Choroidal Neovascularization: A Clinical Account

Most readers will be aware that I suffer from choroidal neovascularization — wet macular degeneration — in my left eye. Like the current U.S. government, the disease is progressive. Which mean that it gets worse over time — also like the U.S. government.

I was first diagnosed with the condition a little more than eight years ago. Last year it flared up again just after the “pandemic” began. The retinal specialist’s office closed down for a couple of weeks. Since we were asked not to visit healthcare facilities unless absolutely necessary, I put off going in for treatment until a month after the new symptoms appeared. That was a mistake, of course: it allowed the new growth of blood vessels to do more damage than it might have if I had had the injection promptly. If I had it to do over again, I’d say, “Screw the CDC — I’m going in.”

I’ve written the following account for my own benefit. When I describe something as distressing as this in a detailed, detached, clinical fashion, I find it helps me cope with the awfulness of it. Putting it into words seems to allow my psyche to contain it better.

This essay has nothing to do with the mission of this blog, and may be safely skipped. However, anyone who is curious about macular degeneration, or who suffers from it himself, may be interested in my descriptions.

The image at the top of this post is a simulation of what I might see in the visual field of my left eye as I begin to ascend the stairs to the Eyrie here at Schloss Bodissey. I’ve exaggerated the effect a little so that you can see it clearly, but this is basically what it looks like at night after my eye has had a bad day. The blob in the center is the scar left by the growth of a “frond” of new blood vessels in the choroid behind the retina. When that happens, fluid leaks from the blood vessels into the macula, damaging it. It can also push the dark pigment from the choroid into the retina, which darkens the field of vision at that location. That happened to me in March of 2013, and it took more than five years for the pigment to migrate to the periphery of my vision and be consumed by macrophages.

The smaller, lighter spot in the center of the oblong blob is the location where the original eruption of blood vessels first appeared, causing a bump that severely distorted my vision just to the right and below the fovea (from my perspective — since the brain inverts the retinal image, the bump was actually above and to the left). Fortunately, the Avastin injections that dried up those new vessels also made the bump shrink, so that I no longer see any topological distortion to speak of.

Because the damage to the macula did not quite overlap the fovea, I didn’t experience severe problems with focusing in that eye. However, last year’s flare-up expanded the trouble zone upwards and to the left. The top left edge of the blob in my simulation is right on the fovea, which means that my left eye now has a great deal of trouble resolving the focus in the central area of the macula.

The past year has also brought new symptoms, ones that I hadn’t seen before. The pattern of larger blood vessels in the eye gradually became visible under certain circumstances. To get a snapshot like the one at the top of this post, I would have to close my eyes for a half-second or so and then open them again. The layout of the vascular network in my left eye then appears briefly before fading out again. The central blob is initially quite bright, then fades after a moment, but never disappears entirely.

That’s on a bad day. On a good day I hardly notice any of that at all.

I also tend to see a wavy, irregular reticulated pattern throughout the visual field in that eye. It may be the interweaving of the smallest blood vessels in the retina, but it’s hard to tell.

The upshot of all this is that the visual acuity in my left eye has been significantly reduced. On a bad day, I can’t really resolve a clear, focused image at the fovea, and the area surrounding it is now also compromised.

Eight years ago, when the bump was causing such agonizing distortion, I contrived a patch for my left eye that could be fitted over the outside of my glasses. I made it from thick brown paper cut from the bottom of a Whole Foods grocery bag. Wearing it while at the screen allowed me to continue working. Late that summer, when the bump had mostly subsided, I was able to take it off.

A few months ago, when my new symptoms were at their worst, I got out that old patch and reattached it to my glasses. It was already in fairly bad shape from having been used for several months in 2013, and it didn’t hold up very well. Last week I used the same pattern to make a new patch from thicker, more rigid dark grey paper cut from a document folder:

I have two pairs of monofocal glasses that I use when working at the computer screen. I keep the patch on one pair, and use that on my bad days. On a good day I can use the other pair.

