I blame Ohio

Well, I've spent an interesting week visiting many doctors.

A couple of months ago, I noticed a blurry spot in my left eye, like this:

After spending a couple of weeks trying to clean my glasses or get rid of a nonexistent eyelash, I went to my optometrist and explained what I was experiencing.

About 20 years ago, when I first saw him, he told me that I had scar tissue on my retina called histo spots that were caused by a histoplasmosis infection during childhood.



Dark places are histo spots



Histoplasmosis is a caused by a fungus that thrives in river valleys and is carried by birds and bats (I knew there was a reason for my animosity). He has tracked my scars, which are around the edge of my retina) for 20 years and noted no change and no significant damage to vision. He did not find any change this time either.

Last week, since the spot was still there despite my best efforts to deny it (maybe it's a floater? maybe a reaction to light changes?), I saw my primary care physyician who referred me to an opthamologist. She thought it was probably a pinpoint tear in the retina since I still "saw" it when my eyes were closed.

I saw the opthamologist on Thursday and, after triple dilating my eyes, he immediately sent me to a retina specialist. Although he didn't tell me what he thought was going on, preferring to let the retina specialist diagnose me, I heard the nurses calling to make the referral for "choroidretinis." They had to spell it several times since neither was familiar with the term. My appointment was for 9:00 a.m. the following morning, just enough time to go freak out and search the internet.




isn't he cute?



The retina specialist, Dr. Tushar Ranchod, was gorgeous!  Young enough to be my son, unfortunately. He is very intelligent and on the cutting edge of diagnosis and treatment. He has a very gentle manner, concerned but not too serious, and a melodious voice, well-designed for delivering bad news.



Retinal angiography



They dilated me and put dye in my veins (did you know it only takes about 15 seconds for the dye to make it from your arm to your eye?)Then they took many pictures of my eye (bright light!) and my urine was flourescent yellow for the rest of the day (TMI?).

I got to see all the photos onscreen. My eye looked like a lightning storm on Mars. A little scary until the doctor told me that I was looking at my normal eye and the "lightning" was the optic nerve.



OCT scan of normal retina thickness



From the "side," the OCT view of the retina is so pretty and colorful. The doctor uses one as a screen saver.

The guilty lesion looks like a volcano ready to erupt.



OCT scan of histo lesion



So. . . the diagnosis is that the histoplasmosis seems to have reactivated after more than 30 years. The new lesion is not on the periphery like the others, but closer to the macula which is responsible for centralized, high-resolution vision.

I get to see Dr. Ranchod every week for a while as they track the disease's progress. It may just stop on its own like it did before and I won't lose any more eyesight.



If it continues to grow, there is no effective treatment or cure. Steroids can reduce the inflammation but encourage the proliferation of the underlying fungus. Laser and other options kill the bad cells and those around them, resulting in a greater (but hopefully limited) loss of vision. If it continues to grow and threaten my macula, Dr. Ranchod may try some experiemental treatments to preserve some vision.

The good news (and I could use some) is that it is only in my left eye. Unfortunately, that's my stronger eye that I use predominantly. But I am not going to miss depth perception since I never had any. The histo is in my blood and it is always possible for it to reactivate in my right eye as well. In that case, I'll be looking for a new career. Any ideas?