Advances in stem cell therapy for retinas

My hopes are beginning to come true! There is already progress being made in healing retinal damage using stem cells. I heard this story yesterday on NPR’s All Things Considered: “Study Finds Human Stem Cells May Help To Treat Patients.” The story is everywhere. Here are links to a New York Times article, “Study Backs Use of Stem Cells in Retinas,” and one on WebMD, “Stem Cell Therapy Shows Long-Term Effectiveness.” Hurray! I know possible help for me is still years down the road, but I am still celebrating this news.

Two years later

September 21, 2014, marked two years of recovery from my accident. Looking back at my last major update, about a year ago, I see that, although the healing process continues, not a lot is changing on the surface. My appearance has improved a little more since my February surgery. The left eye now looks normal enough for people to feel comfortable asking why it’s so red—which the rim of the lower lid always is, to varying degrees. I don’t know if that will ever quite go away. My eye is still easily irritated, which can increase the redness. And it still waters a lot, as the cornea continues to dry out and overproduce tears. The eye still hurts at random moments, especially later in the day, sometimes sharply, sometimes deeply. The nerves in my cheek have almost fully regenerated. My eye crinkles almost normally when I smile.

The central vision in my left eye is still gone, though I hold out hope for future medical developments that may reverse the damage (come on, stem cells!). In the meantime, I use my peripheral vision as much as I can to keep my optic nerve active: I sometimes walk around with my right eye shut just for the practice. I still forget sometimes why I can’t see clearly, especially when I first wake up. I have recently been experiencing a fresh bout of grief about the impairment of my sight. I still often bump into things on my left and lose my balance easily. I continue to have trouble concentrating and thinking clearly. I am still trying to figure out how to see as well as I can while I work; my vision varies a lot, and magnifiers and lights only help so far.

I have not entirely recovered my turning skills. I got tendonitis in my right elbow (my dominant arm) in the spring and wasn’t able to work for several months. Add this to the many gaps in work caused by my surgeries and I guess my rustiness is understandable, if frustrating. It has been hard this time to get back into a creative flow, but I am working to hold a steady course through the latest challenges by remembering every day what I haven’t lost (family and friends, my sense of humor, my curiosity, a damn good life) and what I’ve gained (more love, gratitude, a greater sense of connectedness to everything).

My tale of survival

AW29-3-27

The June issue of American Woodturner featured “Safety Matters: From the Eye of a Survivor,” an article I wrote describing my accident and discussing some of what I learned afterward about protecting myself. Please feel free to share it with any woodturners you know; I am hoping that it will save others from injury. It was accompanied by this exercise for determining your own risk at the lathe, along with a table comparing risk values.

The saga continues

It is looking like another surgery will be in order. My lower eyelid, which was reconstructed with cartilage and skin from my ear, is not doing what it is supposed to. It is pulling away from my eye instead of hugging it. As a result, the inner lid, the tender tissue that should rest against my eye, is being exposed and, because of the exposure, is becoming like skin. The pulling away also means that my eyelids are once again not closing fully; I have to squeeze my eye tight to fully close the lids.

The challenge of surgery will be to tighten the lower lid without interfering with the drainage tube from my eye.

I have been using an ointment for the last few weeks to help remedy the condition. Since the ointment blurs my vision, I have not been wearing my contact, so I am back to being pretty much half blind. I am still turning though. I will find out more in a couple of weeks about the prognosis and the possibilities.

Thirteen months later

Some 13 months after my accident, I am doing well. I look almost normal, if you don’t look too closely. My upper eyelid works and has an epicanthic fold to match my right eye. My lower lid doesn’t move, and the rim is usually quite red, but it does cover the lower part of my eye, and the upper lid meets it when I blink. The nerves in my face have come back a lot and continue to revive, slowly. My left cheek still tends to be somewhat swollen. I either overproduce tears or they do not drain from my eye properly, so I have to wipe my eye frequently.

