Sunday, July 16, 2017

Corneal Dystrophy: A Threat to Eye Health

Map. Dot. Fingerprint. These words don’t appear to make sense together, but they describe a type of corneal dystrophy, the most common of several degenerative eye conditions that occur when material builds up on the cornea. Another name for map-dot-fingerprint dystrophy -- equally odd -- is epithelial basement membrane dystrophy.

By either name, symptoms include blurred vision, intermittent pain in the affected eye, sensitivity to light, streaming tears and the feeling that a clump of eyelashes has gathered in the eye and refuses to come out. The condition most often develops between 40 and 70, literally disrupting any rosy view you may have had about aging.


I know this because after map-dot-fingerprint dystrophy lay dormant for almost two decades, it has recurred, and I am typing this without benefit of clear vision in both eyes. When I was first diagnosed some 18 years ago, my vision was blurry for a couple of months. This time, I experienced blurred vision and occasional pain.

Early in June, for two weeks, I was awakened repeatedly by a stabbing pain in my left eye and the feeling that my eyelid was stuck shut. It was. I was experiencing corneal erosions. That’s what caused the pain, the swelling, the redness and the eventual breakdown of corneal tissue.

Dry eyes play a part in some corneal dystrophy

The epithelium is the cornea’s outermost layer, the clear dome that serves as the first line of defense in protecting our eyes. During an erosion, errant cells on the outermost layer of the epithelium rise up and can stick to the inside of the eyelid. Tears help nourish the cornea, but everyone’s eyes get dry during sleep. That lack of lubrication, I’ve learned, can contribute to flare-ups of map-dot-fingerprint dystrophy.

“I’m glad it stayed away for so long, but I’m not surprised it came back,” said my ophthalmologist. “You’re female, and older now, and all older women tend to have dry eyes. Also, some medications also cause dry eyes. I’m not surprised.”

I was. When the blurriness first began, I dallied, blaming spring allergies. When the corneal erosions began, I started using artificial tears more often during the day and a thick eye ointment at night, treatments recommended when the condition was first diagnosed so long ago. When the erosions increased, I headed to my eye doctor. He said I was doing all the right things; to keep it up.

Three weeks later, an exceptionally painful erosion woke me before 6 a.m. on a Sunday. Though I immediately flooded the affected eye with artificial tears and applied an eye ointment I had on hand, the pain and throbbing did not abate for over 90 minutes. I was back in the doctor’s office the next morning.

Stocking up on OTC eye treatments

I was told to use preservative-free eye drops to both eyes every hour that I am awake, to use ointment in the affected eye three times a day and to apply ointment to both eyes every night. If I wake up during the night, I am to apply additional ointment or drops as needed.

“None of these treatments include medication, so you can use them as often as needed to keep your eyes moist,” the doctor said. The extra moisture could help the cornea heal itself, she said. Because of the corneal breakdown caused by the erosions, the doctor emphasized that I could not slack off. “Be vigilant,” she said. I headed to the pharmacy and bought the eye drops and ointments, all over-the-counter products.

An eye exam eight days later revealed that the cornea was healing and that the bumpy surface caused by the map-dot-fingerprint dystrophy was smoothing out. I asked the ophthalmologist what to expect in the future, what to regard as a benchmark of healing and what would indicate a regression.

“You could improve, you could stay the same or you could have another corneal breakdown,” she said. “It’s too soon to tell what’s next. You may have vision changes because of this and you may not – we don't know. Keep treating your eyes around the clock and we will continue to monitor you.” On the way home, I stopped at a pharmacy and cleaned out another shelf in the eye care section. I’ve done that several more times since.

What’s behind the unusual name

I did find out why this disease is called map-dot-fingerprint dystrophy. The National Eye Institute (https://nei.nih.gov/health/cornealdisease) notes that the dystrophy occurs when the epithelial basement membrane develops abnormally and forms folds in the tissue.

“The folds create gray shapes that look like continents on a map. There also may be clusters of opaque dots underneath or close to the map­like patches. Less frequently, the folds form concentric lines in the central cornea that resemble small fingerprints.”

The site also reports that some people who have map-dot-fingerprint dystrophy never experience any symptoms. For the rest of us, if treatment fails, there are options for outpatient surgery.

Also, I learned that map-dot-fingerprint dystrophy usually is genetic, as are other eye dystrophies. They include Keratoconus, which affects one in every 2,000 people in the U.S., mostly teens and young adults; Fuchs’ dystrophy, which causes a gradual decline in vision and is most often diagnosed in people in their 50s or 60s; and Lattice dystrophy, a condition that most often begins in childhood.

Most of these diseases affect both eyes and most progress gradually. They are not related to other eye diseases or diseases that affect other parts of the body. Some corneal dystrophies cause blindness; others do not.

Costs and a word of caution

So far, map-dot-fingerprint dystrophy has cost me several trips with Uber and Lyft when my vision was especially blurry, co-pays at the doctor’s office and an unknown sum (I am reluctant to add it up) for the eye drops and ointments.

