View allAll Photos Tagged Retinopathy
“Rather, it should be that of your inner self, the unfading beauty of a gentle and quiet spirit, which is of great worth in God's sight.”
- 1 Peter 3:4
Soundtrack : www.youtube.com/watch?v=YYj53rveap0
SEPTEMBER TEARS – SOPHIE ZELMANI
ON THIS DAY
On this day I could hardly see
but my other senses compensated me
I had my retinopathy
examination; drops that half-blinded me
they open up the eye to light
so sensitive to the sun
I donned a pair of sunglasses
I wanted to flee; I wanted to run
blurry scenes; I could not drive
a friend drove me to the sea
he guided me to the water's edge
he was my eyes; he accompanied me
I could hear the birds
I could hear all the words
of the many people who enjoyed this day
an Indian Summer's day had come
to warm our hearts and comfort some
the feelings were intense; it felt like May
beneath my dark glasses I squinted and blinked
just as well the man next to me did not see me wink
my friend shouted there's a kayak way out by the buoys
I lifted my glasses; tried to focus on the joys
usually my eyes are fairly keen
and nothing much escapes me
I've got intuition by the bucket load
it compensated for me visually
later that day when I got home
and my eyes began to clear
I checked my pictures excitedly
wondering had my instincts overcome my fears
looking at each frame I was filled with wonder
hardly a blurred image in sight
even though I stumbled and I blundered
an angel caught my arm; caught a bird in flight
angel's come in many guises
I am fortunate to have one always
guiding me through my many crises
cushioning my fall along external pathways
even in the dark I am not afraid
I can see my way so clearly
because true sight does not depend
on just the eyes to see
but from deep within our souls
and the angels who love us dearly.
- AP - Copyright © remains with and is the intellectual property of the author
Copyright © protected image please do not reproduce without permission
Leica m monochrome ccd summicron 50 f2 collapsible 1st
It was a hot and stormy afternoon. I underwent retinopathy injection surgery. There were memories flashing before my eyes. I suddenly felt compassion for the sun and shadows outside the window.
For .Monday`s Photo Challenge Group. The challenge this week was to photograph something fall or Halloween and to shoot "blind" without looking through the viewfinder in any way. To shoot blind is ironic, since I`m vision impaired (retinopathy) I shot over my head and hoped for the best. The post processing included adding the spiders. A little something for Halloween:-)
As I sat in the waiting area for my retinal ophthalmology appointment, I wondered if I was crazy for taking up photography. I have diabetic retinopathy, seems odd that a person who will eventually have no eyesight (in my 70's, touch wood) take up a hobby, and hopefully a career, where eyesight is so important.. Am i nuts? I guess I want to capture as much life as I can, before it all goes dark..
365 Project Day 17
Post retinopathy screening. Eye drops to make my pupils go huge. It's slightly unpleasant for the first few seconds then you get used to it. When walking around town afterwards it was like having a star filter built in to your head until it wears off - car headlights or anything especially bright look quite good! (takes a good few hours)
Causes of gradual vision loss
1.Painless loss
Refractive error - this is characterised by an improvement of the visual acuity with the use of a pinhole (if you don't have a specific occluder with pinholes, a biro point-sized hole in a stiff piece of cardboard will do). Refer to the optician.
Cataracts - the patient often complains of glare in dark conditions (and so difficulty in driving at night) and may complain that colours appear more dull than they used to. There may be an abnormal red reflex and, in advanced cases, the cataract may be visible to the naked eye (this is increasingly rare these days). Other aspects of the examination should be normal unless there is concurrent pathology. Refer routinely.
Age-related macular degeneration (AMD) - suspect AMD if the patient is aged >50 years and is presenting with either of the following symptoms, usually affecting one eye at a time:
Distortion of vision, where straight lines appear crooked or wavy.
Painless loss or blurring of central or near-central vision. The person may describe a black or grey patch affecting their central field of vision (scotoma).
