Quirky

When things don't totally add up in the usual way, that may mean that it's a God story.  I had one of those happen to me yesterday, at least yesterday was when the story became the God story.  I was born with a birth anomaly, among others, called a coloboma.  This condition involved my right iris and pupil and caused my optic nerve not to grow in properly.  As a result, I have had one-sided or monocular vision since I was born.  The little vision that I had from the "bad eye" was only of movement or color, but I could not distinguish any objects clearly.  Lacking depth perception, I was never much good in the ball sports, having tried out for softball and basketball without making the team.  Thankfully, my chosen sport, horseback riding, was unaffected.  I was able to drive, because my left eye vision was perfect and the brain has adaptations in the setting of monocular vision.  Due to plasticity, or rewiring of neurons in early childhood, I have a heightened sense of size and shadow, helping my perspective on distance.  3-dimensional movies have always been lost on me, and some optical illusions as well.  One doesn't miss what one has never known, at least not much.  I was not destined to be a surgeon either, always told that I cut the knots "too short" or "too long" when I assisted as a medical student in the operating room.

More recently, I had been told that a cataract had grown in that eye but not to bother correcting it.  About three years ago, a brownish spot started floating along the center of my vision, and I thought it might be a floater.  My eye exam only showed a cataract and the need for computer and reading glasses.  Strangely enough, over the past two years my computer and reading vision improved, so that I no longer need glasses.

Then, this past winter, I began to notice that my "bad eye" seemed to lag.  In photos, this created a zombie effect that was noticeable.  Of course, with the history of breast cancer, I worried for a moment; however, consulting Dr. Guyton at the Wilmer Eye Institute and the internet, it became clear to me that this is a common problem when one eye does not see well and the other does.  I had also been working 10-14 hour days, including Saturdays, while gearing up for major work projects.  I looked into having the problem corrected surgically, but when it became clear that it would amount to general anesthesia, I had to resist.  I have had so many surgeries in this short life, including 4 in the past 2 or so years.  After vacation earlier the summer and fewer hours at the computer, this problem has become less pronounced.

I went to see my eye doctor yesterday, also a medical school classmate of mine, and described all of these things.  Eye muscle weakness could have been worse with fatigue.  My vision may have improved with better control of dry eyes and allergies.  What was hard to explain, though, was that the previously noted cataract could not be found, at least not at first.  In addition, my right eye vision had improved to the point that I was able to count fingers!  Dr. Castelbuono asked whether I had had eye surgery, and I said that I had not.

Then he went looking and, lo and behold, the lens that had been affected by the cataract had moved out of position and was sitting in a parking spot at the back of my eye. My right eye, essentially, no longer has a lens at the front.  The rods and cones on the upper portion of my retina (vision and color producing cells at the back of the eye) also looked healthy.  Thus that would explain why my vision in the right eye had improved.  Maybe science, maybe God, or both?  Neither he nor his resident had seen this before.

Anyway, since yesterday, I have been trying out the right eye and find that it allows me to grab the phone or my computer mouse on the right.  Not like I will eventually be reading with that eye, but I think it's time to try to strengthen the muscles now that my "bad eye" sees a bit more than before, so that I really can avoid surgery.  Who knows whether or not that would really work, but it's interesting to try.

As I was exercising at the pool today, I was thinking of the metaphor of "the scales falling off" of my eyes.  Maybe I should marvel even more at how my perspectives have changed over time.  Some things I had failed to see before have become apparent.  I am grateful for the process, both in the case of my eye and in the case of my life perspectives, that the vision changes have been none too sudden nor traumatic and have been for the better.

At some point, I may blog on my trip to Italy, but for now I am just grateful for having had the rest and now having the arrival of reinforcements at the office.  Amy, our nurse practitioner, has been a most welcome addition to the team and is doing her part in sharing the labor and joys of the transformation of our model.  I am confident that our patients and we will reap the benefits of all of the hard work and creativity that is going into our Patient-Centered Medical Home.