Here’s one reason that will make you think twice about skipping your yearly checkup.
I remember my Optometry school profs telling me that the worst of cases always seem to walk in late Friday afternoon, when typically, you are in no mood for anything complicated. That scenario played out at my Sioux Lookout location this past June when Dave walked into my Sioux Lookout office for a routine exam. Dave, 30 years of age, came in with no complaints. He was moderately near sighted, but had never worn glasses and was literally dragged into my office by his wife. I remember this day since typically in summer at my Sioux Lookout office, I schedule my Fridays to end early. I Musky fish. Sadly, as any true Musky fisherman will tell you, during Musky season, we have a disease. I remember Dave well; we shared the same affliction. We spent most of the case history discussing what a great day this Friday was going to be on the lake, and that we’d probably see each other out there.
The reality of most adult eye examinations between the ages of 24 and 40 is that they are routine. For Dave it was not. Mid-way through the examination, on a routine confrontation visual field test, I discovered he could not see at all on his right side. When I looked into his eyes, I was shocked at what I saw. His optic nerve heads had large cupping and nerve fiber layer loss typically seen in older patients with end stage Glaucoma. The picture became grimmer when through my slit lamp, I could see he had pigment dispersion syndrome. His Intraocular pressures were 35 and 25 (normal is between 16 and 21). Visual field testing confirmed he had lost vast amounts of his visual field in his right eye and a significant amount in his left. Dave had Glaucoma secondary to Pigment Dispersion Syndrome; instead of us meeting on Lac Seul in pursuit of a 50 inch Musky, we spent the afternoon trying to find an Ophthalmologist in Winnipeg that would see him on a Friday.
Pigment dispersion syndrome occurs when pigment granules that normally adhere to the back of the iris (the colored part of the eye), flake off into the clear fluid produced in the eye, called the aqueous humor. Sometimes these granules flow toward the drainage canals of the eye, slowly clogging them and raising eye pressure. This rise in eye pressure can damage the optic nerve, the nerve in the back of the eye that carries visual images to the brain. If this happens, pigment dispersion syndrome becomes pigmentary glaucoma. It Typically occurs in younger males, and there is higher occurrence in those who undergo vigorous exercise.
Treatment
Doctors usually treat pigmentary glaucoma with eyedrops such as Betagan, Timoptic, Optipranlol and Xalatan.
In some patients, a laser treatment called argon laser trabeculoplasty works well. This procedure helps open up the drainage system in the eye to increase fluid flow, which lowers eye pressure and protects the optic nerve.
Another treatment for pigmentary glaucoma is a procedure called a laser iridotomy. A laser is used to make a small hole in the iris, causing the iris to move away from the lens of the eye. This prevents the lens fibers from scraping the pigment from the iris and clogging the eye’s fluid flow. However, it has limitations and does not always achieve its desired effect. Researchers are now conducting more evaluations of this procedure to determine its effectiveness.
The scary part of Pigmentary Glaucoma is it’s rate of progression. Most open angle glaucoma’s progress quite slowly, and often when diagnosed, there is only minimal damage to the patients visual field. However Pigmentary Glaucoma moves quickly. In fact, Dave had been to an eye doctor only three years before I saw him, and there was no mention of any abnormality. Thankfully, we did find an Ophthalmologist. Dave was treated, successfully with eye drops and laser and has maintained what was left of his visual field.
It scares me to think what would have become of him if his wife wasn’t so persistent, and insisted he come in and see me. Sadly, in my 7 years in practice, I have met other young adults who haven’t been so lucky. I have likely seen between 15 and 20 thirty- something year old males who have been diagnosed with Pigmentary Glaucoma, and most were disabled from the disease. By the time they came in recognizing visual loss, the disease was in its final stages, and their vision severely compromised. The fact of the matter is that most males who don’t wear glasses just don’t think it’s necessary to have their eyes examined. The disturbing part of this scenario is these are the patients in which I tend to see the most devastating visual loss, that unfortunately could have been prevented.
The reality of life these days is it is expensive. It’s expensive and money is hard to come by for many Thunder Bay families. It’s hard to justify spending money in today’s economy on something you really don’t feel is necessary. I understand this as well as anyone; but I am here to tell you it is money well spent. Odds are your eyes are healthy, and when you come in to see me, all will be routine. But let me tell you, if you are one of those patients who fall on the short side of the percentages and you have a serious affliction at an unlikely age, there is no worse feeling in the world than knowing you could have prevented something that has devastated your vision beyond repair. Like most health matters, early diagnosis and treatment is key in most ocular conditions.
Please get your eyes tested at least bi-yearly if you are between the ages of 20 and 60. We’d love to see you at Superior Vision Centre in Thunder Bay. We’ll make it a pleasant experience that will bring you peace of mind. Oh, and if you have any great Musky stories, we’ll book 10 extra minutes!