Various other visual symptoms can occur, or AMD may be an incidental finding by an optometrist. Visual acuity on a Snellen chart may be normal or reduced. When viewing an Amsler chart (or graph paper), patients may see breaks, waviness, or missing portions of the lines. Refer urgently if AMD is suspected.
Chronic (primary) open-angle glaucoma - is most commonly picked up through screening. If it is so advanced that the patient is the first to notice it, very little can be done. It is characterised by a progressive peripheral visual field loss and 'cupping' of the optic discs (the central area of the optic disc enlarges and the peripheral rim thins out). The degree of urgency depends on how advanced the damage is.
Diabetic retinopathy - the problem may be due to the diabetic microvascular problems (ie exudates and haemorrhages), to associated pathology (eg, diabetic cataract) or unrelated pathology (eg, glaucoma). Refer promptly (within a week), as prompt treatment may prevent deterioration.
Compression of optic nerve or optic pathway - rare, but should be considered if there is a history of headaches and if you find any neurological or endocrinological abnormalities (eg, acromegaly) on examination. Look for a relative afferent pupillary defect (not usually present in the above conditions), a pale or swollen optic disc (the margins are not clear) and visual field defects.
Drugs, toxins or nutritional deficiency - eg:
Amiodarone - various effects on the eye
Antituberculous drugs - ethambutol and isoniazid (optic neuritis).
Hydroxychloroquine (maculopathy).
Systemic steroids (cataracts and glaucoma)
Phosphodiesterase inhibitors (eg, sildenafil).
Others drugs - tetracyclines (benign intracranial hypertension), isotretinoin, tamoxifen (various possible effects on vision).
Alcohol, smoking and nutritional deficiency - eg:
Tobacco-alcohol amblyopia.
Methanol poisoning.
Vitamin A deficiency (classically causes night blindness).
Hereditary retinal dystrophies are rare and, depending on the exact problem, present anywhere from early childhood to middle age. Some are rapidly progressing; others are very slow. Typical features particularly include poor night vision and intolerance to light. Poor appreciation of movement in the peripheral visual field may also be a feature. Ask about similar problems in family members (who may not have been diagnosed). Children should be referred more promptly than adults for whom a routine referral is fine. These patients will need genetic counselling as well as support where the prognosis is poor.
Cerebrovascular disease (stroke and TIA) - although these are likely to present acutely. TIA causing visual loss is termed amaurosis fugax.
Papilloedema - eg, from intracranial hypertension.
-----------------------
2. Painful loss
This is much rarer and tends to suggest a more sinister pathology such as:
A progressive neoplastic (eg, choroidal melanoma) or inflammatory process (eg, chorioretinitis).
A systemic problem (eg, sarcoidosis or collagen vascular disease).
Lesions on the optic nerve (eg, optic neuritis, granuloma or neuroma).
Intracranial pathology or masses (may present with headache, or with endocrine symptoms if a pituitary tumour).
Intracranial hypertension (may have headache).
All these patients should be referred. Referral is more urgent than with painless conditions and patients should really be seen within a few days.
If there is a problem, don't wait seek medical help.
---------------
Candid street shot Bergen, Norway.
here i am again giving this flickr thing another try :) my life is a huge mess right now so not sure how active i can be.. but i miss seeing all the beautiful work from so many truly special artists and human beings and i'm tired of feeling scared to come back because of painful experiences in the past.. it's been 2 years since i last posted and life's been pretty rough since then and lately things have been so bad that even picking up a camera has been a struggle.. but it's in part the reality of this struggle that makes me determined not to lose the rare bright spark in my world that photography is which, while often driving me insane, is something i don't want to live without..
