My daughter was scheduled for eye surgery today. Before taking her in, my husband talked to Dr. Trese who told him his plan was for one of three things which would be based on the pressure in her right eye. Initially her right eye had been at zero pressure (very bad). Over time came back to eight or nine (somewhat low, but okay). For today, if her pressure was normal (or over thirteen), he would remove both the PFO and the Silicon Oil which has been in her eye since December. If the pressure was almost normal he might only remove the heavy substance (PFO), but if it was low, he was going to leave things as is.
Note that the title of this post isn’t “Eye Surgery” but instead is, “EUA” for “Evaluation Under Anesthesia”. That’s because when Dr. Trese got into the procedure he found her eye at a stable eight so he left it as is and didn’t do any surgery. What does this mean? It doesn’t mean anything bad as far as the substances in her eye as he’s had patients with Silicon Oil in an eye for decades without an issue. So, on the substances front, we wait again for their removal.
Her eye pressure isn’t increasing, which doesn’t mean it won’t eventually, but it does mean her ciliary bodies aren’t functioning normally—something we knew. The ciliary bodies produce fluid in the eyes. Glaucoma is typically when fluid is being produced but isn’t draining properly so fluid increases and pressure goes up. In my daughter’s case, he suspects that the initial insult to her eyes was damage to these ciliary bodies and that started a cascade of events in her eyes, leading to her current state.
How does the rest of her right eye look though? The retina is attached, the optic nerve looks good, the eye itself hasn’t changed anatomically in any way for the worse. But there is the problem of her not being able to see in the eye though. So, what’s the situation there?
That’s a tough one. Her retina being attached doesn’t help if there aren’t visual signals being sent from the rods and cones to her optic nerve to her brain. The regeneration of the rods and cones (if it was happening, another unknown) should have taken place over the course of the first four months. But it’s how long will it take for those rods and cones to start fire that’s the unknown. Dr. Trese said we may be early on, citing one case that took years. The key word there is “may” be early on. We may have an eye so damaged that fantastic anatomy or not, just isn’t going to ever see more than general light some basic large motions. But that’s a story that’s not finished yet, so we’re waiting on that front too.
Let’s get to the left eye though, which has marginally good news and some likely bad, although not catastrophic news. For the good news, yet again, it looks a little bit better. The pressure in the left eye is fully normal and has been for some time. The retinal folds are still there but may be slightly less. Without overt action to flatten them though, they will probably remain as is.
The bad news is she’s developing a cataract in her left eye. The lens is partially clouded already and Dr. Trese wants us to work with our pediatric ophthalmologist on addressing the cataract. We have an appointment in two weeks to talk about plan.
What does the cataract mean? It means her natural lens is clouding. It happens commonly as we age and many, many people have cataract surgery each year. The surgery would remove her natural lens, leaving her field of vision clear. The only problem (and this is my problem, not something the doctor’s have said) is we can’t replace her lenses with artificial lenses because her eyes are congenitally too small and probably won’t become large enough as she grows older as eyes grow very minimally after birth.
Why are lenses important? Because glasses or contacts provide a fixed focal length. There are tri-focals and progressive lenses that do more than one focal length, but an artificial lens focuses from near to far effortlessly, and there’s just not a solution that’s quite the same. Again, wanting artificial lenses is my thing, which may be faulty because I’m not an eye doctor of any sort.
There is one thing to consider though about the removal of her natural lens—it’s sphereo-sphakic, meaning like a marble, like a ball. Lenses should be almond-shaped. Think of a flexible almond and how that could be bended by the eye to focus near and far. It’s a lot harder to focus a marble—it just doesn’t bend as much. So perhaps removing her lens could be an overall benefit to her vision. We’ll know more after we see Dr. Grace in two weeks.
And about that left eye’s retina—the one with the folds still in place—what’s the long-term plan there? Dr. Trese isn’t sure yet. There’s a possibility that any action taken to the retina will disrupt the vision she has now or it may leave large blank gaps in her vision. It could also help tremendously, it’s just a huge unknown.
For now we’re going to work on the cataract situation and see Dr. Trese again in three months for another re-assessment and plan update.
The Big Boy Update: I can’t remember if I wrote about this before, but even if I did, this is something my daughter has randomly and unexpectedly said on more than one occasion: “When I grow up, I want to be a tooth fairy.”
The Tiny Girl Chronicles: My son and I are home alone for two days while my husband and daughter are in Detroit to see her retina surgeon. Each time I ask him where he wants to go for lunch or dinner he thinks for a minute and then says, “I think I just want to eat in.” He clearly takes after his father in this respect.
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