When the left eye is unable to resolve a focused image in the fovea, it causes significant problems as the brain tries to create a binocular image. My right eye is in good shape, and I can see a clear, sharp 20/20 image with it when I have my glasses on. However, when my left eye is in bad shape, the overall binocular image never comes into full focus — it looks blurry.

Wearing the patch allows me to see a clear, sharp image, but the left eye is blacked out. That causes its own problems, and sometimes gives me a headache. So it’s a tradeoff — I can either get the disjunction between a distorted image on the left and a clear one on the right, or the disjunction between a blackout on the left and a normal image on the right. But there’s going to be a disjunction, no matter what.

That’s on a bad day. Today happens to be a good day. I only wore the patch briefly this morning, before I realized that I could do without it. Right now the image of this screen is fairly sharp and well-resolved.

The retinologist has increased the frequency of my injections to every thirty days, in hopes that it might effect a more lasting improvement. So in six months’ time, if I’m fortunate, I may have better news to report.

Writing all of the above reminded me of a poem by Pattiann Rogers that I first encountered almost exactly forty years ago. I admire the way she interweaves the anatomy and physiology of the eye with the soul’s apprehension of visual beauty:

Seeing the Glory

by Pattiann Rogers

Whatever enters the eye — shade of ash leaf,
Torn web dangling, movement of ice
Over the canyon edge — enters only
As the light of itself.
It travels through the clear jelly
Of the vitreo, turning once like the roll
Of a fish in deep water, causing a shimmer
In that thimbleful of cells waiting,
Then proceeds as a quiver on a dark purple thread
To pass from life into recognition.

The trick is to perceive glory
When its light enters the eye,
To recognize its penetration of the lens
Whether it comes like the sudden crack
Of glass shot or the needle in the center
Of the hailstone, whether it appears like the slow
Parting of fog by steady trees or the flashing
Of piranha at their prey.

How easily it could go unnoticed
Existing unseen as that line initiating
The distinction of all things.
It must be called by name
Whether it dives with triple wings of gold
Before the optic nerve or presses itself
In black fins against the retina
Or rises in its inversion like a fish
Breaking into sky.

Watching on this hillside tonight,
I want to know how to see
And bear witness.

15 thoughts on “Choroidal Neovascularization: A Clinical Account

  1. “The image at the top of this post is a simulation of what I might see in the visual field of my left eye as I begin to ascend the stairs …”

    Hmmm, that doesn’t look so bad. I was expecting a more blindness-like condition.
    Idea: Might you be better off simply to write off your left eye and live one-eyedly? Maybe by wearing a opaque patch on your left eye?

    • I haven’t been able to find a close-fit patch that does the job adequately and fits under my glasses.

      Besides, that still leaves me with the problem of a disjunction between the blackness in the left and the image in the right. I suppose my brain would eventually rewire itself to ignore the left eye entirely, but I don’t know how long that would take.

      • Hi Ned,

        That doesn’t sound good with your eye…..

        Have you ever thought of having a very dark lens fitted to filter out the light?

        My daughter bought herself a special set of glasses to use when working at the computer, since most Lectures from the University are now online.
        I tried them on the other day, and what a difference it made to my eyes while I was watching something on the Computer.
        I ordered myself a pair now by our Optometrist, since I also would need them for reading, and her ones aren’t.

        • The dark lens and the patch would each present a similar problem, which is the disjunction between the darkened left side and the normal right side.

          The disjunction between the two different images, left and right, makers normal mundane operations very difficult. It’s hard to imagine how much distress it causes unless you have had it.

          How I wish I could once again have two ocular images that jibe with one another!

      • A little searching leads to something I read about once long ago:
        https://www.grand-illusions.com/reversing-goggles-c2x21140037

        Relevant passage: “Back in the 1890s the American scientist George Stratton conducted an experiment to see what would happen if he viewed the world through an inverting prism. He found that after 4 days, his brain started to compensate, and he could see the world the right way up again.”
        See also:
        https://en.wikipedia.org/wiki/George_M._Stratton

        This suggests that your brain’s visual reprogramming can be done within a week.

        • Yes, I remember that one from my studies of the neurophysiology of the eye.

          I don’t know if the reprogramming needed to adjust to monocular vision can be accomplished so quickly. Especially when the left eye is still sending some signals to the visual cortex.