which brings me to the meaning behind this image.. part of it anyway.. i recently had to come stay with my father (in itself desperately hard for me) as i was in serious need of medical attention that i couldn't get in california for lack of insurance.. less than 2 weeks ago i had a long overdo eye exam which revealed really bad news.. i have proliferative diabetic retinopathy, a serious disease which, had it not been caught now, could have made me lose my sight at any moment.. there's nothing they can do to repair the damage already done but i'm currently undergoing a series of intensive (and painful..) laser surgeries that basically burn a large part of my retinas to stop the disease progressing and save my sight.. this has been pretty terrifying for me especially as a photographer and the surgery itself risks damaging my vision further.. but there's no other choice.. and now that the panic has begun to ease a bit, the realization of how close i was to disaster has made me even more determined not to waste any more time and not deny myself soul enriching experiences and beautiful sights when i was so close to losing the ability to experience them.. so i want to overcome my fear and lack of confidence and just do what i love and need to do without worrying if it will be good enough.. for me or for anyone else.. so that's partly why i'm here :)
i'm still struggling to see well as the surgery is quite brutal on the eyes but i pray that once it's all over i will still be able to work without the difficulties i'm having now and that the doctors can help the rest of me so the sight i'm grateful still to have can be put to use by a body not quite so broken..
this is dedicated to seeking the light.. even in the darkest of moments and places...
A Life in the Lab: Four decades of working with Jerry Lutty
I met Jerry in the fall of 1974 when I joined Bernie Hochheimer’s lab at the Johns Hopkins Applied Physics Lab (APL) as a photographer in an NEI-funded study to examine dyes for possible use in clinical ocular angiography. Bernie, who was a brilliant physicist in optical systems, and subsequently worked on the repair of the Hubble Telescope mirror, co-developed ICG angiography in the early 70’s with Bob Flower who I would later go on to work with. Prior to joining Bernie’s lab, I had been a cinematographers assistant at APL, working on a documentary film about the life of Dr. R.E. Gibson. He was, at that time, Director Emeritus of the Johns Hopkins Applied Physics Lab and and Professor of biomedical engineering of The Johns Hopkins University School of Medicine. One day after filming wrapped, he invited me to join him for lunch in his office at APL. Dr. Gibson suggested that I would be better served if I pursued a career in science, even though I had no formal training in that field. He asked me to meet with Bernie to discuss working in his research lab at APL and Wilmer. Needless to say, when Dr. Gibson spoke, I listened.
I met with Bernie shortly thereafter, and was offered the position which I promptly accepted. Bernie was such a good man and someone who made a tremendous contribution to the field of ophthalmology. In addition to ICG angiography, he helped develop, (in collaboration with Dr. Arnall Patz), laser photocoagulation as a method for treating diabetic retinopathy. I reported to work the following week and was introduced to Jerry who was, at that time, conducting the toxicological aspect of the dye study. I later found out that Jerry also had a connection to Dr. Gibson who steered me to Bernie’s lab. His father-in-law, Dr. Alfred J. Zmuda (A.J.), was a specialist at APL in geomagnetism, ionospheric physics and space physics, and an expert on the Aurora Borealis. I had to admire Bernie for hiring two guys who looked like they could have been at a political protest or an Earth Day celebration on the National Mall the day before. We both had hair well below our shoulders and Jerry had a big beard which he wore for the remainder of the subsequent 40+ years we worked together. We hit it off immediately and would take walks around APL’s campus at lunch time discussing art, music, politics and photography. I looked up to Jerry as I found him to be a kind and gentle soul, with a passion for knowledge and a temperament for teaching.
Following the completion of the dye study in the 70’s, Jerry and I worked in different labs on the same floor of the Woods Research Building at Wilmer. Jerry became involved in ocular angiogenesis research under Dr. Arnall Patz (who was director of the Wilmer Eye Institute at the time) and I worked with Bob Flower to further develop ICG angiography for clinical use. Later, in the early 80’s, Jerry and I collaborated on studies of Retinopathy of Prematurity under Patz and Flower. Dr. Patz had received the Lasker Award in 1956 for his research showing that giving high levels of oxygen to premature infants was causing an epidemic of blindness in those babies. We felt that a key to understanding the vasculopathy of ROP was a better understanding of normal retinal vascular development. Jerry and I worked closely on the project for the next several years and developed a new technique for visualization of the retinal vasculature. In the 80’s, the number of NIH biomedical research grants to be funded was slashed by 23%. Even though we kept the project going for the following several years, primarily through the generosity of donors to Wilmer, I eventually was forced to return to APL for several years until the biomedical research funding situation improved. While Jerry was fortunate to remain at Wilmer, we did manage to collaborate part-time on several projects during that period.
