BRAO: my new challenge

BRAO is short for branch retinal artery occlusion. Today's email to my vision therapist explains this new challenge, and I wanted to share the same news with my Sovoto friends here before blogging about it later this week.

Dear Dr. ---,

I have some very bad news as far as my future with 3D vision is concerned, but my goal remains to see as well as I can see.

We will have to work on a major new issue: this last Saturday my body decided to throw a small clot or plaque into the lower branch of the central artery of my right retina. (See attached jpg with opthalmologist's photos.)

I'm in very good spirits, in spite of losing sight in the upper half of my right eye, including a small piece of my central vision that interferes with reading.

The ER doctors admitted me as an inpatient and, on Sunday, I had every baseline test you can imagine to determine the source of the obstruction. All my tests have come back normal so far. Only a few blood tests remain for rare clotting diseases, so the primary cause thus far is looking like the hormone replacement therapy I had begun 17 years ago when I became pre-maturely post-menopausal at age 35. No more tri-estrogen for me— as the progesterone combo may not have prevented this tiny clot.

Life has it's ironies … of all the places for this tiny clot to land! But it could have been much worse … so I am thankful.

Being a life-long alternating suppressor has it's advantages as well: I don't even "see" the fogged area with both eyes open. My left eye has taken on the full-time job that used to belong to my right.

A different artery (choroidal) still supplies blood to the rods and cones underneath the damaged layer. Perhaps, when the swelling goes down, the affected tissue will admit more light. At this point, I've got myself a built in sun visor!

My next appointment is April 7th, and I would like to use the time for any retesting you feel is needed, and discuss a revised game plan. I will see a retina specialist on April 5.

I did drive yesterday, and will need to work on the remaining peripheral vision in my right eye so that I don't feel the need to turn my head to see the right rearview mirror with my left eye.

Here's my self assessment as of today:

I checked myself with the McDonald chart and found all letters save the elusive V.

The tranaglyph reveals a missing upper right dot. The left upper dot sometimes goes out and all four dots sometimes come in briefly. The circle remains complete and can grow larger and smaller. Not sure I see "float."

Brock string lacks the upper right portion of the X at all points and bead fusion is more elusive than ever. I can get a stable green bead with two entry points for near strings at 2" … I would say at this point that I do not have a baseline fusional area, due to the obstruction to my central vision.

Physiological diplopia reveals one and a half fingers when converging on a distant object, however, when I converge on the finger I can usually get one "whole" finger and two distant objects if the are positioned slightly lower.

Yesterday, I adjusted my bi-nasal occluded glasses by removing the right nasal occlusion. This breaks suppression, allows the right occlusion to come into view, and gives my left eye a rest. So I still find them useful for everything but reading and driving as before.

I am able to use my new, built-in partial central occlusion to create diplopia and then work on divergence to bring the two distant objects together, but not with any consistency.

All this will no doubt change depending on what the affected area will look like after the swelling goes down. I still plan to keep useful elements of my VT exercise routine that will help me adjust to my new left-eyed world, if nothing else!

You would think that I might regret having undertaken vision therapy these last fews months, but in fact the opposite is true: my increased awareness has allowed me to feel more at peace with my current situation. In fact, vision therapy has laid a good foundation for the challenges ahead.

Thanks to vision therapy, I have come to this crisis empowered.

Until the 7th,
Lynda

Tags: alternating, artery, clot, retinal, suppression, tropia

Replies to This Discussion

Permalink Reply by Lynda Rimke on April 9, 2012 at 11:17am

Thanks, Frances. I appreciate your interest and encouragement. I shall follow up soon with a post about my current VT goals, now that the hindsight sharing is out of the way.

I am cautiously (lazily?) working on expanding the stereo vision that has occurred as an indirect but natural result of the trauma of changing from right eye dominance to left. eg. I seem to have naturally developed stereovision for doing dishes, petting the cats and dogs, some driving and some gardening activities, but the 3D is only within range of my reach or the windshield of the car.

All good stuff! so I'll let you know when I've got a post up.

All best,

Lynda

Permalink Reply by Frances McIntosh on April 9, 2012 at 6:04pm

Wow! Go figure. I keep being surprised by how weird and wonderful the brain is.

Permalink Reply by Sue Barry on April 7, 2011 at 9:41am

Dear Lynda,

I am really sorry to hear about your visual problems and am amazed at your positive, fighting response. It's definitely true that knowing more about your own vision helps you to adjust to and maximize the vision you now have. I hope things improve as the swelling goes down.

Best,

Sue Barry

Permalink Reply by Lynda Rimke on April 7, 2011 at 3:25pm

Thanks Sue, for the encouraging word.

Oliver Sacks has been on my mind as I've gone through this. I think I should investigate if The Mind's Eye is on audio tape.

You both have been such an inspiration both to try for all the vision we can get and to accept the vision we have.

I had a really good report from the retina specialist yesterday. Indeed, that artery is hanging in there for my central vision, so there is a good chance for some improvement.

I also feel I've had some plasticity occur as the left eye attempts to fill in over my right!— although my VT today wasn't exactly convinced. She's an anchor to my over-filled sails ;-)

And I've been having 3D moments, too, where I can't possibly invent what I am seeing, all wishful thinking and dreaming aside. But again, my VT wasn't convinced because, in her office, I haven't tested for fusion beyond 8" before the BRAO.

I've rambled at length in my latest blog post http://leavingflatland.wordpress.com/2011/04/06/more-3d-and-a-bette... which needs to be cut in half, really!

