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,
The bottom portion of the retina supplies vision to the upper field, so my new field of vision is a mirror of these photos. The fovea is the dark spot and optic nerve is the bright spot from which the veins and arteries radiate.
#1 and 2 color photos are of the left eye. The damaged tissue looks like a yellow storm cloud. #3 and 4 are photos of the right retina for comparison.
The next set is a fluorescent angiogram, which shows the artery supplying my central vision firing up about 5 seconds late, but still in the game ... it's not giving up and neither am I!
Your perspective is unbelievable. I wish you the best in a full recovery of retinal function in your right eye and in continuing to maximize your visual potential.
(goodness--my original comment I typed days ago never posted here!)
I have been thinking of you every day--thank you for sharing the details of this frightening episode. I admire your positive attitude and ability to find the silver lining in this situation so much! It is heartening to learn that the artery supply is okay, and as you said, the swelling will continue to diminish. I hope that you are on the fast track to healing.
Best wishes to you, strabby sister!!!
I know you've been thinking about me and rooting for those arteries. Thanks, sis!
I am hoping the one to central vision will open up again, and that by firing up 5 seconds late, it is still getting blood supply to the central vision. I'll know more when I see the retina specialist tomorrow. Let's just say I'm avoiding googling any prognosis for "ischeal tissue" until after then. To me, prognosis is the average of hundreds of coin flips.
I'll be seeing my VT on Thursday and blogging all the findings after that.
Thanks all, for the well wishes and prayers. I am noticing some new brain plasticity and possible binocularity occurring, and have blogged about it today here http://leavingflatland.wordpress.com/2011/04/01/my-new-brain-plasti...
Let's just say that I am in a bargaining phase and wish to take advantage of any opening for binocularity I am given, before I settle for monocular vision. ;-)
I appreciate your insights, Dr. Press.
Since you mentioned it, I have been well aware of the risks of HRT and chose from age 35 on to only use "bio-identical" compounded formulas, which include a form of micronized progesterone that is supposedly more effective than the progestin found in prempro, etc in reducing risks of stroke and breast cancer.
When I attempted to cut my dose in half at age 50, I developed an auto immune disease that required choosing between my full dose of BHRT or steroids with their own nasty side effects. I went back on the full dose of BHRT because both my family practicioner and my obgyn said the risks were minimal, due to the bio-identical nature of the therapy.
Obviously, not minimal enough! So I am waiting to see what my immune system does with my cold-turkey withdrawel and I'm staying off gluten 100% instead of most of the time (I should get tested for Celiac disease). So far, so good. No need for the steriods just yet.
The research is even more shoddy for this auto-immune disease, I'm afraid. And there needs to be more research on BHRT as well. Obviously, I'm not a good statistic ...
But enough on all that!
My VT emailed back: "Good thing we started doing some work with [the left eye]! Continue doing as much eye movement work as possible with the left eye ( and right if you can). " I'll be updating after my appt on the 7th. :-)
Quick note about gluten: Some people have bad reactions that are not celiac disease. Don't know if those reactions have anything to do with the immune system. But they might.
For example: I get *really* groggy/feeling drugged about a day after I eat a food containing wheat-type gluten (I'm fine with rice...) lasting for several hours. I have Chronic Fatigue Syndrome which some people think has something to do with immune system. And I think the gluten problem started with the CFS. But I don't have celiac disease.
So even if the celiac test comes back negative you might want to continue not eating it. With so much going on it's sometimes best to just play it safe whenever possible.
Frances, I'm not sure I have full blown celiac or simple gluten intolerance, where my immune system starts attacking my body after being triggered by the gluten. My most recent blog post has a link to a great Scientific American article on gluten. I address more in depth the hind-sight that diet was what my body needed, and not the large BHRT dose my doctor advised to prevent inflammation http://leavingflatland.wordpress.com/2012/03/31/brao-prevention/
Sounds like whether it's celiac or some other form of intolerance the "fix' would be the same.
Note: Scientific American rocks. Some of us have been saying for *years* that "the same trio—an environmental trigger, a genetic susceptibility and a “leaky gut”—seems to underlie other autoimmune disorders as well." Now it's (finally) out there a well respected publication.
Although unrelated to V.T. in most cases, I think that it may behove anyone here with a chronic condition of any kind to look into food intolerances; even just reducing symptoms of an illness will make it possible to take better advantage of V.T.
I'm keeping fingers crossed for you Lynda--on all fronts.