Saturday 16 January 2016

Eye eye.

On Friday morning as I drove Olivia up to school, we looked up to see the most glorious sunrise.  It was stunning.  Awe-inspiring.  The kind of thing which stirs you to your very soul.  I nearly burst into tears.

I'm sometimes a bit emotional about beauty, but there is a good reason for this particular bout of emotion.

This week, I nearly lost my vision in one eye.

I need to remember how it unfolded, and I want people to know the symptoms because it might help someone else not lose their sight, so for that reason, I'm writing it all up here.

There'll be a bit of anecdotal rambling first, because I'm incapable of avoiding that no matter how I try, so if you get bored, scroll down to the big asterisk below.

Background information, first.

Back in October, I had a routine eye test.  Being pretty fiercely myopic (-6 in both eyes), I don't think twice about eye tests.  In fact, I have them so regularly that I question how valid they are because I can actually reel off the letters on the chart with my eyes closed.  I have begged for a new chart, but no dice.

Anyhoo.  This particular eye test was a little different.  As I was casually reeling off such literary delights as VOTH and LPED, I realised that, with my right eye, as I looked directly at the letters, they disappeared.  I could see them if I looked around them but if I looked directly at them, they simply were not there.  The optician could not see any problems with my eye, but suggested that it was probably worth looking into.

The following week was half term and we headed over to Belgium to visit my parents.  My mother has had serious problems with her eyes, and as such is on first name terms with Belgium's premier eye doctor.  It's a two month wait for appointments, but he agreed to squeeze me in two days later.  His examination showed something odd and he said that I needed to be seen urgently by his mate who had a machine specific to the problem which he thought I had - a super-powerful HD imaging thing which would scan a slice of my eye and show us exactly what was going on.  Unfortunately, that wasn't going to be possible before we returned home the next day.  Once we were back home and back into a week, I rang Moorfields and was admitted the next day as an emergency.

Various machines wot go ping (and some wot actually ping physically ON your eyeball - bloody unnatural) came into play, including a super-powerful HD imaging thing which scanned a slice of my eye and showed us exactly what was going on, which, it turns out, is a touch of the old vitreo-macular traction, resulting in a blind spot and surrounding distortion right in the centre of my vision.

It looks like this:


Yeah, that's the inside of my actual eyeball.  Nice.  It's hard to see, but above the thick undulating layer, very close to the top of the image, there's a thin white line which follows the curve.  This is the macula.  Where the little dimple is in the middle, the white line actually pitches down sharply and attaches back to the main bit.  This is the traction.

And this is what it looks like from my side:


Somewhere between picture one and picture two, but much smaller - it hasn't affected that proportion of my eyesight.
Not ideal, but apparently no major drama, and it was a question of having a check-up 6 weeks or so later, as it's the kind of thing which can conceivably just sort itself out.  A letter was typed off and dispatched to my GP, asking him to arrange a referral, and a copy was handed to me for my own reference.  Nice touch.  We don't get enough of that. 

6 weeks or so later was Christmas, and as a result, it ended up being nearer to 8 weeks by the time I remembered that this should have happened, and chased my GP, who denied all knowledge - for one reason or another, he had never received a letter from Moorfields instructing him to arrange a referral for a follow-up.  

I would have chased this up straight away, but I was a little preoccupied, as the reason I was at the GP's in order to check this was that Olivia had a hacking cough, for which she had already been seen once, with a horrendously high temperature.  She was given antibiotics and I thought I'd go home and chase up Moorfields over the next couple of days.  Olivia, however, got worse, and on Friday last week I took her back to the Doctor where he checked her SATS (oxygen saturation levels in the blood) and asked me whether I was okay to drive her to hospital or would I rather he got us an ambulance.  I elected to drive, and while he was doing the paperwork, I mentioned that Maddy had had a collision in netball at school on Tuesday and was still complaining of a sore shoulder in the collarbone area.  He stated categorically that I should haul her out of school and down to A&E for an X-ray.

Potential logistical nightmare, but as fluke would have it, Simon was off work, so while I rang school to have Maddy sent out and drove Olivia to the hospital, Simon collected Maddy and drove her along, too.  So there we were.  Me on the 6th floor with Olivia.  Simon in A&E with Maddy.  

This seemed bad enough, then Maddy was diagnosed with a broken collarbone, and Olivia was put on oxygen and admitted for an undetermined stay in the hospital.  I can't really express how frightening that was.  If your children have ever been in hospital, you know, so let's not labour the point.

