December 23, 1999

Dear Pam -

You’ve asked about the vision improvement I’ve seen with submacular surgery. Well, here it is - all of it! Are you ready for a very long read?

The first thing I’ll say is that if I ever needed to, I’d do this surgery again without a moment’s hesitation. But, to be totally frank, all is not as perfect as I’d hoped. All is much better, though. The key is that there has been improvement, which is "hopeful", and that for me is paramount.

A detailed description:

Pre-surgery, my left eye was precisely as your right eye image in Dan’s "Through Our Eyes" page.

Post-surgery, there is some remaining scarring. The result is a ring scotoma sketching the periphery of the macula and another scotoma about 1/6 the area of the macula at nearly the centre. Imagine a clock sliced into pie-shapes with the wedge from 11:00 to 1:00 blanked out.

There is some distortion such that vertical blinds appear to be braided in some places. As a result of that distortion, I have slightly "doubled" vision, with one image apparently sliding out of the other, so of course I have no depth perception.

Anything smaller than size12 font is useless, so medicine bottles, television guides and telephone books are impossible without my trusty magnifiers, but with those - and a good halogen light - I can manage quite small print.

Speaking of light, office flourescent lights are awful. Night driving is not a good idea, and romantic restaurants and candlelight really cause a problem, but (tee-hee!) I’ll just have to ignore that one...

The ocular migraine symptoms are nearly constant, but usually dim unless I’m fatigued or stressed; the interesting thing about that is because they’re there in the first place, I’ll often get a very interesting vibrating effect. Also, with the discussion about flashes of light indicating changes in the retina, I’m intrigued that my "tracer" follows the path around the ring scotoma, and my "lightning bolt" flickers in the area at the centre. I like to think that they’re indicating that my retina is working to heal these two scars, and that there is hope for continued improvement.

The last time I visited the specialist, he noted that I was reading one more line than the previous visit, but he didn’t give me the numbers. I could read 4 or 5 lines, where pre-surgery I couldn’t see the chart, and two weeks after the surgery I could read 3 lines.

So yes, big IMPROVEMENT indeed. I still feel obscenely lucky and extremely grateful, but in actuality, this is not perfection. I’m always very clear about this when I’m describing my experience to people who are considering submacular surgery, and I tend to paint myself as one of Dr. M’s failures - in fact, judging by his reactions during my exams, he seems to feel that way himself. I’d be very intrigued to know how much improvement some of our people are seeing after going through the Visudyne therapy and Proton therapy.

By the way, I do remember having a black rice grain (mine was more like a tiny kidney bean!) with the very bright green fluorescent aura that you described a week or so ago. I saw it when my MD was first diagnosed, while I was being examined with that horrifically bright light through the prism. Do you still see it? Is yours changing? Has your left eye stabilized or are you having more laser? and are the doctors hopeful that after the laser show, the existing fluid is being re-absorbed? Hah! When you’re up to it, you’ll have to sit down and write a tome describing your vision improvements to me! (Tit for tat, right?)

Okay, have you read enough? You should probably go rest your eyes, now.

Take it very easy, Pam. I wish you and all your loved ones a Very Happy Christmas and an Absolutely Fabulous New Year.

All my very best,