Permalink Reply by Sue Barry on April 8, 2011 at 9:05am

Dear Lynda,

That's great news about the retina.

Your observations, as detailed in your blog, are amazing. Keep documenting and posting. Your descriptions give a lot of insight into how the brain can find new ways to handle the input from the two eyes.

I loved your description of seeing in 3D. You write:

"UP. DOWN. BOTTOM. These are such abstract concepts to me … not things to be SEEN other than depicted on a flat surface. But I am seeing these and other words that describe WHERE in three dimensional space with an explosion of never before understood meaning."

What a beautiful description of the perceptual and cognitive changes!

Oliver Sacks in The Mind's Eye does describe his loss of the same spatial concepts you are gaining . His book is on audio tape and you would enjoy what he's written (although his condition may not improve as yours might.)

Our brains were meant to continually adapt to the challenges in life, and you are certainly showing that.

Best,

Sue

Permalink Reply by Lynda Rimke on April 9, 2011 at 10:25am

Sue,

Thanks so much for reading my post and for cheerleading. I agree that it's so important to journal or blog or somehow write down what's happening with our eyes and brains. Your book has been an inspiration, and I am happy to contribute my own story however I can.

The best part is the community we are all experiencing as we share our stories with one another!

Have a great weekend,

Permalink Reply by Lynda Rimke on April 11, 2011 at 9:46pm

For those interested, my latest update has three illustrations of what my new vision impairment looks like in my brain, and two more apparent 3D "happenings": http://leavingflatland.wordpress.com/2011/04/11/the-daily-grind/?pr...

Life is good, considering ... :-)

Permalink Reply by Lynda Rimke on April 13, 2011 at 11:23am

I've been testing my vision with the red-green glasses these last two days, and have concluded two of the three 3D happenings were more than likely due to brain mapping over mostly normal correspondence. My post on how I see my bathroom sink with patched together right and left viewpoints is my best scientific guess at what's going on inside my head most days.

http://leavingflatland.wordpress.com/2011/04/13/in-search-of-verifi...

CMYK and RGB color theory are also explained. (I am a graphic designer) In my humble opinion, the scientific name for "luster" is yellow!

Permalink Reply by Lynda Rimke on May 9, 2011 at 10:11pm

My 6 week appointment was not good news. The swelling has gone down, and I managed to read the chart, taking about 5 seconds to move my gaze around enough to read each letter as it slid out from under the brown rug of blocked vision. The retina specialist did not mince words, and called what is left "dead tissue" which means blood supply did not return to any portion of the arteries and tissue. I am pretty much legally blind in the right eye and unable to do anything about it.

My brain is doing an amazing job of giving me complete vision in spite of the loss of half my right visual field. I can't explain why I see the top half of my right glasses frame, and the ceiling lamp in the next room. I also see the pattern my fully functioning rods and cones make under the ischemic tissue, dancing just about my laptop screen.

It's an odd mix, what I've been given. I am thankful I can do most anything I want ... other than seeing 3D in all it's glory.

Anything in the lower half of my vision is fare game for 3D experimentation for me. I can make my feet smaller, and my coffee cup hollower.

Also, I still enjoy doing physiological diplopia exercises by holding a finger five inches from my nose, looking out at an object (the moon, a doorknob, a stoplight) and seeing two fingers; then looking at the finger and seeing two objects.

But I am completely on my own at this point. My DO-VT can't do anything more for me as this new challenge is beyond her, she says. I was the only adult patient in her practice wanting 3D so she was a bit stretched before ...

I will still work on expanding peripheral vision and push for more periphery from my right eye, especially. At least my non-dominant left eye is gaining in ability as it pulls the freight each day!

Permalink Reply by Sue Barry on May 10, 2011 at 9:49am

Dear Lynda - brave lady,

I'm sorry the retinal specialist had such bad news, but the brain can do amazing things. With vision, we take current sensory input and combine it with past experience and expectation so, while part of the retina may be dead, how the brain will re-interpret your remaining visual input is an open question. You may see better than the dead tissue would suggest. As you say, you can't explain why you can see the top half of your right glasses frame. If you learn to see in 3D in the lower half of your visual field, perhaps the brain will "fill in" that information to some extent in the upper half. In other words, you'll have a richer view of the upper visual field than predicted. With your resilience and powers of observation, things could be better than the retinal specialist suggests.

Best,

Sue

Permalink Reply by Susanna Z on May 10, 2011 at 9:02pm

Lynda,

Have you looked for other developmental optometrists with experiences with adult patients? I know how odd it is to be the only patient above 3 feet tall in the office. Perhaps working with another DO who has more adults may not be so much of a stretch for the DO. I was overjoyed today when I went to see my optometrist that another adult walked in and asked "Do you treat adults or only kids?". Before the lady at the desk could answer, I said "I'm an adult and I'm here!". He then told her that he had strabismus and amblyopia and several operations. Again, I beat the office staff and said "Me too!". I wanted him to feel comfortable because when I first started, I saw no other adults. In the past 15 months, I've seen 2 or 3 people above the legal age to consume alcohol as adults. So it does feel good to be in the company of others who are adults.

SUSANNA

Permalink Reply by Lynda Rimke on May 10, 2011 at 10:38pm

Susanna, I think I would have to drive out of state to get that. There might be somebody in Pittsburgh, and I am moving 35 miles closer to there. At this point, I'm working like crazy to restore the house my husband and I just bought "in the country" so we can move there. After we move, I may consider another evaluation by someone innovative and crazy enough to take my case.

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