Thursday, October 16, 2014

Ophthalmology October 2

Diagnosis: Bilateral cataracts, bilateral macular degeneration
Visual acuity: 6/9 right eye, 6/9 left eye

OCT scan showed atrophy and mild subretinal fluid at the left macula, and retinal pigment epithelium disturbance with no fluid at the right macula. Both eyes are white and quiet and lens opacities were noted bilaterally. Geographic atrophy was noted at the left macula with some subretinal fluid. Retinal pigment epithelium disturbance was noted at the right macula with patchy hyperpigmentation. No treatment is indicated at present.

We have explained to him the risks and benefits of cataract surgery and the guarded prognosis due to macular degeneration. We have given him some information to read regarding cataract surgery and we will see him again in 2 to 3 months time with his decision......
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The 'Guide to cataract surgery' says nothing about the 'guarded prognosis due to macular degeneration', but since 95 out of 100 notice an improvement in their vision and only 1 in 1,000 experience a total loss of vision after surgery it is a good bet. The Guide says there isn't a point when the condition is 'ripe' or 'ready' for surgery, but it should be when it affects daily life. Though I can still drive, 6/9 is getting close to the margin, so I think I'll ask to go ahead at the next appointment.


With Jason Brooke, founder of the Brooke Heritage Trust today

Wednesday, October 15, 2014

With Maryam al-Khawaja


At Maryam al-Khawaja's press conference this morning, at Index on Censorship office. She is head of foreign relations for the Bahrain Center for Human Rights, but lives in Copenhagen. Her father, Abdulhadi al-Khawaja is serving a life sentence for freedom of expression offences, and her sister Zainab is awaiting sentencing for tearing up a picture of the King in front of a judge.

Maryam told the press conference that IS sympathisers are being recruited into the police and security services in Bahrain.



Thursday, October 02, 2014

Eyes wrong


Visit to St Thomas's eye clinic this morning where after various tests Dr N H  confirmed cataracts and macular degeneration in both eyes. 'Right eye doesn't look too bad' its 'predominantly on the left. Vision is now 6/9, just within the limit for driving. Surgery isn't recommended for the cataracts because so far the deterioration isn't serious enough to outweigh the minor risks, one in 20 patients experiencing some complications, some of which can be corrected by further suger.

Nothing can be done about macular degeneration. When pressed, the doctor said that the median time between diagnosis and blindness was five years, and that should see me out as I expect to step off in July 2016.

Wednesday, October 01, 2014

Haematology

Blood test this morning:

Hb                  105
PLT                347
Neutrophils         1.30
WBC                   3.11

The consultant was 'a little bit worried' by the trend of the neutrophil count, which has declined over the last three tests and is below the normal range of 2.2 - 6.3 10^9?L. Neutropenia, the condition of reduced neutrophils, means a greater susceptibility to infection, Dr M thought a bone marrow biopsy might be necessary, the previous one having been taken in July 2011, but first recommended cutting the hydroxycarbamide to five days a week to see if that would improve the neutrophil count, and arranged the next appointment for October 29.