Tuesday, April 21, 2015

Janus and Vision

Janus was the Roman god with two faces: one faced forward to see the future and one faced backwards to see the past. Seeing was clearly a big focus of Janus'. I always found the image of Janus intriguing, perhaps because vision has been a big part of my life. Vision, the kind that describes imagination has been a big motivation for much that I have tried to do, but here I am looking at Vision, the kind that lets us physically see things.
The former moves us to imagine and pursue whatever we imagine - one former US President called it "the vision thing" and everyone knew instantly what he was talking about. The latter, the ability to see our surroundings is considered the most complex and most important development in the history of animal evolution.

Most people do not give vision much thought unless they lose it to some degree or completely. Throughout my life however I have repeatedly dealt with serious vision issues and have stayed ahead of disaster only thanks to a few wizards and the just-in-time evolution of technology. So here is my chronology of dodging the bullet and my reason for wanting to spread rose petals in front of my eye surgeons.

 Troubles started in my teens needing eye glasses like many other kids. By the time I was 19 and finished three years in the Italian Navy, my condition, keratoconus (in both eyes) had deteriorated enough that I could no longer be in the military since vision correction could be done only with special contact lenses. In 1970 I moved to the US and was rejected for the then compulsory draft for the same condition, A young optometrist at Indiana University, Barry Gridley, took my case as a mission and became a wiz at hand grinding my hard contacts to custom fit. Without him I probably would have never finished my MBA and started my career. That was the time when I started being a "special case" that students would come and look at to see the "real thing" described in their textbooks.



By 1976, at 25, in Seattle, my condition had deteriorated enough that I could wear my contacts only few hours a day and was legally blind without them. Then I depended on helpful friends to help me cross the street and to tell me what bus to take, I learned to count stops to get home, and fell off sidewalks when walking alone. For much of my day I was effectively blind. By then, however, cornea transplants were coming out of R&D. The development of corneal sutures made the operation more practical and I was lucky to find one of its leaders at University of Washington. Seattle was also one of the first locations in the country where organ donation was getting traction, so donated corneas where easier to find than elsewhere. Those early surgeries did not deliver the near perfect vision they do today, so I was back to needing a hard contact lens, BUT I could wear it all day. My life changed overnight. The following year the right eye got the same treatment.

Over the years, the corneas deteriorated  into extreme astigmatism. By 1998, in Scottsdale AZ, a new wizard, Robert McCullogh, and new laser technology, LASIK, came to the rescue and both eyes were treated. Once again I was a new man.
By 2007 I was back in contacts, and the cornea in the right eye was failing. It was suspected that a baby's cornea had been implanted (because of no better alternatives available) in 1977. A new transplant saved the day - bless donors, surgeons and technology again. With the new state of the art I was in and out of surgery in three hours, back to work in two days with perfect vision and a cataract removed simply because while the eye was open, why not?
By 2008 the left eye too needed a cataract removed and a special lens was implanted to correct astigmatism. For two months I had perfect vision in both eyes. Then the implanted lens rotated in its setting and perfection was just a memory. Contacts to the rescue again, life would go on.

In 2012, in Park City UT, astigmatism was once again messing up my life. Even with contacts I could not see a tennis ball coming at me until it had crossed the net. At the University of Utah I found a new wizard, Dr. Bala Ambati Chief or Corneal Research at Moran Eye Institute (the youngest MD ever graduated in the US, 2015's  #1 of Ophthalmology 40 under 40 and more at www.doctorambati.com), and a new laser technology promising deliverance. Laser relaxing incisions in the left eye gave me vision good enough to pass a driver's license vision test with no correction. Not perfect but good enough. So in January 2013 I had the same treatment in the right eye. The result was not expected: the cornea, cut by the laser, became completely cloudy. I was totally blind in one eye. It was determined that the cornea implanted in the second transplant, had Fuchs' Distrophy, a disease that could not have been screened for before the transplant or before the last laser procedure. One year of visits and medications gave us no solution, so in 2014 it was time for a third transplant. This time it was to be a "partial transplant" to minimize the chance of rejection (it increases at each successive transplant). This mind-boggling surgery scrapes a layer of diseased cells from the inside layer of the cornea and replaces it with donated cells. Impossible to imagine unless you see it (see it here, no gory bloody scenes).  The transplant was a total success and in three months my right eye was better than the left. But we were not done: last month Dr Ambati put two permanent stitches in my left cornea that eliminated the remaining astigmatism. End result: Left Eye 20/25, Right Eye 20/40. Scientists do make miracles

So, if I were Janus, after this long look back at my life, what should I plan looking forward?
1. Spreading rose petals to walk on for the wizards that save my vision would be appropriate,
2. Practice gratefulness by finding ways to give back to others the gifts that were given to me

Every day I celebrate the beauty of the world that I now see around me and I feel like dancing.



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