Vision

A representation of my visual field.  I do not see what is black.

I acquired four major visual deficits post-injury:

 1) Left Homonymous Hemianopia (or, Hemianopsia)

2) Terson’s Syndrome

 3) Double vision

4)  Afferent Pupillary Defect


The first 2 visual deficits were not discovered until about 2 months post injury.  A formal diagnosis of Hemianopia was not determined until 8 months post injury and after the vitrectomy.  In 2009, I began noticing  intermittent double vision, which was formally diagnosed in 2012.

 

Left Homonymous Hemianopia is when you lose the left half of the visual field in both eyes.  Each eye receives images from the right side and left side of the visual field.   These images from each eye join and cross over to be interpreted by the opposite side of the brain (left visual images are processed by the right side of the brain). My brain injury happened to the right side of the visual pathway beyond the optic chiasm.  Basically, the junction that brings the images from my left visual field no longer exists.  That part of my brain passed away.  I am told that this condition is permanent and legally cannot drive because of this deficit.

 

Hemianopia is, by far, the most difficult deficit for me to deal with.  Objects appear and disappear out of nowhere.  I walk into things and knock them over. I almost got hit by a car because I did not see it.  I sometimes miss the first or second letter or number when reading.  At first, I would only see half a car or one headlight which shocked and unsettled me.  Now, I think my brain has filled in the other half of the image so it looks like I see a whole image.

I met with Dr. Greer at UC Berkeley’s Low Vision clinic and tried prisms.  Prisms are affixed to your glasses and you must glance or scan constantly to pick up images from the non-seeing side.  I tried prisms for a week. They were confusing, distorted my visual field and did not give me enough warning for objects I might walk into.  The more time I spent scanning to my left, I would have inattention on my right and walk into things.

  Vision uses 50% of brain power and is the sense most difficult to regain and is not very hopeful to grow another pathway.  You can relearn to move your finger because it is an action.

 

A lady from my support group, who had hemianopia tried hyperbaric oxygen therapy and vision therapy.  She regained enough of her vision to return to driving.

     

I tried hyperbaric oxygen therapy and vision therapy.  There was minimal graying along the half way point of my visual field test.  A subsequent visual field test showed a solid hemianopia. 

I would still like to prove the Doctors wrong and build a bridge to restore this optic tract.  I guess that’s a bit of my stubbornness shining through.

I developed my own experiment in 2009 to try to “solve” hemianopia.  Fashioned after the upper limb constraint therapy, I created custom contact lenses with UC Berkeley to block off the seeing half of my eye…essentially forcing the non-seeing half to see.  How would you “regrow” vision if you cannot separate out each side and make it work?  When I have statistically sound results. I will present my findings and protocol.  Stay tuned, I think I am on to something. 🙂

 

Terson’s Syndrome is when there is so much pressure and blood inside the brain that it hemorrhages into the eyeball.  The eye is considered part of the brain.  It is believed, but uncertain, that the blood travels up the optic nerve and pushes through the retina into the vitreous of the eye.  Terson’s Syndrome affects 3-13% of severe cerebral hemorrhages.  In 2011, I was diagnosed with phantom pain behind my right eye, due to the residual from the severity of my brain and eye hemorrhage.  This pain is best explained as someone is trying to pluck out my eyeball with a meat-hook behind my eye.   

 

It is like a snow globe of a floating blood clot in the eye. 

 

In my right eye, most of my vision was occluded, with the exception of the right periphery which I could see a little but, only through tendrils or, cobwebs of clotted blood.  If I moved my eyeball or head, the tendrils or, cobwebs would move.  I was told to wait six months to see if the large blood clot would resolve on its own (be absorbed by my body).

 

After six months the blood was still there so a vitrectomy was recommended and performed.  A vitrectomy is when a retinal surgeon sucks out your eye juice (vitreous) and puts new eye juice back in.  The new eye juice is clear plasma that, over time, my body will replace with its own vitreous.

 

After the vitrectomy, we were all hoping for a curtain lifting so I could see.  My vision was very blurry after the vitrectomy, in part due to the dilating eye drops.  After about 2 weeks or so I began to “see” some improvements.  Unfortunately where the blood pushed through my retina, there was damage to my macula (roughly the center of my retina responsible for detailed central vision).  The vision in my right eye was very blurry due to this damage. 

 

I started taking eye vitamins and patching my eye.  I patched my left eye at least half an hour a day to make my right eye work and possibly rebuild my macula.  How can I expect my right eye to get better if it is lazy and tags along with the left eye?   I have improved my visual acuity.  It is not 20/20, but 20/50, a vast improvement from when the curtain was first lifted.  Fast forward a couple years and I have improved my vision in my left eye to 20/30 with corrective lenses.  My central vision is still impaired but, all a vast improvement. 🙂

 

In my left eye, the hemorrhage is encapsulated behind the retina (sub hyaloid).  I do see a little floating cobweb when I move my eye.  If this clot ever dislodges and occludes the vision in my left eye, I would need to have a vitrectomy of my left eye.  For now, it’s status quo.  Fast forward a couple years, in 2011 I visited my retina surgeon and that clot in my left eye has been absorbed by my body. 🙂  There is still blood under the retina in my right eye, nasally, so it is on my hemianopic side and should not “impact” my vision.  In 2015, I learned that blood was finally reabsorbed.  Very cool.  See the body is always trying to heal.

I have pain directly behind my right eye, as if you were to scoop out my eye, right back there.  I have been referred to an occular orbit specialist, a.k.a. the eye socket doctor.

Double Vision I have another image superimposed lower and to the right.  This is due to my right eye not aligning to focus.  It is more noticeable when I look at a PowerPoint presentation and also at times when reading.  I have a small prism affixed to my right lens in my glasses to correct this.  

Afferent Pupillary Defect (a.k.a. APD)  This means that my optic nerve of my right eye was damaged, quite possibly from when the blood in my brain hemorrhaged into my eyeball.  What this means is my pupil does not react (constrict down) to bright light as much as my left eye.  Only a little more than 5 years later did I learn this diagnosis.  My first neuro-ophthalmologist mentioned APD to his entourage of medical students but, this was not explained to me back then.

 

Once again, I am hopeful that I will regain some of my visual field and more acuity.  

About 1 week post vitrectomy

About 1 week Post Vitrectomy

 

 

A neat photo of my eye

A neat photo of my eye