Because I have cut back on screen time, I am not working. I am behind on the news (not a bad thing), FaceBook and on-line Scrabble and Words With Friends. What have I gained?

A sense of peace about my slower days and also time to think about what I want the next stage of my life to look like. (Yes, I am counting on stable vision eventually – and I want to get back to writing about wildlife!) In a rare recent moment dedicated to math, I figured out that I have spent 43 years of my life working, 32 of them full time. Maybe that’s enough!

I also have an increased appreciation for my eyes and the importance of caring for them and an immense sense of gratitude that I was able to see well enough to write this. Listen up: If your vision becomes blurry or you wake up with dry eyes and stabbing pain, get to an eye doctor right away.

Friday, March 10, 2017

Monet, Defiant Bears and Good Pals

Claude Monet was born 108 years before I was, and I didn’t learn about him until I was 15, when a gifted French teacher decided to instruct us about the art, the music, the literature and the architecture as well as the language. His work, as pictured in art books the teacher brought to class, astounded me. When I saw some of his paintings close up at the St. Louis Art Museum, they took my breath away.

Three years later, when I received my first check for freelance work, from Dell Publishing Company’s Ingenue magazine, I used the money to buy a biography of Monet. At the time, I had no idea the magazine was written by old white men, so when I submitted the article, I didn’t mention I was a teenage girl. The check was for $25. My mom photocopied it for me at her office.


In the decades since, I have continued to read about Monet, think about him and seek out exhibitions of his work. Earlier this week, I abandoned my current freelance assignments and ran off to the Legion of Honor Museum in San Francisco to see “Monet: The Early Years,” a splendid exhibit of 53 works painted between 1858 and 1872.

The exhibit is exhilarating – read more about it at https://legionofhonor.famsf.org/monet-early-years and if you are a fan, do try to get to San Francisco to see it before it closes May 29. Many of the paintings depict light dancing on water. One shows a haystack, not purely realistic but not yet infused with light at different times of day. Some show the early influence of Japanese art on Monet’s work.

In one gallery, I zeroed in on an immediate favorite, a painting I’d never seen before. “A Hut at Sainte-Adresse” shows a humble structure hard by the sea, with flowers crowded just behind and sailboats in the distance on the waves. I looked at it a long time. “I want to live there,” I thought. Then I realized in so many ways, I already do, with the edge of this continent in such close proximity to my apartment.  I bought a postcard of the painting.


It was fun to see “Luncheon on the Grass,” Monet’s jibe at Édouard Manet’s painting of the same name. “The Magpie” is here, a painting I’ve always loved. Dear friends in St. Louis have a large print of it hanging in their home. Toward the end of the exhibit are the works that led Monet to Impressionism, the movement he named and the genre he mastered beyond any other artist.

Before I left, I sat for awhile in the outdoor café, just steps from the Golden Gate Strait. As wisps of fog drifted over the café wall, two nearby fog horns sounded like cellos warming up for a concert. Then I headed back to my excellent parking spot, just a short walk from the museum. I had scored the spot by calling on the spirit of the museum’s founder and benefactor.  “Alma Spreckels,” I yelled as I approached the museum, “I need a good place to park!” She came through.

Spreckels’s story is highly entertaining. For one thing, she was the model for the 9-foot-tall statue atop the 85-foot-high Dewey Monument in the center of Union Square. Read about that in Bernice Scharlach’s fun book “Big Alma,” which also teaches much about San Francisco’s history. Spreckels was friends with dancer Loie Fuller (one of my favorite women from history -- see us together, below), and it's Fuller that gets the credit for the many Rodin sculptures at The Legion of Honor.


Driving away, I rolled down all the car windows and invited in the sea air as I cruised slowly along Ocean Beach. Next I stopped to shop and schmooze at 3 Fish Studios in the Outer Sunset, where Eric Rewitzer makes linocut prints and Annie Galvin paints. The shop sells affordable original paintings and prints, postcards, other works on paper and particularly appealing totes.

Right now, the big draw at 3 Fish Studios is an image depicting Eric’s personal response to the election. “California Rising” depicts a giant bear, standing erect and roaring loud, with California poppies at its feet. The image and Eric’s story appeared recently in Time magazine (http://time.com/4657662/california-president-donald-trump/ ).


About bears: Since 1911, the California flag has depicted a grizzly bear. Much more recently, Annie has painted assorted versions of a sweet brown bear hugging a cut-out of the state of California. This particular bear image is in the public domain, but Annie’s interpretations are unique. (For a look at her work and Eric’s as well, see 3fishstudios.com)

A few blocks away is Avenues Dry Goods (https://avenuesdrygoods.com/), a cozy Outer Sunset emporium specializing in "useful, practical and delightful things," many of them made locally. The company in the shop is always good too. Eve Batey, my co-author for “100 Things to Do in San Francisco Before You Die” (https://www.facebook.com/100thingsSF/), owns the store with her husband, Tim Ehhalt, and most of the time, one dog or another is in residence. Also, gifted florist Peter Cochrane works out of the adjacent space.

We sat and talked about Monet, defiant bears, the Outer Sunset and more -- a lovely ending to a perfect afternoon.