A Happy Patient

“I went from being an advocate for the work of the Lions Eye Foundation to being a cataract surgery patient, and that was a different pair of shoes to put on!” laughed Sally Cofer-Lindberg in a recent interview.

Sally’s second husband Bert Cofer was a 40-year Lion and one-time President of the Lions Eye Foundation. Sally assisted with fundraising and communications, writing newsletters and producing videos about the “fine work being done by the wonderful people associated with the Lions Eye Foundation.” One video, “In My Eyes,” shared case studies
of individuals who had to undergo cataract surgery, and demonstrated their successful outcomes.

Sally explained, “When it came my time for cataract surgery, I assumed my experience would also be positive. But it wasn’t. I knew from the get-go that the surgery did not come out well, and my eye was not right.” Her surgery had been near her home in Modesto, in the Central Valley. Based on her past experience, Sally turned to the Lions Eye Foundation for assistance, seeking a second opinion. She connected with Dr. Lee Schwartz in San Francisco.

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Dr. Schwartz offered to see her immediately, so she and husband drove two hours to San Francisco on a Friday. She found that his office staff was welcoming and warm, and that
Dr. Schwartz “was just awesome, an incredible human being!”

Dr. Schwartz asked Dr. Margaret Liu to join him, both teachers at the Lions Eye Clinic at CPMC. They each repeatedly reassured Sally by saying, “We’re going to figure this out.” An ultrasound was needed to aid in the diagnosis, and, Sally reports, “It was a hard procedure to get through with gel on my eyes. But the staff at CPMC was gentle, kind, and nurturing.” At first, Dr. Liu, or “Dr. Peggy” as she came to call her, tried a conservative approach. But it
was determined that Sally needed to have lens replacement surgery, also known as lens explantation.

Dr. Liu scheduled surgery which, according to Sally, was “another fabulous experience.” Dr. Liu is so competent and capable that I always felt comfortable with her. And Dr. Schwartz came, too! From both of my doctors, it was all about care, compassion, and connection.”

Sally continued, “I hardly slept the night after my surgery because it was so thrilling to witness my eye coming back into focus. It had been a very difficult two months; everything was blurred by filminess, my eye twitched and jerked, and my brain couldn’t figure out what to look at. It was fatiguing and hard to live with.

“The day after the surgery, the same technicians that had tested me before, when I could barely read the charts, tested me again. I had 20/20 vision and no astigmatism; it was a miracle! Dr. Liu’s first words to me were, `Look at that smile!’ They were all celebrating with me, and it felt very personal. It was an amazing experience.”

Sally further elaborated: “Dr. Schwartz and Dr. Liu went above and beyond, they have Lions hearts. It was all about my healing, and healing the whole person, not just the disease. I cannot sing their praises enough. I feel very blessed!”

The Gift of Sight is Priceless

For Ginny Doyle, an artist whose paintings have been exhibited from Beijing to New York to Paris, the process of losing her vision actually fostered new forms of visual expression. Describing her condition as driving on the Golden Gate Bridge in thick fog, she has been undergoing treatments for Macular Degeneration for over 5 years. She is able to continue creating art thanks to injections she receives every 6 weeks from Dr. Arthur Fu at the West Coast Retina Group. “I know that injections in the eye sound pretty horrifying,” she admits, but “Dr. Fu does them very smoothly and it’s really not painful.”

 

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She remembers buying drugstore reading glasses with progressively stronger lens before finally making an appointment with San Francisco Ophthalmologist Dr. Gary Aguilar, who insisted that she see a retina specialist immediately, phoning for her appointment himself. Today she is most grateful for his referral. Doctors Aguilar and Fu are colleagues in the Department of Ophthalmology at California Pacific Medical Center.

According to Dr. Fu, wet macular degeneration results from abnormal bleeding in vessels underneath the retina and if untreated, the retina becomes scarred and cannot be repaired. For patients who receive an early diagnosis and treatment, damage can be halted through periodic injections

Before Ginny’s vision problems, she painted detailed figure studies and landscapes, and today, as a result of this challenge, she has developed more abstract expressionist types of paintings that tapped into her new feelings of coping with life. “One of the paintings I’m most proud of is called ‘Balance’ in which a man is dancing inside a nest. It’s always been my metaphor for home: your sense of being and who you are. The man is trying to grab at something that’s falling apart.”

“Losing my sight was scary at first, but expressing fear in my painting has helped me feel less afraid,” Ginny said. As part of her success story, “Balance” won the big prize at a juried exhibition of blind artists’ works in Chicago sponsored by Second Sense, a non-profit that helps artists cope with vision loss.

Ginny said that doing her art is “a lot more fun now. I’m achieving goals that I couldn’t achieve before, and people are buying more of my art than ever before.” Dr. Fu continues to provide injections every six weeks, and she can still realize her vision artistically.