In the early 90’s Jerry received an NIH grant to study sickle cell retinopathy, and an RPB grant to study diabetic retinopathy. I returned to Wilmer again on a full time basis. I was incredibly lucky to have worked with both Jerry and Dr. Morton Goldberg on the sickle cell project. Dr. Goldberg was Wilmer’s Director at the time and an expert on sickle cell retinopathy. We were very productive during that period and gained valuable insights into vaso-occlusive processes in both diabetic and sickle cell retinopathy. We identified growth factors in sickle cell retina and showed that arteriovenous crossings were a preferred site of seafan formation. Seafan was the term coined for the neovascularization that formed at the interface between perfused and nonperfused peripheral retina which resembled the marine invertebrate Gorgonia flabellum.
In diabetic retina, we showed increased levels of the cell adhesion molecule ICAM-1 in retinal vessels. This protein could contribute to the retinal microangiopathy observed in diabetics by enhancing leukocyte adhesion to endothelium and consequently the incidence of capillary obstruction. Our study and subsequent work demonstrated ICAM-1 and its binding partners are operative in diabetic retinopathy and may serve as potential targets for therapeutic interventions. The publication of that work, in The American Journal of Pathology, has been one one of our most cited papers.
In addition to our work in diabetic and sickle cell retinopathy, Jerry also received NIH funding to continue our work on Retinopathy of Prematurity during the late 90’s and early 2000’s. We demonstrated the anti-VEGF (Vascular Endothelial Growth Factor) therapy was effective in reducing neovacularization in animal models of ROP, but that therapeutic doses should be carefully considered clinically so that retinal revascularization wasn’t inhibited.
The 2000’s brought continued success and renewed interest in normal fetal development of retinal and choroidal vasculatures. The discovery that the fetal choriocapillaris formed by a process of hemovasculogenesis, a process in which vasculogenesis and hematopoiesis occur simultaneously, was intriguing. Our work in fetal choroid led us to begin studying the choroidal vasculature in disease states, particularly, in Age-Related Macular Degeneration (ARMD). We showed that choriocapillaris dropout occurs in eyes of ARMD prior to clinical manifestations of disease. Additionally, we found that mast cells in choroid may contribute to the dry form of ARMD. These studies are still ongoing by Dr.’s Malia Edwards and Imran Bhutto at Wilmer.
I officially retired from Wilmer in 2018, however, I continued working with Jerry on a part-time basis to finish up some papers for publication. I had known and worked with him for over 45 years. He had been a mentor, a collaborator and one of my dearest friends during that time. He was a remarkable human being and I consider myself extremely lucky to have been a part of his lab and his life. He mentored countless high school students, undergrads, medical students and postdocs during his career. His teaching style, patience and desire to inspire future generations in science was an attribute to his impeccable character. I was deeply saddened by his passing as many in his circle were. We lost a a giant in science, a kind human being, dear friend and a devoted family man!
Day 77, March 18th, 2021
Waiting at the Vet
It was time for the dogs’ annual check-ups at CanyonVet Canyon Lake with Dr. Leakey. Even though it’s a lot of work to take all three dogs in at once, it’s nice to get them all done at the same time. CanyonVet has the most stringent Covid-19 protocols I’ve seen anywhere. When you arrive, you call them to let them know you’re there. They check you in over the phone, verifying what services you want. Then a vet tech comes to the car to bring the dogs inside. We wait in the car the whole time. We pay over the phone and they bring them back out. Charlie, Lola, and Stuart all got clean bills of health, got their vaccinations, and their heart worm preventative. The only thing I forgot was the nail trims. Ugh. Not sure what to do about that, I hate doing it myself because I’m worried I’ll hit the quick. Poor Charlie is almost totally blind now, his cataracts combined with his degenerative retinopathy means he can’t really see much at all especially at night.
