Last April 25, an essay was produced here called, “Fading to Gray.” It had to do with the possibility of approaching blindness which is not an inspirational subject by any means.
In the interest of full disclosure, there may be a development which accounts for the title of this little story. So far, so good.
Back in April when “Fading to Gray” was written, there was not much encouraging news to report. The eye contains a fluid called aqueous humor. The aqueous humor flows through the eye and empties through the trabecular meshwork. If the drain becomes blocked, intraocular pressure in the eye increases. The medical name for this condition is called glaucoma. Unless the pressure is released, damage to the optic nerve may take place. Vision, in all likelihood, will diminish and blindness can occur. About the only source of favorable news in my case is that, in spite of the increased intraocular pressure in my one remaining eye, the optic nerve seemed to be in fairly good shape. If that’s all we have to feel good about, so be it. Let us salute the optic nerve that has survived the intraocular pressure for a year or two or three.
When intraocular pressure is below 20mmHg, as measured by ophthalmologic instruments, glaucoma is considered controlled. When pressure exceeds that barrier, however, glaucoma is considered uncontrolled. In spite of all the eye drops, medicines taken orally and a new device called the “Selective Laser Trabeculoplasty,” the pressure in my only eye remained dangerously high. If 21mmHg is where glaucoma is considered uncontrolled, my pressure regularly was found to be in the high 30’s and in one reading, at 42mmHg. Obviously, those readings can’t be tolerated forever.
At this point, Miss Chicka offered the thought that perhaps a second opinion might not hurt things. When Professor Gurwin, my long term ophthalmologist, was approached, he not only roundly approved the idea, but he had a man who had seen hundreds or thousands of glaucoma patients. So we set off to see what another voice might say.
It seems to me after years of being involved with the medical community, that it is a rare physician who will say that another physician might have something to contribute. The original treating physician may say that he has all the facts and has worked with the patient for many years. So what could an outsider have to contribute? The fact that Eric Gurwin enthusiastically embraced the thought of a second opinion, told us that he cared more for my situation instead of being concerned about any issues of pride. He has our grateful applause for his attitude.
According to Dr. Gurwin, the man to see was L. Jay Katz, MD, who operated out of the Wills Eye Hospital in Philadelphia. We were warned by Dr. Gurwin that it might take two or three months to receive an appointment. So a call to Dr. Katz was made and an appointment was arranged for July 6, an interval of only three weeks. Dr. Katz could see us at 9AM following the July 4th holiday.
Jay Katz was recommended because there is a whole floor in the doctor’s offices wing at Wills Eye Hospital devoted to the treatment of glaucoma. If my statistics are anywhere near accurate, glaucoma affects only about three million of the American population. Only half of these know they have it, so it is not a well known ailment. It is apparent that other ailments are more prevalent, thus it is a fortunate turn of events to have a whole section at what seems to be American’s leading eye hospital devoted to dealing with glaucoma.
So on July 6th, we left the house at 5:15AM to catch the 6:15AM Acela train. Even with two stops, the Acela arrived in Philadelphia at about 7:08AM. For train buffs like us, Acela is the way to go.
Even though we arrived at Wills at 7:45AM for a 9AM appointment, the Wills people set to work preparing for Dr. Katz’s examination. There were tests of every sort; however, Wills had no test that Dr. Gurwin’s staff had not had me take previously. In short, Eric Gurwin’s examinations were as complete as the extensive examination at Wills, probably the leading eye hospital in the world. Professor Gurwin earns a large salute for keeping up with glaucoma technology.
When the work of the technicians was completed, Jay Katz came to talk. He is a busy man, but it appeared to me that he spent more than 30 minutes examining and discussing my right eye. His only drawback seems to be that he is a fan of the Philadelphia Phillies, which we generously agreed to overlook.
Jay Katz said the intraocular pressure in the eye which registered 37mmHg when Dr. Katz measured it, made the sight in the eye a precarious proposition. He also recommended the use of Pilocarpine which had been tried some years ago. He agreed to write Eric Gurwin with the results of his examination.
Dr. Katz’s description of my eye sight as having a “precarious” nature to it and his assessment that “he is at a very high risk for surgery” would have floored me had those comments been uttered 15 or 20 years ago. The fact is that those dire assessments were acquired by me some two or three years ago. My belief was that it might require another trabeculectomy to give me respectable intraocular pressure readings. Always in my mind was the thought that in 1994, a suprachoroidal hemorrhage had interrupted my first trabeculectomy which resulted in blindness in the left eye. When Dr. Katz was questioned on having a successful trabeculectomy on the right eye, he said it was something like one failure in 100 operations. For people who do not have my intraocular pressure problems, the odds are around one in 20,000 operations. So you see that the odds are greatly reduced. With only one eye to start with, if my operation is the one in a hundred operations to fail, it means that this old essayist is pretty much out of business.
Jay Katz’s odds of one in 100 were an improvement over my odds, which were calculated by me to be one in 10 or 20 operations. As was said earlier, if the precarious nature of sight in the one remaining eye were dropped on me unexpectedly, deep concern would inevitably follow. On the other hand, in my mind, Jay Katz’s estimate of one failure in 100 operations was regarded by me as a piece of good news.