Dr. Fu, who serves as Chief of the Retina service at California Pacific Medical Center volunteers at the Lions Clinic teaching residents and treating patients, says that the clinical trials conducted by his office permit experimental treatments that create new options for people with impaired vision. He enjoys having the chance to form a relationship with patients who see him frequently. “Ginny Doyle is really impressive,” he says, “just like Matisse who worked with scissors and colored paper when he couldn’t stand at an easel, Ginny has learned to accommodate her style.”

Reconstructing the Eye So Her Inner Beauty Shines Through

At age 19, Christine Nakato, from Uganda, suffered a disfiguring and traumatizing injury when she was attacked with battery acid. Her left eye was completely destroyed and the left side of her face and body severely burned. A local clinic performed skin grafts to protect her eye, which was little more than basic first aid, not the long-term sophisticated treatment needed to help her recover her health and appearance.

Her rescue lay with the Grossman Burn Foundation in West Hills which brought her to California for a complex series of treatments that ultimately involved two members of the PVF board. Their skill and compassion effectively changed her life, a combination of philanthropic generosity and the donated services of skilled physicians. Today, at 22, Christine is back home with her 3-year-old daughter and a new life.

This is her story.

In July 2015, at the Grossman Burn Center, ophthalmic plastic surgeon, Dr. Mark Baskin, performed eye socket reconstruction surgery. Knowing that she needed an artificial eye, he contacted Steve Young, an ocularist who specializes in creating lifelike ocular prostheses who is also a member of the PVF board. Christine’s journey back and forth between Southern and Northern California, was coordinated by Marcus Whithorne, Executive Director of the Grossman Burn Foundation, who accompanied her for the various procedures.

Steve Young “is a real master, and so people come from all over the world to see him,” Dr. Baskin said. “And being a great person as well, he also agreed to create Christine’s artificial eye for free.”

Because Christine was blind in her left eye, which was covered with skin, there was no space for an artificial eye. Dr. Baskin removed scar tissue and replaced it with a skin graft from the lining of Christine’s mouth; then Dr. Young created a customized “conformer,” a molded plastic shell that keeps the eyeball and eyelid separated after surgery while the eye heals.

About six weeks later, as Young was preparing to remove the conformer to make room for the artificial eye, he discovered that tissue had fused the conformer to her socket requiring a last minute surgery. The issue was resolved by a quick call to fellow board member Dr. Erich Horn, the Chief of Comprehensive Ophthalmology at California Pacific Medical Center who practices in an office only a block away. Arriving with a scalpel, some surgical scissors and topical anesthetic, Dr. Horn removed the conformer in just a few minutes. “Steve and I are both on CPMC’s faculty,” Dr. Horn explained, “and our physicians are both collaborative and collegial.
For a patient who had come such a long way for a remedy and a colleague who had requested a favor, he said, “I was happy to do this minor procedure at no charge.”

Explaining his work, Young said that he crafted the scleral shell that would fit like an oversized contact lens over Christine’s damaged eye and make her look like herself again. “I begin by studying the patient’s intact eye to replicate its appearance as closely as possible in every detail, from the pigments in the iris to the intricate pattern of the blood vessels,” he said. “Then I paint layers of color onto an acrylic disc, cover it with clear plastic to prevent it from getting scratched and polish it with a special buffer.”

“The happiest I’d seen Christine in months is when she saw her new eye for the first time,” Whithorne recalled. “She cried out of sheer joy. It was like she had gotten back a part of herself that she’d lost.”

He also marveled at the generosity of everyone who’d provided care for Christine at no cost. “This is the Grossman Burn Foundation’s first time coordinating with Steve Young and Dr. Horn,” he said, “but it certainly won’t be the last. This was something of a bridge-building exercise that will benefit the Grossman Burn Foundation, (www.grossmanburnfoundation.org) PVF and, most importantly, people suffering from eye burns and that can have catastrophic effects on their entire lives.”

A World-Expanding Alignment

Alberto Consuelo was born with strabismus, sometimes referred to as cross-eyed” or “wall-eyed,” but as a youngster in Mexico he did not have access to physicians who could correct this misalignment. “I had a hard time as a kid, because people made fun of my lazy eye,” he lamented. “When I got older, people didn’t want to hire me because of how I looked. Living with this disability was very difficult because people treated me differently, and that made me very self-conscious.”

 

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Although Consuelo moved to San Diego at age 12, it wasn’t until he was older and living in Alameda, California, that a physician in an Oakland clinic told him that surgery could straighten his eye. Soon he had an appointment with Dr. Taliva Martin, a pediatric ophthalmologist and adult strabismus specialist who enjoys the challenges and rewards of helping adult strabismus patients. “Too many adults live their entire lives unhappy with their appearance, hesitant to make eye contact and interact socially due to ocular misalignment,” she said. “It can have a significant negative impact on their lives and careers. Reconstructive procedures in these cases can be life-changing.”