Dr. Leakey came out to the car and chatted with Anna about all of her current interests… he always lets her come into the clinic and see the animals but couldn’t this visit. He promised next time she could. He’s a sweetheart. This is a terrible photo, Charlie's not in focus and Lola is blown (and my hair, ugh!) but it captured the chaos! Would you believe we had to bathe Stuart twice before we came in? Dominic did the first bath then that stinker of a dog went out and rolled in the sand pit while he was wet so I had to give him bathe number two. Little butthead!
A lot of times, people will encourage you on Flickr to 'view larger' for the full effect. The photo above however is the exact opposite as I think it looks better smaller.
I tend to go 'rapid fire' when exiting a Disney park, most notably Epcot. Part of me is hoping to grab something special, while I suppose the other part of me just doesn't want to leave.
What this misuse of burst mode usually spells is a lot of culling and deleting when I finally get back home. Sans for the photo above. Something about it stood out to me - though admittingly, the fisheye lens (Sigma 10mm) makes it a bit of a visual annoyance for my eyes. It looks Spaceship Earth is being twisted and mushed - at least it does for me until I finally go crosseyed. That darn central serous retinopathy in my left eye probably doesn't help.
Got another WDW trip on the books, though for that one we'll have a 4-month old and my running shoes in tow. Not sure how much time (or energy) will be left for photography, but I'll do my best. Was thinking of picking up a compact or mirrorless system for the trip since I'll be trading the camera bag for a diaper bag. Yea! More toys!!!
Will have to see how that goes
Canon EOS 7D
1/100 sec at f/7.1 | ISO 100
10mm
Day 65, March 6th, 2021
Groomed Charlie Chewing a Toy
Charlie got groomed and that makes him extra frisky. Whenever he gets home from the groomer, he prances all around outside. He found an old chew toy and plopped down to gnaw on it for a while. I’m glad I’m getting some photos of him because he’s starting to show his age. I had to physically pick him up to get him in my SUV and Curtis had to come get him out. I haven’t seen him up on our bed in months. I think it’s because he’s having trouble seeing. He has a degenerative retinopathy common to poodle breeds. He will be 12 years old in April.
it was a sunny, beautiful morning and odin came into the bedroom.
"poppi, i see spots. i think i'm getting sick."
and so, that's how an otherwise normal day started. at first i thought he might be playing a game, but he was pretty specific and consistent with the details about the spots in terms of size and color and number.
i suddenly found myself attempting to not freak out as i recalled that the sudden appearance of floaters could be sign of retina detaching and, of course, most of you know he's at a higher risk for retinal detachment thanks to his history of retinopathy of prematurity.
so, after debating whether or not we were being alarmist, we scheduled an emergency eye exam and i found myself having a surreal lunch with co-workers about the odds of odin having a detached retina.
a few short hours later and we're in the doctor's office and odin is going through the pupil dilation routine and time is slowing down to a halt. dilation drops go in both eyes. and left eye checks out fine. right eye didn't dilate properly. doc thinks the nurse didn't put drops in, but i'm sure she did.
something feels wrong.
the doc looks into odin's right eye after putting more drops in and waiting 10 more minutes, pauses, covers his odin's left eye and asks him to identify the shape on the wall.
"i can't see it," odin responded.
time is slowing down more. odin is smiling, happy to be sitting in the cool eye doctor chair as i hear the doc say, "we have a problem," followed by phrases strung together loosely.
"detached retina"
"essentially no vision in the right eye"
"emergency surgery at the mayo clinic".
we won't know much about prognosis or probable outcomes until he gets evaluated by the experts. we expect that we'll hear bright and early tomorrow from the mayo about when he'll go in for evaluation and surgery.
needless to say, coming less than 2 weeks away from his fourth birthday, we're feeling a little sucker-punched.
it's been almost 1,400 days since rop surgery and i was really starting to hold out hope that we had finally escaped its grasp.
The drops they put in your eyes hurt like hell hot coals still they have to do it glad it's only once a year strong sunlight is a nightmare sat at home with the blinds closed !!
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