As for my vision, I’m still largely impaired. My central vision is still gone. My peripheral vision is much sharper, as I now wear a contact lens (in lieu of a lens implant) in combination with glasses. I know that I am seeing something with my left eye, that my brain is incorporating some input from it, because I can now tell when the contact lens is out (I have a problem with it sometimes falling out): I feel more blind without it and less blind with it. I would say that, functionally speaking, the correction may add from 5% to as much as 25% to my overall vision, depending on the level of light. I still run into things a lot on my left side. Without central vision, I am not sensitive to light, but without a functioning iris, I need to protect against overexposing my retina, so I am careful to wear sunglasses outside. (You would think that, living in Arizona, I would already have made that a habit, but I never felt the need before.) I have been able to stop all medication for my eye. There had been concern that I would develop glaucoma, but I seem to be maintaining normal pressure in my eye without medication.

Emotionally, I’m good. I experienced a period of grief this summer, after I realized that the doctors have done about as much as they can for me. Until then, I had been so focused on recovering that I hadn’t stopped to consider what I had lost. I had to stop and retreat for a spell. Having grieved, I am still grateful. I have recovered much better than any of my doctors ever expected, and I learned that I have far more support in my life than I ever realized. I say it again: I am a lucky, lucky woman.

And my creative juices are flowing again. When I first resumed turning back in January, it felt like I had never stopped, but around March I mostly quit turning again, because of pain in my eye. When I resumed again in September, this time I felt like I had lost my skill. I felt clumsy and blind and incompetent. I’m getting back up to speed now. Most important, the ideas and the love of the work are flowing again; for a while, I was so focused on feeling ineffective that I let the flow nearly stop. I knew the flow was back when I started dreaming about making art again.

Yamaguchi_Lynne_600

A not-so-slick oil change

Yesterday’s surgery to remove the silicone oil from my eye was . . . interesting. The plan was to combine a nerve block with MAC anesthesia, so I would be awake but not care—while not experiencing any pain. Turns out the anesthesiologist couldn’t administer the nerve block because of scar tissue under my eyelid, so they used a numbing eyedrop—but not enough of it, as it turned out. So, though I started out asleep, I woke up midway and I could feel the surgery—the clamping, cutting, and stitching of my eyeball—and it hurt. A lot. When I finally tried to speak up, I was told not to talk—it seems I chose a particularly critical moment in the surgery to open my mouth—so I didn’t. I just observed. After the surgery, my eye continued to hurt. Fortunately, a pain killer finally did its job.

In her defense, Dr. Harris was appalled and apologetic when I told her about this at my post-op appointment this morning. I didn’t move or moan or twitch even, so she had no idea what I was experiencing.

The outcome appears to be good. The pain was actually preferable to my previous reactions to general anesthesia. The salt-balanced fluid that is now in my eye will be replaced by my eye with its own fluid over the next few days. There is also a gas bubble in my eye, which will gradually be absorbed. Freakishly, it is visible floating in my wide-open pupil: for a few days, one will be able to tell if I am level just by checking my eye! I don’t know yet how my vision will be. The fluid is murky from the surgery, while the bubble is bright. I just have to wait for it all to clear.

My eye is bloodshot, and there is bruising and swelling around it. I feel like I have a black eye. I don’t have to maintain any particular position, so I can sleep normally. I cannot work or exert myself for a week.

In two and a half weeks, I will get a prescription for new glasses.

Fingers crossed. Prayers welcome.

Complicated

“Complicated.” That’s the word Dr. Levine used again and again to describe the condition of my eye at our last appointment. After we thoroughly discussed my condition, the options, and the potential complications, he recommended, and I agree, that I wait on getting a lens implant. Yes, it is generally true that one needs a lens to see, but he thinks that the current shape of my eye will leave me very nearsighted but not exceedingly so, even without a lens. Between the accident and the buckle put on my eye to retain the retina, my cornea is now severely astigmatic (misshapen, not spherical) in a way that counters the elongation of my eyeball, potentially leaving me with vision that will be able to be corrected with glasses. Complicating the situation, my damaged iris may mean that I will need to wear a contact lens (tinted or printed with an opaque iris) to shield my pupil from too much light. Ideally, such a contact would also be a corrective lens, but my astigmatism may be too severe for correction with a contact lens, in which case I would have to wear glasses with the contact. In addition, my damaged eyelids may make wearing a contact lens difficult. So another consideration in waiting on a lens implant is that having one now might prevent me from getting a prosthetic iris implant in the future, if I cannot wear a contact lens or it does not prove sufficient. Once the silicone oil is replaced with saline (which Dr. Harris will do on Tuesday, March 19), we will be able to evaluate my vision and my light sensitivity without guessing.

