one day and comes back the next.
The actual visit takes just under two hours.
Mrs. Mann said doctors and technicians give her a full check-up each time she goes. She has to read the Snellin Chart with each eye (commonly called the Big E and used to determine if you vision is 20/20, 20/40 etc.) and is tested for glaucoma.
“They also use an instrument where they can see directly into the eye,” she said.
“ The technician has shown me the screen and I have seen that there is a bulge at the back of my eye. All the blood that was there has been absorbed but some fluid remains and appears as the bulge.”
Operation
“Drops are administered to dilate my pupils,” she said.
Next they deaden the area with an injection (in much the same way Novocain is used by the dentist before drilling a tooth). A small spring is placed between her eyelids to keep them propped open. A needle with the drug is injected into the white of her eye.
“They tell me to look away to the right,” she said. “I do it but I can still see the needle coming. Sometimes I feel it. But I try not to think about it.”
After the injection Mrs. Mann said vision in her eye is blurred. “I cannot see too well because they’ve dilated my pupils. I like to go to the mall. When they do just one eye then I can go because I can see,’ she said.
“I feel a bit dizzy and things are blurred. But if I close the left eye, I can see very fine. If they do both it is more difficult - things are blurred.”
Understanding how debilitating her life would be without the shots, Mrs. Mann believes she lucky not to have developed the condition earlier.
“If I had this before this drug was available,” she said, “ I think it might have come too late for me.
“I think the blood vessels would have multiplied to the point where I would have lost too much of my vision. I consider myself lucky.”
