The more I read and learn about macular degeneration, the more I realize the signs have been there for years. It started with television actors. Some casting directors seem to have very limited tastes, especially when it comes to female actors. Several actors in the same drama would be young, blonde etc. Obviously to the taste of the (no doubt male) casting director. The trouble was I found it increasing difficult to tell them apart, which made following the story line of a drama rather awkward at times. It was fine if they were particularly distinctive, or well known and recognisable. But often I would find myself checking with my wife which character was which. There is a known condition which causes people not to recognize faces called prosopagnosia or more simply, face blindness. (https://en.wikipedia.org/wiki/Prosopagnosia). I thought this was what I had, and even joined a society for sufferers. The trouble was though that I had no problem with familiar faces, so it didn't quite fit.
As I got a bit older, another issue I found was that it took longer for me to adapt to changes in light levels. This was most noticeable of sunny days when I was driving, and I looked down at the instrument panel and found I could not see it. Before my eyes had adjusted to the car interior, I had to look back at the road. I assumed that the problem was my ageing irises now could not move quickly enough to open up the pupil of my eye. But I could see the angle of the speedometer needle even if the figures round the edge could not be read. So one carries on.
As the years passed, I accommodated to these minor nuisances and as far as my vision went generally, all seemed normal. Except I was now getting new glasses more often.
I started to find glare a problem, especially when driving, for example on a bright sunny day behind a white van or car. I would screw my eyes up a bit to reduce the glare. Of course, polarised clip-on sunglasses helped with that. Another little adaptation, and life goes on. I was told the glare was caused by my mild cataracts I was developing, but as everything else seemed as usual, I was not concerned.
At one regular eye check up, I was advised to make an appointment to see a specialist at the excellent eye hospital not far from where I live. This I did.
"Who told you that you had cataracts?"
I told him and he replied, "Well, you do but they're very mild. You main problem is macular degeneration."
My heart felt like stone. My mother had suffered with this and so I knew a bit about it and it wasn't good.
"I wish I had cataracts," I said to him.
"Because you can do something about cataracts."
"True," he said.
Aged 69 I was diagnosed with dry macular degeneration in my left eye and wet in my right. For those that have never heard of this it is in fact the most common cause of blindness. The cells at the focal point of the retina, the macula, start to die off, causing loss of vision directly in front. Sufferers are not totally blind because the edges of vision are not affected. An example from many years ago when I took my mother on a trip out among the Lake District mountains.
Suddenly she said, "Look at the climbers up on the crag."
I looked and found some tiny figures high up a mountain. "I thought you couldn't see."
"I saw them out of the corner of my eye, Now I look straight at them and I can't even see the bloody mountain!"
My additional problem is that because of an accident many years ago my right cornea is badly scarred meaning that for the past forty years I have relied on my left eye for vision. However, as the dry type in my left eye has no treatment available as yet (although there are some interesting developments but cures are years away), they decided to treat my right eye with injections which cause the rogue blood vessels which disrupt the macula to reduce. These injections are given straight into the eyeball which is not a lot of fun but is mercifully quick and it beats the alternative of losing sight. Discomfort level about on a par with having a small filling at the dentist, but it's over a lot more quickly. Their reasoning is that if they can save the right retina with injections, if my left eye deteriorates too much, a corneal transplant might be possible so I can use my right eye again. I have now had fifteen injections, the interval is varied depending on the state of the retina. I have been taking a supplement designed to protect the retinas to try to halt the decline of my left eye. This is made to what is called an AREDS2 (Age Related Eye Disease Study 2) formula, the main ingredients being lutein along with zeaxanthin. The consultants at the eye hospital are happy with this, and the loss in the left eye seems to have plateaued, for the time being anyway. Fingers crossed. I am still able to drive although I am aware my vision is not what it used to be. So I am careful. Dusk is the worst time I find, especially when people in grey cars drive on a grey evening along a grey road and decide it's not time to put any lights on yet.
So why did I start this by discussing face blindness from twenty years ago and reading my speedometer from about ten years ago? Because I now realize that these were the very earliest signs of macular degeneration starting.
Human faces are all pretty much the same - forehead, two eyes, a nose in the middle and a mouth. The brain devotes huge resources to identifying and magnifying small differences. We learn this as we grow up and facial patterns seem to be wired into us, which is why we often see 'faces' in objects, like looking into a fireplace into the burning coals, or the man in the moon; or in one case that went round the internet, a house that looks like Hitler. People often find the faces of other ethnic groups harder to distinguish, especially those where complexion and hair colour tend to be the same. But we learn to adjust to the fine detail and then their faces too become recognisable, But what if our eyes aren't seeing that fine detail? I have likened the loss of vision a bit like going from high definition 1080 television back down to 720 or 640. It is in facial recognition that this is first noticed by many people. Seeing who is who at a distance becomes more difficult, and it means that people have to be closer before you can be sure who they are. Of course body language and other cues may enable you to know who the person is before you can actually resolve the image of their face.
So far in my left eye I have no totally blind areas and no distorted vision, as seen on a grid square called an Amsler Grid. It's harder to tell with my right eye of course because the cornea scatters the light. There seems to be some distortion at about '10 o'clock'.
So what about the changes of light? I have taken part in a study into dark adaptation as a test subject because it is now thought that the inability to quickly adjust to changes in light level is another early sign of macular degeneration. This study is ongoing.
So that's where I am. With treatment, lutein and whatever, things seem stable. Long may they remain so.
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