Friday, July 21, 2017

Cataract surgery did not improve vision, another problem found

As Gohan's vision continues to deteriorate since he fought cancer, Dr. Wakelee referred us to see an ophthalmologic oncologist at Stanford. After examination, Dr. Mruthyunjaya informed us that Gohan didn't have any major eye disease or tumor growth in his eyes except cataract - a relief news for us. Dr. M referred us to see Dr. Artis Montague, a renowned eye surgeon to check if Gohan is a candidate for cataract surgery. Dr. Montague said that Gohan's lens is at grade 2 on the scale of 4, she was confident that his eye vision will improve with cataract surgery just as the mass majority of her patients would. With hope, we signed on. The surgery was to perform on his right eye first and two months later his left eye. She asked if we still have the lasik record, which will help her determine the best lens for him. Gohan's lasik was done in 2001, and he did not keep the record, so she would do her best to guess. That is something noteworthy for those of you who have lasik done - ask your lasik doctor for a record now when she/he is still in practice. 

Dr. Artis Montague doing eye exam to determine suitability of cataract surgery 02-13-2017
The surgery did not happen until four months later in June because Gohan was hospitalized in April for a pneumonia as a result of a flu. The surgery went smoothly, although it is still energy draining for Gohan. I have gotten used to the doctors and nurses' reactions, when they first saw Gohan's medical record - a mixture of amazement that he is still living life as usual (as evidenced by getting the cataract surgery), sympathy and compassion. It is definitely a challenge for them to perform any procedure on Gohan because his health condition is so complex.

The post surgery care was not hard, only requiring diligence in using three different eye drops four times a day, but it still add extra tasks to our already busy caregiving schedule. We hoped that our efforts would lead to a better vision for him, hence, a better quality of life. He would be able to enjoy the scenery of mountains and redwood forest that he so loves. So when in the one week post op appointment, Dr. Montague found that his vision did not significantly improve due to an underlying problem, we were very disappointed. 

Excited to get cataract surgery on his left eye for the prospect of vision improvement 06-13-2017

With the new and clear artificial lens that is now in Gohan's right eye, she can see that a major portion of Gohan's retina has degenerated, hence, limiting his vision. As we discussed further, I came to the realization that she has not done her due diligence in reviewing the report and the scan result done by Dr. Mruthyunjaya in January. She pulled up the OCT graph from January which showed 75% degeneration. The condition is called degenerative myopia and can not be cured, and most likely will progress. The disease was caused by having nearsightedness for many years and the globe of the eye was stretched for too long as such the retina was stretch too thin. Now that is very disappointing news. Dr. Mruthyunjaya did not informed us about the disease, nor did the other ophthalmologists that Gohan has seen. I have found some doctors only want to talk about the good, not the bad in Gohan's presence. I also wonder if the disease was set off by the many cancer treatment that he has endured.

I asked Dr. Montague if she had known about the degeneration earlier, would she have recommended the surgery. She said she would have because it would bring in more light which will brighten his vision.  She comforted us that the cataract surgery has slightly improved his vision from 20/100 to 20/50 with glasses. He will not get 20/20 vision, but he will see better. However, she does not recommend surgery on his left eye implying the limiting factor to his vision is not his lens but the degenerative myopia disease.

Receiving OCT scan to track his degenerative myopia 06-21-2017
I felt her advice is contradicting, so I plan to consult an optometrist or an ophthalmologist for the next step or what we can do to slow the progress of the disease which may lead to vision loss and blindness. At the mean time, the initial disappointment has waned as days go by, and we are back to before, content with a blurry vision which Gohan seems to have grown accustomed to.


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