You’ve had dry eyes, right? You read for too long, or played beach volleyball into the evening, you stared at your game system or Daily Kos, and now your eyes sting a bit, feel gritty, itchy, dry. So you take a break, you rub your eyes (the wrong way, probably), maybe use some OTC eye drops and it passes.
But what if it doesn’t pass? What if the itching, stinging, gritty feeling continues? What if you start getting blurred vision or seeing double and triple? Then you have clinically significant dry eyes.
For me it began several years ago. My optometrist recommended several commercial drops and gave me samples to try out. The drops eased the discomfort but never restored vision.
Imagine waking up with slightly blurry vision, knowing that as the day went on it would get worse. Imagine wondering whether this was as bad as it was going to get, or whether functional vision would also be lost. That’s where I was this summer when a stray impulse led me to ask my optometrist whether he had anything new to suggest. Could my dry eyes be related to my rosacea, for instance?
“Rosacea? You have rosacea?"
I held up the back of my hands next to my cheeks, which answered his question.
“As it happens, I am just back from a meeting where several new approaches were discussed. Set up an appointment for next week and I will review the options."
At that appointment he explained how sometimes rosacea can lead to occular inflammation as well as the skin form. Rosacea is a poorly understood condition, usually chronic, that can lead to rosy cheeks, microveins in the nose and ongoing discomfort. In the eyes it can be countered acutely with a course of steroids and antibiotics; if those are effective longterm treatment can involve Ciclosporin .
He began me on the new course of treatment that day. By the end of the week I had regained crisp vision just in time for a long bike ride, the Courage Ride that raises money for cancer research. What a vivid day! The grass, the clouds, the leaves on the trees, all of them were restored and an immense source of joy. To get a sense of the change, here is a table I put together for my doctor to compare the various grades of vision (grade 5 was included for completeness, as I have very mild cataracts and extreme (correctable) myopia):
Grade |
VISION |
[5] |
[20/20. NO FLARE AT NIGHT.] (Would require cataract removal) |
4 |
THE HIGHEST TWIGS HAVE LEAVES; DISTANT TREES HAVE BRANCHES. A SQUARE FOOT OF GRASS HAS THOUSANDS OF BLADES. POWER LINES HANG IN CRISP CATENARIES. ROAD SURFACES HAVE TEXTURE. TEXT ON TRUCKS IS LEGIBLE. I CAN SEE LAMINATIONS OF COLORADO CLIFFS, FINE CURDS OF CUMULUS CLOUDS, CRATERS ON THE MOON. |
3 |
FAINT HALOS ON POWER LINES, STOP LIGHTS. SIGNS ARE LEGIBLE. GRASS AND TREES BECOME RENOIRS. |
2 |
STREET LIGHTS AND POWER LINES DOUBLE OR TRIPLE. SIGNS DIFFICULT TO READ. |
1 |
STOP LIGHTS STRONGLY DOUBLED. SIGNS ILLEGIBLE. DIFFICULT TO SEE PEDESTRIANS AT NIGHT. DIFFICULT TO READ TEXT EVEN AT CLOSE DISTANCE. |
A couple of days later we began a long road trip to the west coast to visit our adult children. Poor, patient Tall Papa! How many exclamations he had to listen to! “Look at those pine trees on the butte! Look at how fine the layers are in the sedimentary rock! Look at how beautiful the finest wisps of clouds are!” He must have felt like he was traveling with someone who was high or with a five year old.
Since I had responded so well to that course of treatment in a couple of months I began using Restasis, an ocular formulation of the immunosuppressant cyclosporin. Each day I take a moment to look out the window during breakfast and relish consciously the minutely detailed twigs of the tree across the street. In the course of this I have come to realize that the natural world is far, far more detailed than the one we humans have constructed.
Medical advances do happen. I have lived with chronic conditions for over three decades, and sometimes things get better. I don’t have my thyroid stem cell transplants (yet) but regaining my vision has profoundly improved my life, after I had more or less resigned myself to never seeing clearly again. Folks who are valiantly soldiering on with chronic conditions may want to check in at intervals to see if any substantial progress has been made on their particular burden. Sometimes our caregivers don’t connect the dots spontaneously but will with prompting.
Finally, public policy: Money spent on research makes a difference in daily experience and the quality of life. I was fortunate enough to have coverage for eye care and the medications needed to translate that research into better vision for me. Everyone should have access to care for their vision. Everyone should have access to the medications they need to live a full life. Anything less falls short of respecting the dignity of every human being. Forward!