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Your precious they are!

Some time ago I wrote about the importance of looking after your eyes and some of the things that can go wrong with them as we age. It was titled "The eyes have it!" and I encourage you to refresh your memories by looking back on it. And today I had cause to do likewise.

Typically my trusty glasses - the tortoiseshell ones in our masthead graphic - needed repair because, of all things, I had lost one of the 20cent soft rubber nose grommets from the bridge. So I called by a local optometrist in our village in the Highlands, rather than travel all the way back to Sydney for what appeared to be a simple fix. Unfortunately, this pair of glasses was not mainstream and it seems neither is the nose piece! So, their being now more than 2 years old, I thought it prudent to book in for an eye examination and update my glasses, which I've recently done. During my examination, which included a full check for macular degeneration, my optometrist discovered very irregular shaped and abnormally enlarged optic nerve "cups". He immediately advised me of this abnormality and his preference to conduct a "visual field test" which detects, measures and graphically maps any dysfunction in central and peripheral vision. To my dismay, my test revealed significant loss of peripheral vision, particularly in my left eye, despite my vision being still very good (I am a little short sighted, hence the need for glasses) and has altered only marginally since my previous examination in 2011. My optometrist immediately referred me to a leading ophthalmologist, who sadly confirmed the findings through further examinations today - his official diagnosis: Advanced Low Pressure Glaucoma!!

I must confess, I am more than a little nonplussed by all of this but his calm assessment and explanation of the problem has somewhat assisted my acceptance. Here's the thing:

  • Glaucoma is the major cause of irreversible blindness worldwide

  • Glaucoma is an irreversible deterioration of the optic nerve fibres that make up the optic nerve - we have approximately 1 million of these fibres making up the optic nerve in each eye. They pass through a "donut-like" hole (cup) at the back of the eye and carry images from the eye to the brain for interpretation and as the glaucoma "kills" them, the hole through which they pass gets larger.

  • Glaucoma is caused by the pressure build up brought on by excess "aqueous", the clear fluid which continually circulates and nourishes the eye. The build up is a blockage of this continual circulation caused by its inadequate drainage.

  • It will usually be hereditary but not necessarily - neither of my parents since deceased had it, so likely not that!

  • It can be congenital or the result of severe eye trauma - I don't believe so!

  • it is more likely with diabetes - but I have undergone an extended blood sugar test and officially confirmed non-diabetic - so not that!

  • It can be caused by present or past use of cortisone drugs - and this is what I suspect was the culprit in my case. Some years ago whilst taking non-steroidal anti-inflammatory for back pain management, I developed a kidney irregularity (low "gfr" for my age) and was advised to take only steroidal anti-inflammatory. The kidney situation righted itself but I guess the steroids took their toll!!

So what now! Well, since there is no way the dead nerve fibres - possibly hundreds of thousands of them - can be restored, the whole treatment is focused on preserving what is left. The treatment is an eye drop in each eye each day for the rest of my life. It's a synthetic drug with two essential elements, one, a beta-blocker that lowers the eye pressure by reducing fluid production and increasing blood flow to the optic nerve and the other which allows more fluid to flow out from the eye. While there are some possible side effects, apparently it has wide acceptance - as high as 80% - and I'll soon know my reaction as I start on the journey tomorrow. Apparently it takes about one month to take effect, so best to get cracking with it without delay.

But there is another aspect which has me a little troubled - I'm scheduled to have an orbital brain CT scan on Friday - whereas the eye tests to date have viewed the inner working of my eyes from a front-on perspective, the specialist wants the added dimension of seeing the nerve from a side-on view as it enters the brain - is it doing anything unusual? I cannot know the result of this vital test soon enough!!

During my examination today, I put a couple of vexing questions to my ophthalmologist:

  1. I've been wearing glasses and having regular eye examinations for some years - the last only 2 years previous. So why has this only shown up now? He said that this could have been missed in previous tests but, more likely, it has only manifested itself within the last 2 years. He also reiterated that Glaucoma occurs without any early symptoms - hence my still very good eyesight, despite the now detected advanced nerve deterioration. LESSON - do not put off your BIENNIAL (every two years) eye test, including checking for macular degeneration and optic nerve abnormalities.

  2. The visual field test I did at the optometrist's which landed me here, was, to my mind, highly subjective in that it relied on a high level of concentration and physical response agility, it took way too long and my worst result was on the eye done second. Was the result nevertheless reliable? He agreed it does rely on highly subjective criteria, but its findings were indisputably corroborated by other more sophisticated tests he conducted today. My scepticism was thus allayed.

Before leaving the specialist surgery this morning, I asked for and secured copies of the results from both the visual field test done several weeks ago and also the further digital examinations conducted today. Whilst I'm obviously not an expert, I understand them sufficiently to provide a level of comfort and understanding. For me there is nothing worse than not having at least some knowledge and insight into my own medical destiny. You'll recall I did similar when going through the whole prostate cancer thing 3 or so years ago. And naturally, I have of course spent a good part of the day since being diagnosed, doing further research - thank goodness for Google, it's all there at your finger tips!

And without boring you too much, I really recommend you look at Glaucoma Australia and in particular check out their video

And whilst I was writing this article this evening, would you believe a national current affairs TV program ran a story on this very issue, where people were visiting a particular suburban optometrist who, with the aid of his computerised diagnostic optometry equipment, found greater underlying medical issues. By his referring patients back to their GP and other specialist medical services for further diagnosis, he is helping people to get potentially dire issues treated before catastrophe strikes.

So, like me, make sure you religiously attend to your biennial eye examinations as they become due - ask questions and take charge of your health. Your eyes are a unique gateway. I've said many times before that in order to embrace your retirement lifestyle, you need to first ensure you are as fit and agile as possible - that includes your eyesight, so do not ignore it - have it checked regularly.

...and remember...have a fabulous retirementLIFE!

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