Four days later, late on Monday, we were discharged and Olivia was allowed home.  

Tuesday was a relatively normal day, with Maddy at school and Olivia having a final day off to recuperate.

Wednesday seemed like it was finally going to be the proper, real start to the year, with everything under control, work being possible, children learning stuff and not being critically ill.  Aces.  

Thoughts turned to myself, and I rang Moorfields, who found my notes and faxed a copy of the referral letter to my GP, for adding to notes, but told me meanwhile to come in as an outpatient in the next week or so and they would give me a follow-up appointment without needing the involvement of any other parties.  Pretty cool.

I had noticed over Christmas that I was getting some flashing lights, when I blinked at night.  By Wednesday, I was able to see these during daylight and for most of that day that I had a small floater (snurk snurk - sorry - I know - pathetic) in the corner of my eye, meaning that I spent a high portion of the day whipping my head around to look over my shoulder.  I kept thinking that something was creeping up on me.  Most distracting.

In the evening, I went out to teach Zumba, feeling perfectly fine.  In the middle of one of the tracks, and noticed that the floater had become far bigger and was beginning to move across my eye.  It looked like ornate, black ink, scroll-work or calligraphy flourishes.  Very attractive but scary as fuck.  Over the course of the next few seconds, it continued to move across my vision and suddenly exploded in slow motion across my vision.  It looked like when you drop marbling ink on water:

First this:


Then this:



I stopped the music and turned to my class to say that I had to stop and go home.  As I very seldom so much as take a day off sick, it was clearly a bit of an event.

My participants were very understanding and I left quickly, driving home (hmm) to ring Moorfields.  I described the symptoms to the very nice man on the end of the phone, who told me to come in.

Me:  First thing in the morning okay?
Him:  No.  You need to get here now.

With the girls newly out of hospital and with a broken collarbone respectively, we didn't feel we could offload them on someone while we both charged up to London - too scary for them - so, pausing only to whip out my lenses and sling both a book and kindle in my handbag (chronic fear of being somewhere with nothing to read *shudder*) Simon drove me to the station (still in my Zumba gear, thankfully not sweaty as it happened early in the class) and put me on a train to London.  

Of course, while on the train, there's nothing to do but worry, is there?  So from being calm, together and getting on with it, I turned into a gibbering, sobbing, snivelling wreck and did what all self-respecting gibbering, sobbing, snivelling wrecks do.  I rang my mum.  As she'd only just gone home having raced over to help us out over the weekend with the whole "being in two places at once" scenario, I forbade her from coming over again, and rang my brother to see if he was in London.  After a bit of panicking re non-answering of phones (he was a the theatre), I got through and my lovely brother met me at Waterloo and accompanied me throughout the rest of the night, doing a bloody good job of taking my mind off it all.

We got to Moorfields around 10.30pm, where we were efficiently checked in, triaged (possibly not a verb) and seen by a second nurse who did various preliminary tests.  Around midnight, I saw a doctor who began the consultation with what came across as an everso very slightly smirky "so what has prompted you to run all the way up from Basingstoke at this time of night?".  I guess he sees a few hypochondriacs.  Either that or I totally projected my own fear that I was being a drama queen onto his entirely innocent question.  He smirked a little less when I told him it was not my first time at Moorfields, and still less when he'd had a look in my eye.

"Ah, you have a bad tear in your retina.  We will need to operate first thing in the morning."

What?  What?!  A torn retina?  Hm.  Okay.  Kind of what I was expecting, if I'm honest.  How serious is it, Doc - will I lose my sight?

"If fluid leaks through the tear and lifts your retina away, you will get a detached retina and lose the vision in your eye."

"Do you mean go blind in that eye?"

"Yes."

"Okay, and the likelihood of that is?"

"There's no way of telling, but we will operate first thing in the morning.  It's a nice fresh tear" (oh good!!!) "so the chances are good that there will be no complications."

"Is there anything I can do to minimise the likelihood of fluid leaking through?"

"Not really, no.  Don't jump off anything high.  Or operate any pneumatic drills."

Thinks:  "Great."

"Just show up tomorrow morning at 8.30 in the retinal emergency unit, with this letter."

We returned to my brother's via a comedy cab ride - "you two had a lovely evening, have you?  You lawyers, are you?" - er, no and no, but so it went on.  Jon distracted him beautifully, allowing me to wake Simon up and tell him what had happened.  The cabbie managed somehow to find all the cobbled streets and speed bumps between the City and Kennington, so I spent most of the cab ride hovering above the seat trying not to jolt my eyeball about.  Great for the thighs.