About 5% of children in the US are affected by strabismus, but up to 50%-90% of children with associated conditions such as cerebral palsy or Down syndrome may be born with strabismus. Parents and siblings of children with strabismus also have a higher chance of being affected. In this condition, a person looses the ability to direct the right and left eye towards the same direction. This loss of binocularity can disrupt the development of normal vision in a child and create double vision in adults. Many strabismus sufferers are treated during childhood and avoid the impaired vision and discrimination that often accompany the condition.

Consuelo, was born with a large angle esotropia, meaning that his left eye turned inward. During surgery lasting about 90 minutes, Dr. Martin, assisted by resident Dr. Michael Hemond, realigned the eyes by moving his eye muscles. Bandaged overnight, he viewed his transformation the next morning. “It was like a dream come true,” he said.

“Now I can see well with both eyes instead of just one, and I can look people straight in the eye instead of looking down or away,” Consuelo says. “Along with my new appearance, the world looks much bigger to me now in more ways than one. I will be forever grateful to Dr. Martin for being so helpful and kind to me.”

Bringing "Amazing" Clarity

Karl Kuhlmann, a software engineer, was creating programs that interpret scientific data from DNA sequences when in September 2011, the complex strings of code on his computer monitor started getting blurry. “By December, my eyes had gotten so bad that I could only read code by supersizing the font,” recalled Karl, who lives in Menlo Park, California. “I also stopped driving because I had trouble seeing street signs. That’s when I realized there was something seriously wrong.”

 

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After a diagnosis of Fuchs Corneal Dystrophy, a genetic condition affecting the endothelial cells of the cornea, he was referred to Dr. Margaret Liu, Chief of Cornea, at California Pacific Medical Center. Dr. Liu performed a type of corneal transplant surgery called a Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) on Karl’s left eye. “The surgery was very successful,” she said, “but tragically, his wife passed away and we lost touch for almost a year.“

When Karl returned for a followup visit, he had developed glaucoma in his left eye, and symptoms of Fuchs Dystrophy in his right eye. Dr. Liu provided treatment that stabilized the glaucoma, and in January 2015 performed an even thinner donor cornea graft procedure on his right eye. This technique, a Descemet’s Membrane Endothelial Keratoplasty (DMEK), uses a graft that is just 15 microns thin and has the advantage of faster visual recovery and shorter durations of high-dose topical steroids.

The result “is a lifesaver,” he said. “I can’t get over how much better my eyes are. I’ve worn glasses since I was eight, and don’t remember when I could see this well. I can read everything now, even the words on my smartphone without enlarging them. And I passed my driver’s test without glasses.”

Dr. Liu said that vision improvements resulting from corneal transplant procedures are often quite dramatic, and Karl’s case was no exception. He was so grateful, in fact, that he was inspired to write lyrics to the tune of “Amazing Grace”:

Amazing Peg, how sweet the things

that Doctor Liu can do

I once was blind but now I see

all thanks to Margaret Liu.

Receiving a Present of Safety

For nearly a decade, Jeanie Mohan suffered from a blocked tear duct on her right eye. “I would be working in the garden or doing something else,” the retired math teacher explained, “when suddenly a huge drop of water would fall down my face.”

While it was annoying, Jeanie was apprehensive about having a delicate eye operation yet consulted with Dr. Stuart Seiff, an oculofacial plastic surgeon at California Pacific Medical Center. In less than an hour using local anesthetic, he created a new drainage tract from Jeanie’s tear duct to her nasal cavity – and with no visible scar. “It was absolutely amazing,” she said.

Meanwhile, another longtime condition was limiting her vision – she had cataracts in both eyes coupled with a moderate amount of astigmatism, a common condition caused by eyes that are more oval than round. The greatest impact, besides nearsightedness, was difficulty driving at night because cataracts clouded the lens of her eyes, making vision blurry.

 

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Dr. Kevin Denny, now Chair of Ophthalmology at CPMC, conducted careful tests to evaluate the amount and orientation of her astigmatism, and the results demonstrated that she was a good candidate for lens implants (called Toric Lenses) that would neutralize most of that condition. In the spring of 2015, he then performed cataract surgery in her left eye, which went well. Two months later, during cataract surgery on her right eye.

“Her surgeries were a big success because she sees much better, both with and without glasses,” Denny added. “She feels more comfortable driving, especially at night, and her chronic tearing to which she had become resigned was resolved.” This great result required careful evaluation, consulting among physicians with different skills and formulating a plan “that is consistent with the patient’s needs and goals learned from extended conversations over time,” Denny explained, adding, “About thirty to forty percent of cataract patients will benefit from a Toric Lens. When combined with removing cataracts, it really clears up people’s vision, and it’s very gratifying to help restore people’s sight in such a dramatic way.”

According to Jeanie Mohan, it’s “like getting a present every single day. Being able to drive safely and walk without worrying about tripping makes me confident and younger. I feel so grateful to both of them every single day for everything they did.”