In my calculations, there had always been a numbers game having to do with my sight as it relates to my advanced age. The thought was if my sight held our fairly well, and if this elderly patient were to be struck by a bolt of lighting, he might be spared the drama of another trabeculectomy. If my eye sight holds up until angel wings are my reward, then it might be said, “To hell with a trabeculectomy.” But if angel wings are not in the immediate offing, there may be a use for the operation – which would not be a cheerful thought to me.
Jay Katz was an engaging fellow who offered me the best assessment of where glaucoma had taken me. But in a sense, Jay Katz had offered me a pragmatic reading of a precarious situation with my eye. His views simply confirmed mine which were not embossed or imbued with rose petals.
In my view, after many years of submitting to hundreds of examinations of my eyes, Jay Katz, Wills Eye Hospital and Eric Gurwin are an innovative and competent team. They have earned a rousing salute from me for their pragmatic evaluations.
So we left Wills and walked up Walnut Street to Le Bec Fin, a French restaurant that would rank with some of the world’s best. Luncheon included an assault on escargots, lobster and creamy crab cakes to go with a little champagne and a bottle of Loire Valley wine. And we had an opportunity to shake hands with the chef and to thank him for our meal. My memory may give me a problem now and then, but it is clear that the U.S. Army never once provided such a meal to me, even when they were pleading with me to re-enlist.
Dr. Gurwin was revisited shortly after the return from Wills. The intracular pressure had increased to 42mmHg, which is twice the pressure where glaucoma is regarded as uncontrolled. So Pilocarpine was the next stop.
The knock on Pilocarpine is that it risks retinal detachment. It has some other peculiarities. All drugs have adverse effects. Some are greater and some can be lived with. Pilocarpine makes me believe that sunglasses are being worn inside. The pupil narrows so that it is necessary to look to the left or the right as distinguished from seeing the object with peripheral vision. And there is occasional sweating when sleep is attempted. One time it took three pajama tops to complete the night.
But when Eric Gurwin measured the intraocular pressure after only 2¼ days of taking Pilocarpine, the pressure had dropped from 42mmHg to 15mmHg. All the adverse drawbacks still exist, but if subsequent readings are in this neighborhood, it will be regarded as a minor miracle. The drawbacks can easily be lived with.
On August 25th, only a month later, the pressure reading, was again 15mmHg, so it might be argued that there is some hope after all the bad news.
So perhaps there will be an occasion for an Irish eye to smile again. There have been so many disappointments and setbacks along this road which started in 1969, that we’ve become accustomed to unpleasant news. On step at a time. It could be that when the local Digger O’Dell comes to take my ancient bones away, he may be impressed with the thought that my eyesight lasted longer than my mortal remains. In Ireland, a fellow who takes bets is called a “punter.” Betting on my eyesight versus my longevity may open the way for a punter to set up shop in Northern New Jersey, perhaps in the building that the Summit Medical Group will vacate in the next few years.
Now an ancillary subject. There is a car for sale. It should give the new owner lots of trouble free mileage. The car is my own Chrysler 300M which has less than 7,000 miles on the odometer. It is a 2001 model and is in perfect shape.
Over the July 4th holiday it occurred to me that other cars were jumping out of shadows. The same could be said for human beings. My driving career had gone on for 67 years. In Missouri during the Depression, the cops would overlook a youngster driving a car or a truck if he was a year or two short of the legal driving of 16 years and if he was working. So my career as a driver started at 15 years. It struck me that 67 years might be enough and so my days as a driver have been voluntarily surrendered.
In the back of my mind was the thought of my father, who had an epic struggle with glaucoma. Somewhere in the sixth decade of his life when he should not have been driving, he hit a city bus. He claimed that the bus had been obscured from his vision by an ornamental bush. He said, “He hid behind the bush.” Not long after that, as part of his job of trimming a tree, he fell out of the tree and fractured his skull. No more driving after that traumatic event.
So this old essayist said no more driving for me unless there is an emergency. In the meantime, Miss Chicka has generously offered to let me ride as a passenger where my comments about her driving will be only laudatory ones. Obviously, she has my profound thanks for her generosity.
Well, it struck me that after “Fading to Gray” was issued in April, a new essay ought to report the state of the record a few months later. It is a source of great pleasure to say that this report is not quite as gloomy as “Fading to Gray.” And so my thanks go to Miss Chicka, to Eric Gurwin, to Jay Katz and to the Wills Eye Hospital. And finally, if someone needs a nice car with less than 7,000 miles on the odometer, perhaps we can make a deal there.
(NOTE: Before this essay could be distributed, the car was sold. The aged and wealthy Short Hills matrons who traditionally have pleaded with me to spend the night in New York’s most fashionable night clubs, will now call for me in their chauffeured limousines.)
So you see, Irish folk stories have fairies and leprechauns who make things pleasant for believers. If the pressure in my eye continues to hold, in addition to Miss Chicka, Doctors Gurwin and Katz and Wills, profound thanks will also go to what the Irish people call the “wee folks.” Stay tuned.
E. E. CARR
August 15, 2004 (updated 8-25-04)

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Well, if memory serves, Pop went blind sometime in 2005. I wonder if he just got unlucky with the “1 in 100” surgery, or if there was some other complication. It’s kind of a bummer that this is one of the more optimistic essays, in light of that particular outcome.
I thank Pop for giving up driving when he did, for the sake of all the other people on the road. It’s a bummer that Pop passed away soon before self-driving cars become available. I’m not sure Pop himself would have used them, of course, but I think in due course that’s going to be an incredible mobility tool for the blind. Would have been nice to read an essay about that.