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Stories From the Edge of Blindness

In 2002, Retinitis Pigmentosa changed my life. This is my story of a slow approach to darkness.

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degenerative diseases

Isn’t that Something Only Old People Get?

RP is anything but straightforward; it comes with lots of extras that you wouldn’t expect. A year after my diagnosis, I thought I had become pretty versed in the language of RP and what I might possibly be faced with as the disease progressed.  Night blindness had become a part of my fabric, light sensitivity was something I was constantly dealing with and I was learning how to become a vigilant scanner while walking down the street.  But, I had only skimmed the water.  And, at that time, I still had about 50 degrees of vision.  This diagram may help with the whole degrees of vision thing.

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As I understand it, normally sighted people have about 85 to 110 degrees of vision, well into the far peripheral.  At the time of my diagnosis in 2002, I had about 50 degrees.  Now, I have between 15 and 20 degrees, and in the RP world, that is actually pretty good. I think this diagram also shows how much of what we see is considered peripheral vision. This was a bit tangential, but I hope it gives some clarity.

So, back to 2003.  I was due for my annual visit to the retinal specialist; Dr. Heckenlively had left UCLA to work in Michigan and his patients had been split between 2 other Retina guys.  It would be my first time meeting Dr. Sarraf, and despite the fact that he would inform me of an RP extra I hadn’t expected, I loved him.  Dr. Sarraf is an incredibly kind and gentle doctor, who gets genuinely excited to give good news and is insanely smart; he is one of those serious research guys and I am lucky to be in his care.

The day I met him, he walked into the darkened room, shook my hand, chatted to me for a while and proceeded to examine my eyes.  I can’t lie, I don’t look forward to this eye exam; it hurts, a lot.  My light sensitivity is extreme on a regular day, even with sunglasses, so imagine how much a bright light aimed directly at my dilated pupils feels; it’s like someone is poking my eyes with hot needles.  Not fun.  Anyway, I digress.

Dr. Sarraf does the exam, sits back down in his chair and, in his soft and comforting way, tells me that I have cataracts in both eyes.  What the Fuck?  Cataracts?  Isn’t that something only old people get?  Apparently not.

Here is a simple explanation of cataracts: A clouding or loss of transparency of the lens in the eye as a result of tissue breakdown and protein clumping. Cataracts affect most people who live into an old age. Symptoms include double or blurred vision and sensitivity to light and glare.

Cataracts are commonly seen in RP patients, but doctors and researchers don’t seem to know why.  When Dr. Sarraf told me I had cataracts, I felt devastated, which was difficult for some people in my life to understand.  I remember my step mom telling me that it wasn’t a big deal because cataracts can eventually be treated, but for me, it was a huge deal.  Of course I knew that cataracts could be removed, but I was 34 years old and I sure as hell hadn’t met any other 34 year olds who had fucking cataracts. It was one more thing piled on top of everything else that RP had brought into my life; it was one more thing that made me feel defective, broken and different.

Almost 16 years later, the cataracts are still there, slowly ripening, but I don’t give them much thought. They are just another thing that comes with having RP, an added challenge to an already challenging disease. I don’t love that I have them, but I have accepted the cataracts as part of my RP journey.

 

It’s Right in Front of You

I was 33 when Dr. Heckenlively told me I was going blind.   After dropping the bomb, he took a vial of my blood to, as he so eloquently put it, “rule out syphilis”,  gave me a list of vitamins that might slow the progression of my disease, and sent me on my way. I felt like I had been punched, like I was lying prostrate on the floor and couldn’t breathe.  I was overwhelmed, felt clueless and afraid.  I had no idea what RP was going to do to my life.

When I first heard about RP, it was from a TV show, and a million miles away from my reality.  The TV program talked about RP being genetic and introduced families with multiple people affected by the disease; the first time it was suggested that I might have it, I ignored it because no one in my family even wore glasses, except me.  I soon learned that RP is most often genetic, but not always; there are a handful of us that are the sole proprietors of RP in our families, and in my case, I was completely unprepared for it.

