Losing Well Part 7

Continuation of my series, Losing Well. Part 1 can be found here. 


January, 2000
They decided to do away with my whole group as soon as this project is over at the bank. It’s classic common sense accounting that makes no sense in the software industry. Let’s cut all these expensive techies. But they don’t realize how much we save and earn the bank. Just another sign that MBA training is behind the tech curve.  Everyone is leaving. Stressful time.


February, 2000
I bought the condo! Went to San Fransisco for the first time. Got to see the Golden Gate. Went to a great 150 year old bar for breakfast not far from the Wharf. Also got a new job at the bank. I’m working on the web now. Another notch in my belt. I’ve been promised a team lead position if I stick it out. Otherwise, going out a lot. Dated a couple of girls. I’m not really ready.


March, 2000
Moved into the condo. Now I have a swinging bachelor pad right downtown. Let the fun begin. Running sound whenever the band gets a gig. Been a year since I found out about RP. What a mess it made of my life. Not all changes are unnecessary.


April, 2000
My life is surreal. It makes no sense to me. I’m fighting against a future so certain that I falter under it’s gaze. And yet I do the impossible. Everyday, day after day.  I no longer recognize what I have become. I never planned this version of me.
   

19 April 2000
    Went to Johns Hopkins. They had nothing good to say to me. My fields are down to 10 and 7. Around 5 percent. Found a cataract in my right eye, inoperable. They did not want to operate on my amblyopia either. Fine with me. I get the sense they’re just trying to make me comfortable without wasting effort on mostly fruitless opportunities. Did the DC thing on the way home. The capitol mostly. Also, I am now a team lead at work. 
    The following is my medical report from my appointment with Johns Hopkins. I’ve elaborated on the findings in brackets. The information was presented to me in this complicated fashion with little explanation.

Letter from Johns Hopkins:

We discussed the surgical options for the exotropia. He has a quite restricted visual field, and he may actually be gaining an artificial increase in his visual field with the strabismus [lazy eye]. I explained that we could surgically straighten the eye which would improve his ability to make eye contact and improve the appearance, but it would have the negative consequence of constricting his already limited visual fields.

Regarding the symptomatology, he has a strong left eye fixation preference and probably has used that eye most of life. Perhaps as the visual field has begun to decline, he is s witching spontaneously to the right eye more frequently. This use of an amblyopic eye can cause the instability that he noticed. In addition the cataract is probably causing the halos and blurred vision on that side..

Major Findings:

There is no significant improvement on pinhole. Retinoscopic [the refractiveness of the eye] flash of the right eye over his Rx was plano [flat].

Extraocular movement were full. The lids were normal. Visual fields were constricted with spared islands peripherally. Conjuctiva is normal.  Cornea is clear.  Anterior [toward the front] chamber is deep and quiet. The iris appears normal. The patient is pseudophakic [no known meaning] in the right eye and has a tiny posterior subcapsular opacity [opaque] in the left eye which I do not believe is visually significant.

Dilated fundus [the base of a hollow organ] examination was performed with indirect ophthalmoscopy [examination with a ophthalmoscope] and slitlamp for biomicroscopy [microscopic examination]. There is disc pallor [unnatural paleness] in both eyes. The arterioles [arteries between the muscles arteries and the capillaries] are narrowed.     

There is no definite macular edema [accumulation of fluid or hard tissue around the macula in the retina], but this was a difficult examination. There is diffuse bone spicule [small sharp-pointed particulates] pigmentation for 360 degrees in both eyes.

Goldmann visual fields [manual tests] were performed with to document any progression in the RP. In the right eye, he no longer had a temporal [towards the temples] crescent present. The central field to the V-4 appears slightly more constricted to about 25 degrees in diameter in the right eye. The left eye, there is still a preserved crescent temporally with a central field diameter of about 30 degrees to the V-4. Thus, there was a loss of the temporal crescent in the right eye and some small amount of narrowing of the field centrally.

Assessments:

1. Retinitis pigmentosa, sporadic inheritance.
2. Cataract, posterior subcapsular, right eye.
3. Exotropia constant [lazy eye].

Part 8 can be found here.