The good news is that the most severe cases can be treated with full-thickness corneal transplantation with a very high success rate. Thank God for the many talented fellowship-trained corneal specialist ophthalmologists across this great country (and all the organ donors also!) For now, I am sure that Glenn is probably having difficulty with his reading and possibly night driving. The real problem is that the mild to moderate cases will cause lots of aggrevation and blurriness but may not get to the severity where transplantation is recommended. It’s kind of like having a bad heart and you get short of breath and feel weak and tired but you’re getting by and you’re not bad enough to go through the rigors and long recovery of an actual heart transplant. For Glenn Beck, at some point down the road, his problem might get bad enough that corneal transplantation could be considered. At present, I pray that his problem remains stable and he can retain reasonably good vision.

Last week, one of my cataract surgery patients had to take a cab to the surgery center, since her family lived far away and she didn’t have a ride. Her surgery went perfectly well, but I discovered that the surgery center had a policy of not releasing patients to go home in a cab by themselves. After much discussion, no one could find anyone to come and take her home, so I had her wait 30 minutes until I finished my last case, and I took her home in my minivan. She had a very safe driver (me), a very safe vehicle (5-star rated Sienna) and we had a nice little chat.

It’s not something I do everyday. I did the same thing last year for a cataract surgery patient that drove in by himself from out of town and stayed at the cute little motel near my office. Sometimes you just have to get things done and it’s nice to be able to help.

     This patient was a 65 year-old man on only 25 mg of Topamax a day for headaches.  It took us over 8 hours just to get the eye pressure under 50 (which is still about 3 times normal.)  He was rapidly losing vision from an attack of acute angle closure glaucoma IN BOTH EYES.  That is one of the most significant things that people don’t always realize.  In my business it is extraoridinarily rare for an acute, severe problem to happen to both eyes unless there is some sort of terrible industrial accident, explosion or facial trauma.  Topamax, when it causes this extreme side effects, will almost universally affect both eyes.  What is the indicence?  I don’t think anyone knows but I’ll just throw it out there.  If I make a very gross estimate that there might be 2000 people in my city taking Topamax and I, personally have seen 2 attacks in one year, then that would put the risk at about 1 in 1000.  Please understand that I have no scientific evidence to base this rate on and that this is purely my very rough estimate from my experience only.  So take it for what’s it worth.

     By the way the patient has improved dramatically but is still on four different glaucoma medications and one dilating drop.  He is nowhere close to a full recovery and I suspect that he will probably have long term negative effects from the attack.

     If you are on Topamax or considering taking it, please be aware that it can cause acute myopia, choroidal effusions, acute angle closure glaucoma and severe vision loss.  There is absolutely no way to predict who will get this side effect and it can occur even at very low doses.  If you are already taking Topamax and you notice any early signs of vision loss or eye pain please see an ophthalmologist immediately.

All this brings to mind other animal related eye injuries that I have seen over the years.  The worst have been dog bits and for some reason, dogs seem to have a preference of going for the face.  The funny thing is that it’s not always the big Rotweillers, Pit Bulls and Dobermans you would suspect, but sometimes Shih Tzus and Jack Russells or other energetic little dogs.  Our middle child Ashleigh, was actually bitten in the face (very minor injury) by a nearly blind Jack Russell while playing at the beach.  Thank God I have never seen any snake bites, lizard bites, bat bats or otter bites (even though a man was just attacked by a rabid otter in Venice, Florida last week.)

Did you know that people who have pet tarantulas can develop severe eye irritation from the little spider hairs getting into the eye.  It’s a well known situation described in multiple medical journals, so tarantula lovers, keep those furry friends far away from your eyes.  Definitely not a problem for me.  And if you are tempted to play with a Walking Stick bug, beware, since these mild looking, but potentially angry little guys, can shoot an extremely irritating substance into your eyes.

I guess, the take home message is to just be careful and use common sense around pets, animals and insects.  It’s one thing to get scratched on the arm but quite another situation if it happens to one of your eyes.

The American Academy of Ophthalmology has recognized Dr. Kutryb with the Lifetime Education for the Ophthalmologist (LEO) Continuing Education Recognition Award.  Only Academy members who have earned at least 150 AMA Catagory 1 Credits in Academy-designated programs within a three-year period are eligible for this award.