And at the end of April, I will see Dr. Polonski to schedule further surgery for my eyelids.

At the end of my appointment, in order to avoid any more surprises like I had with my iris, I asked Dr. Levine if there was any other damage I didn’t know about. Here is a summary of the damage to my eye: My conjunctiva is scarred. My cornea is dry and severely astigmatic. My lens and capsule are gone, surgically removed. My sclera has a thin spot. My iris is ruptured, leaving my pupil wide open. The structures that maintain the balance of fluid in my eye (which are part of the iris) are damaged. My retina, especially the macula, is very scarred but no longer detached.

Yes, it is a miracle I can see. Hurray for miracles!

Thrown for a loop

I was caught completely by surprise yesterday when I learned that my pupil is permanently blown. All this time, I have been so focused on the damage to my eyelids and my detached retina that I never really looked at my eye itself in good light. Apparently, the blunt trauma from my mesquite missile also ruptured my iris, leaving barely any iris visible at the perimeter and no functioning muscle. This means that my pupil has no way of constricting, so it will always let in too much light.

None of my doctors has ever mentioned this aspect of my injury to me. Dr. Harris didn’t even know; at every visit, one of her techs has dilated my eye before she saw me. She saw me on Friday without dilation to assess the possible options for attaching my lens during my upcoming surgery (one option might have been suturing it to my iris) and realized that I never needed dilation: my pupil is wide open. Dr. Levine apparently knew of this condition, because he wasn’t surprised when I called him with the information, but he has never talked about it with me; I guess it was low on the list of damage to be dealt with. I have no idea whether Dr. Polonski knows; I think his assistant dilates me too, but I may be mistaken. (Karen had noticed my huge pupil when she was putting drops in but didn’t realize the significance and never mentioned it.) I will see Dr. Levine at the end of the week to discuss my iris and any implications for the surgery. Online research indicates that the only surgical options for actual repair of the iris (prosthetic iris implants) are still experimental. I am guessing that I will end up wearing a contact lens with an iris printed on it and a fixed clear pupil to limit the amount of light that can enter.

Up to now, my open pupil has not been a problem for two reasons: first, because my eyelid opens so little, the pupil is mostly covered; second, the silicone oil dims the light that does enter. I do notice some glare in that eye when I am sitting next to a lamp. Once the oil is removed, that will likely be exacerbated, and when I am outside, I will have to start wearing sunglasses regularly.

I am still adjusting to the information. The surprise of it so long after my accident has temporarily thrown me for a loop, but knowledge is power, and the more I learn about the condition (apparently known as traumatic mydriasis) and my options, the easier it is to accept it and proceed.

My next surgery

I postponed my next surgery so that I will be able to make work for and participate in the Tucson Museum of Art’s Spring Artisans’ Market, March 15–17. My surgery will follow on Tuesday, March 19, when the silicone oil in my eye will be replaced and a new lens will be installed. In preparation for that, I will have another laser procedure tomorrow, Tuesday, February 19, just to make sure that my retina is fully tacked down (this is the procedure I mentioned in my last post, postponed along with the surgery).

The March 19 surgery should be the last on my eye itself. Surgery on my eyelids will likely happen in May or even June. After a day like today, when, inexplicably, I could barely keep my eye open wide enough to let in light, I will be glad for that too. I don’t understand how or why my ability to open my eye can vary so much from day to day, but it does. A day like today is scary, but I trust that tomorrow (or the next day or the next) will be better.

In the meantime, I have just started the last piece in the series of commissioned work that has occupied me for so long. By the end of the month, I will be free to make whatever pleases me. Hurray for play!