          For the time being, I’ll focus my efforts on strategies to get the two eyes to work together again. Binocular vision is preferable, if I can possibly attain it.

  2. Sucks that has happened to you. I wish you the best recovery to the extent possible.

    And just for knowing, I said screw the CDC about a year ago.

  3. Dear Baron,

    This is an outstanding column. I really enjoyed reading it although it saddens me that you have this particular eye trouble. My father-in-law also had it. He loved to read so it was truly sad for him to have this particular problem.

    I wish you the best!

  4. Dear Baron- as a fellow voracious reader, my heart goes out to you. I can think of no greater tragedy that could befall someone like you who loves to read and write.

    I don’t know what else I can do except to pray for you more than usual. Let us hope that Divine Providence inspires your doctors with the wisdom and talent to take good care of you.

    As an aside- do you take any supplements like lutein that are supposedly good for eye health?

    All the best from your friend,

    Seneca

    • Yes, I take the full AREDS2 regimen of supplements, which includes lutein, astaxanthin, and numerous others. I think that’s probably why my right eye has held its own for eight years.

  5. Sorry to hear of the eye and the situation.
    Do what you can, as it always good to have binocular vision.
    Good for driving. and though life changes, always good for your independence.

    My Aunty, over 90 years old started those eye injections about the same time as you.
    Appreciate being informed via your eye reports, and as my Aunty noted, her eyes did improve at that time, and I am sure yours will again too.
    She still confidently drives. 🙂 and uses a computer.

    Pace your self, and cut your cloth accordingly, as sometimes some adjustments to make life easier.

    I have over the past 5 years, I really do need to take care of the body as I have learnt, when I met the barrier.
    The suffering initially was mild, feeling off for a few days, but did not realize it until a “state of shock” alternating chills, sweats, that night, then painful morning, seeing me drive off to the local medical centre.
    Immediate Doctor’s referral to hospital.
    The first warning shot, although not peritonitis came close to taking me out as it proved to be gangrenous as well.
    Took quite a while to recover from that appendicitis.

    Strangely that saved my life, for a year later, when I had an unwitting “heart event” and figured to be a bit more timely, but not thinking it was at all serious.
    Just an un-comfortableness, that just made me not able to bed down that night & get to sleep.
    So midnight, made my way to the “volunteer” ambulance station, not to save time, but just to be more helpful & not wanting to inconvenience them too much.
    A suspicion of back pain, alleviated when the nurse gave me nitroglycerin, shocked me, as it confirmed it in my mind of it being possible.
    Then the blood test with a high enzyme level proved it, so straight to a major hospital, and then kept there, waiting for a month after other tests. Told I was a great candidate for quadruple bi-pass.

    So that postponed some other issues that were raised but not checked on after the appendicitis.
    Recovery from the CABG. put that on hold.
    Finally 6 months later getting some teeth removed.

    Until heart medicines over time have been reduced over a year or so, then more able to have a Colonoscopy

    However the follow up, on the possible suspicion of what may have been a part of the reason for the appendicitis, was finally done just a few months ago.

    Covid lock downs had got in the way, but I really pushed back on the local doctor, and so fortunately was able to finally get a specialist check up, that then went on to give the go ahead for a Colonoscopy.

    I was lucky, as the 2 different polyps removed.
    One type, though small is more prone to turn to cancer.
    2nd one was now more than large enough to have a higher risk of turning to cancer.

    So another test to be run once a year, besides having 6 monthly Doctor and blood tests.

    I mention this as encouragement for all to do these check ups, when there are even small symptoms, signs or just Doctor’s advice.

    At the same time, Doctors are not the be end all, but it is part of seeking advice, and can be very interesting getting different takes on things.
    It is good to be able to bounce your own silly ideas of some one who should know about such things.
    Just beware when some answers may be as silly as your ideas. 🙂
    Not that that Doctor is bad, but just not in his strength.

    Appreciate your work Baron, and other commentators on your posts and news aggregation.
    I often take an aspect of it that I relate to, customize & research a bit more to relay the facts & information,
    Thank-you

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