At 8am, after four hours of not very efficient sleep and some pretty funky dreams, I was back in the hospital, clutching my letter, and feeling sick as a bloody pig, my loves.  In all the excitement, I hadn't asked enough questions.  I like to know what is going to happen.  I didn't even know if I would be okay to leave the hospital unaccompanied.  As Jon had had to go to work and I was on my own, this was a pretty stupid question not to have asked.  It turns out, yes - not a problem.  Which was kind of reassuring about the whole thing.

I was the first person called, which was nice, and the lovely nurse assessed me and put dilating drops in my eyes, with many jokes about how she likes doing this to young men as it makes them cry, but doesn't like doing it to ladies.  I'm sure she has a different line for all the different patients she has - one which would put anyone at their ease.  She was an Asian lady of indeterminate age - tiny and birdlike (such a cliché, but she was), beautiful and funny, efficient and charming.  

With pupils like a fully committed pill-popping maniac, I returned to the waiting room, assuming I'd be there for another hour or so, and was once again called almost immediately.

"Hi, I'm Miles, I'll be doing your retinoplexy today.  Let's have a bit of a look and see how it's presenting."

Miles, like everyone I have met at Moorfields, was an entirely charming person.  They are so quietly confident in their ability to save your sight, and so delightful in their self-deprecation, I felt that I was in the best of care throughout the whole horrible experience.  I cannot emphasise enough how frightened I was that my tear would prove inoperable and I would lose my sight.  I also cannot over-emphasise how little fear I had that the operation would go wrong.  Even as I signed the consent form confirming that I was aware that the operation could result in permanent loss of vision, not one iota of me brooked the possibility that Miles in particular, and Moorfields in general, would let this happen to me.  I hadn't really worked that out until I'm writing it now, and to be honest, it's made me totes emosh.  *dabs eyes, womans up, carries on*

Miles filled my eyes with numbing drops, which are absolutely amazing.  I don't have any squeamishness about things touching my eyes, as I've worn contact lenses since I was 12 years old (profoundly short-sighted and a fairly serious ballerina - couldn't wear glasses for dancing) but I can't say I relish it.  He had a good peer into my eyes and pronounced the tear thoroughly operable and fairly easy to reach apart from a couple of areas for which he would have to use a tool directly on my eyeball to depress it and deform it so that the edges of the tear were attainable.

Boak.

Yeah, I take it back.  I discovered a little squeamishness when he demonstrated the kind of thing and I worried that my eyeball would actually pop or pop OUT, but it was pretty much painless, just uncomfortable and icky.  Technical term.  Meanwhile my phone sprung to life and started pinging, ringing, vibrating, dan-dan-daaaaan-ing and general making its presence felt.  Miles patiently (and unnecessarily) suggested that I switched it off.  He explained that while he was firing the laser into my eyeball, it may be distracting.

At this point he told me that a not inconsiderable amount of fluid had begun to leak behind the retina.  If I hadn't rung straight away and come straight in, that leaking would have continued.  There is a very good chance that, as I'm sitting here two days after surgery, I would have been completely blind in my right eye.

The laser machine, it turned out, was in the other examination room, so we needed to wait for that to become free before he could perform the retinopexy, so it was back to the waiting room, this time with eyes which were not only junkified but numb, too.  Mental!  Again I expected a long wait, and again I was pleasantly surprised.  I was checking all the phone things which had happened, which included a call from School to ask if Olivia was allowed to stay for debating club, a message from Simon that Maddy had decided not to go to A&E after all (arm playing up following Olivia falling over and grabbing Maddy's arm for balance the night before) and FB messages from team members and customers - the life of a self-employed working mother.

I'd dealt with school and was ringing Simon to let him know that Olivia was staying late when I was called in - it couldn't have taken more than three minutes.

This was the big one.  It was finally happening.  I was a little nervous (ahahahahahahahaahah) about what was about to happen, so, as is my wont, I asked Miles to describe exactly what he was doing as he was doing it.  He was kind enough and patient enough to do so.

First thing was to lock the door.  Apparently you don't want people barging in while you're firing lasers into people's eyeballs, as it can cause complications.  If the door needs opening after the laser has been set, the whole process needs annulling and starting again from scratch.

So, we're locked in.  The chair made a dentist's chair look like a bit of an under-performer, and I was comfortably supine.  Meanwhile, Miles set a contraption on his head which looked like a combination of an optician's glasses:


And a miner's helmet:












The lamp bit being the laser.  Yoinks.