I did my share of online research in the months before my diagnosis, but a lot of it was about the genetic aspects of RP; this gave me a false hope that I didn’t have it.  I read countless simplified descriptions of RP symptoms: Night blindness, loss of peripheral vision and eventually central vision, resulting in total blindness.   I am not a particularly sciencey (yes, I know that isn’t a word) person, but I will try to throw a little bit in here.  Basically, the retinas are made up of 2 kinds of cells (photoreceptors), called rods and cones.  The rods are responsible for low light and night vision, while the cones are responsible for color and detail.  There are way more rods than cones, and the rods are the ones that begin to degenerate first in a disease like RP; that is why we experience night blindness and a loss of peripheral vision.  I am sure this is a very rudimentary explanation, but hopefully you get the sciencey picture.

When most of us think about peripheral vision, we think about stuff that is seen way off to the side, or out of the proverbial corner of the eye.  The truth is, because peripheral vision is dictated by the rods and the rods are pretty plentiful, peripheral vision is actually most of our vision.  It is what you see all around you, not just way off to the side.

About six months after my diagnosis, I remember looking for a coin purse that I had dropped on the ground; I was looking all around, repositioning myself, but I couldn’t find it. The person I was with was perplexed and said, “it’s right in front of you.” The thing is, that phrase, “It’s right in front of you,” means nothing to someone with RP.  When you have RP, right in front of you can shift and change and disappear completely. It can seem to an observer that I am looking right at something, but if my eyes are directed just slightly to the side of whatever it is I am looking for, it may as well be a grain of sand in the ocean. Peripheral vision is huge and complex.

I have searched for my husband in our apartment, walking past his desk 10 times, and it turns out he has been sitting there all along.  When my dogs are standing at my feet waiting to have their harnesses put on for a walk, I have to scan the area several times to locate both of them.  In a restaurant, I never see the waiter trying to hand me a  menu, and glasses of water seem to materialize out of thin air.  If I drop something on the ground, I often have to ask for help to find it. RP comes with so many challenges that I could never have imagined, but I am learning to be more patient; to take the time I need to find things and not allow my frustrations to take control.

I am sure that I leave stuff out that people might be curious about, and I welcome curiosity, so please don’t hesitate to ask questions.

You can also find me on Twitter and Facebook.

 

 

 

 

 

What do you See?

Most of the time, I find that people seem reticent to ask about my vision; I don’t know if it makes them uncomfortable or if the concept of someone being partially sighted is just too hard to grasp, but the presence of my blindness often takes up a strange space in the room. When people do ask, I actually appreciate it because it gives me an opportunity to explain how RP behaves, and also because it offers a window into what I am missing visually, by seeing what others see.

Sometimes, I’ll be walking down the street and it will occur to me that I am seeing something in a way that may be different from other people. The other day, my husband and I were out walking the dogs; he was walking about 5 feet in front of me and I was looking at the back of his head, when I realized I could only see the back of his head and a bit of the tops of his shoulders.  I asked him to stop and look at me from behind at the same distance; he could see all of me and cars parked across the street and buildings to our left and a whole lot more. When you have RP, but still have some usable vision, it can be easy to forget how much you are missing visually.  I find myself lulled into a false sense of security, so I think it is good for me to get a good kick in the pants from reality when I slip off into space.

When asked what I actually see, there are a couple of tricks that I use most often:

  1. Look straight ahead.  Stretch your arms out to the side as wide as they will go, thumbs pointed up, then slowly bring them in and stop when you can see your thumbs.  You may not have to move them at all, or maybe just a little bit, before your thumbs come into view.  When I do this exercise, I see my thumbs when they are about 7 inches apart.
  2. When you are sitting in a chair, put your hands in your lap. Keeping one hand flat, palm parallel to your lap, start raising it and stop when you can see it.  You may have to raise your hand a little bit to see it, or you may see your hands resting in your lap. When I do this exercise, I don’t see my hands until they are in line with the bottom of my nose.

These exercises are by no means definitive, but they do give an idea of what it’s like to live with diminishing peripheral vision; and, in the world of RP, I actually have a good amount of vision….I think. Every case of RP is different.

I thought I might write a series of posts that give a better idea about the mechanics of RP.  If you found this post interesting or helpful in gaining a better understanding of RP, and you would like me to write more, please let me know.  If you have any specific questions, please ask.

You can also find me on Facebook and Twitter.

 

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