five centimeters

I spent the morning with a Neuro-Ophthalmologist at the University of Washington Medical Center in Seattle.  Essentially he told me (again) that I was unlikely to regain vision in my left eye, absent some significant advances in medicine and technology.

The condition I suffered as a result of the bicycle accident is called Traumatic Optic Neuropathy (aka TON).  I sustained damage to the bone structure surrounding the optic nerve, which caused significant orbital hemorrhage, essentially killing the optic nerve on my left eye.

The short story is that I need to regenerate about five centimeters of nerves in order to be able to see.

Yes – things could have been a lot worse.  Had the injury occurred in the area of the Chiasma, I would likely have lost all vision.  Also – the examination this morning established that my right side had not sustained any related damage, despite me having also broken my orbital bones on my right side (I know this because I can feel a screw protruding from above my eye socket).  And of course if the damage to my frontal lobe had been more serious, I could have had much more significant limitations. 

The optic nerve for my left eye is non-functional.  The ultrasound measurements taken this morning reveal it to be significantly thinner than the nerve on my right side.  This is effectively atrophy, or “pallor” (if I read the literature correctly).

Now – I hadn’t gone into the appointment with any real hope of getting surprise good news.  The little bit of reading I’ve done on TON tells me that the window of opportunity to improve things is primarily limited to the time of the trauma.  Treatments can include corticosteriodal therapy or optic nerve decompression surgery. 

According to one of the articles I read about TON, medical intervention has not demonstrated clear benefit in recent studies, even when the intervention occurs within hours of the trauma.  Further, cases in which vision is completely lost show that vision is usually not recovered.  There are always exceptions to the rule, but chances are just about nil that my eye will start seeing without a more radical form of treatment becoming viable.  According to the Neuro-Ophthalmologist I spoke with today, there is nothing even to the point of animal study that looks promising for me to recover vision.

I was very disappointed to hear how remote the possibility for medical correction seems to be. 

More things would be more possible if the eye itself had been damaged, instead of the optic nerve.  For example, if the issue was with the retina, I might benefit from having an electronic device implanted to transmit quantized digital image data to a healthy nerve.  Apparently this function is achievable with current digital technology.  Simulating the sophisticated function of a healthy optic nerve in a digital implant is not.

So yes.  The short story is that I need to regenerate about five centimeters of nerves in order to be able to see. 

This is far more similar to the requirements to correct a spinal injury than what we ordinarily think about for recovering vision.  And I have no idea how long the stints of dead nerve channels are in a ‘typical’ spinal injury, so it is also possible that I’m an outlier relative to spinal injuries too.

In any case, the appointment left me feeling a bit down.  But I’m no less determined to see from my left eye someday, no matter how improbable that seems now.

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