Off North Road

A patch in time

By Russell Hoxsie - November 2, 2006

Five years ago, tuning in at 6 o'clock to the "News Hour," I found Jim Lehrer looked as if he'd undergone some poorly advised facial surgery and an atypical hair-do. As I blinked my eyes, his appearance changed a bit and, after a while, I realized that my eyes were the agents of change, not Lehrer's surgeon and barber. My eye doctor looked at me carefully and sent me for consultation with a retinal surgeon who also looked at me carefully and evidently with great interest. "Hmmm," he hummed and, when I posed some questions, told me to stop talking until he'd finished. He soon reported I had developed a wrinkle in the retinal membrane in my left eye just at my macula, the medical term for the central point of vision essential for fine detail in seeing objects clearly and for common tasks such as reading and driving. Light-sensitive cells in the macula transfer light images as nerve stimuli instantly to the visual cortex of the brain. Macular, the adjective, is a heavily freighted word in the science of eye conditions for it is associated with the diagnosis of aging macular degeneration (AMD), the most common cause of visual loss and blindness among persons over 50 in the United States. My eye doctor scarcely ever used the term at first and I found questioning him too often seemed counter-productive. After all, who wants to be told he has a veritably untreatable condition? At least that had been my understanding. The most common form of the disease, so called "dry" AMD, seldom went on to blindness.

The good news was that I had little disability although my view out over the south side of the Vineyard had changed. My horizon became a series of gently undulating peaks and troughs, not the sharp razor straight line of the past. Each medical visit involved bright lights, intrusive examinations of my eyes and brought the doctor's same response, "Everything looks quite the same, no need for surgery or special treatment. Come and see me again in three months and use that printed grid I gave you to see if there is any change in the straight lines."

A year ago I noticed that the island of Cuttyhunk, the western anchor of the Elizabeth Island chain, assumed more of the proportions of a foothill to the White Mountains rather than the slightly raised sand spit that it is. And I found myself stationing magnifying lenses about the house near a brightly lit lamp to improve my reading. More significantly, my usually dominant (and normal) right eye was a little blurred and the doctor could see an early cataract clouding my right lens. The wrinkled left retina produced an image for me which now was brighter than the other side, despite the mild distortion. I could erase the blur by closing the good and old faithful eye and enjoy the brighter, although distorted, left eye.

Change hastened its pace over a few months and the original "dry" macular degeneration, now confirmed, turned "wet," hence the elevation of Cuttyhunk and suddenly decreased visual acuity between two office visits. Fluid had begun to leak out of weak blood vessels growing just under the macular, elevating it and causing image distortion and destruction of visual cells accounting for the decreased acuity. This brings us to the point of my title this week, "A Patch in Time." The patch is window dressing only, nothing in the way of a medical patch to the affected eye itself.

In the past two years a new medication has been developed which has bright prospects for halting or slowing the destructive progress of wet aging macular degeneration. Fortunately, 90 percent of patients with AMD have the so-called "dry" form, which progresses very slowly and seldom produces outright blindness. Treatment in the past for the wet form has been limited to certain patients and has had only modest success, in some instances actually destroying normal cells as well as diseased ones. The new medication, Lucentis, developed by Genentech Corporation, has produced unexpectedly favorable results in as many as 95 percent of patients so treated. Monthly injections of Lucentis into the back (vitreous) chamber of the eye require an eye patch for 24 hours after injection, thus the title.

This treatment slows or stops deterioration and as many as a quarter to a third of patients may report improved vision. Side effects are reported to be rare, most involving infection. Other serious reactions are said to occur in less than two to four percent of cases in clinical trials. I found the prospect of this treatment daunting. It was too reminiscent of imagined injury or suffering at the hands of mythical warriors or psychopaths. We view our eyes as essential to health and normal life. The experience of serious injury, disease, or loss of one or both eyes is a disaster.

A week before the appointed day for my first injection, an old friend, age 93, called unexpectedly and told me, "It's a breeze, nothing to it, just a pinch and a patch overnight." Another friend said, "Nothing but soap suds in your eye and a little something caught in your eye the next day; don't worry about a thing!" Despite my white-knuckle approach to the treatment room, I breathed a great sigh of relief knowing there was help at hand, signified by the patch over my left eye as I left the doctor's office. My vision has not changed for the worse in three months and I may yet believe the doctor's admonition, "You'll never go blind."