I'd read the Moorfields leaflet on the procedure (which a friend very kindly drew to my attention at 2am - thank heavens for friends who live on the other side of the world) and had half an idea what was going to happen.  One of the points in the leaflet about the actual treatment is that it can feel like electric shocks in the eyeball, sharp pain, burning etc.  So you'll forgive me for being a little trepidatious.

Miles asked me how the numbness was and if I wanted any more drops.  As I tend to morph into desperate comedy mode under stress, I responded that I've never knowingly turned down a drug in my life.  I know.  He's heard it all before, hasn't he?  But he laughed patiently, and further numbed my eyeballs.  I breathed deeply and tried to concentrate on keeping my heart rate nice and steady.

I should mention that there is no restraint whatsoever involved in this.  You hold yourself, your head and your gaze motionless.  The surgeon angles his head to point the laser where he is looking and activates it with a foot-switch.  Your eyeball is the size that your eyeball is and the laser enters it through your dilated pupil.  The margins for error here are tiny.  The chances of rupturing a blood vessel or slicing across the optic nerve are, presumably, considerable (I didn't ask, but unfortunately have always been quite interested in human anatomy etc and know just a little more about the inner workings of the eye than I wished, at that point, I knew).

This is what happens:



The dots on the wall of the eye are the small welds to reattach the retina where it belongs.

What amazed me is that there was very little sensation, let alone actual pain, involved in what ensued whatsoever.

I found it quite mentally disturbing, however, as it was almost exactly like a recurring dream which I have had for many years, and which has woken me into insomnia on many an occasion.

The laser, you see, completely dazzles you.  So your eye is open, you have to hold it as absolutely still as you can (or you'll end up with someone's tag graffitied on the inside of your eyeball), which in my case was looking up and left, but you can see nothing at all.  Your eye is numb, you're looking up, and you see nothing.  I don't know why this has been a recurring dream/nightmare for me, but it has.  If it were not for that, the experience would not have been in the least bit unpleasant.

 There were moments when I could feel the laser on the inside of my eye.  Not going to lie, that wasn't nice, caused me to go "argh" and Miles to say "Shall we stop for a minute?", which he did.  And then we'd proceed.

The bits when the depressor was on my eyeball weren't nice either - mostly when they were close to muscles which are not used to being prodded about.  But it was easily, easily bearable.

A couple of times, Miles called the head of department in to have a look at how it was going, and she suggested he could turn the laser up from 250somethings to 400somethings (at which I turned into tedious comedy patient again, and more or less told her to fuck off, because Miles was doing just fine - I need gagging, really, in these circumstances), which he did, and it was a little more obvious that something was going on in the eyeball, but still entirely bearable.

I ended up with two rings of welds around my tear, and three at a couple of points where it was tricky.  It was harder to get the retina to adhere where the fluid had crept through, so he had to pull back from the tear, leaving more of a space between tear and weld.

Every time we stopped, I was completely blind in my right eye - I checked that this was normal.  I like to know these things.  But my vision would slowly creep back.

Miles would tell me "we're about two-thirds of the way around, and you're doing very well", and generally keep me informed.  It felt very much like team-work, which clearly it wasn't.  He had years of experience and study and a huge amount of pressure on his shoulders, whereas I just had to keep my eye still.

I think the whole thing probably took about half an hour, but I'm not entirely sure.  What I do know is that 12 hours after I arrived at Moorfields with an undiagnosed eye problem, I walked out cured.

It didn't cost me a penny.

I am SO FUCKING LUCKY!!!

I came *this* close to losing my sight, and I know what to do if it happens again.

*
If you read all of that - well done.  If you've skipped down to avoid my rambling, that's fine, too.

What you need to know:

If you are very myopic (short-sighted), you are at an increased risk of having a torn retina.

It can happen at any time - it could happen while you are asleep so if you wake up with blurred or occluded vision, do not hesitate to have yourself checked out.

Indications that you are at risk of a torn retina are flashing lights and floaters across your vision.  These can be specs, lines, dots or larger areas.

If you see these, get checked out.

Find out where your nearest Opthalmic A&E department is.  It may be your local hospital or it may not, but if you're very short sighted, you ought to find out just in case.

If a large floater appears and does that marbling thing - sort it out!  Don't delay.  Don't feel like a twat for bothering t'doctor.  Just do it.

Delay marks the difference between saving and losing your sight.

Don't be afraid of the operation.  It's not bad at all.