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CHAPTER 1
Some Sad Things Known to Man
Memphis did not seem like the city where I might solve a complex medical problem. Nothing, though, was making sense to me at this point in my struggle to save the sight in my right eye. I had recently passed my driver's license vision exam with one eye and was rolling up the Natchez Trace in Mississippi, taking a scenic run to Memphis with my daughter in the hope that I might be able to distract myself from the curtain of darkness that had fallen over the right side of my face. The Ross Barnett Reservoir glistened in the spring afternoon, and the reflected sunlight broke into diamonds and made me smile. I was becoming melancholy about the beauty of the world and what, if anything, I might miss if I ended up with only one good eye.
My Austin retina surgeon, Dr. D, had mentioned the name of a physician in Memphis who was considered without peer in his microsurgical subspecialty, and I had sought him out online. Though I had spent more than three decades as a journalist and was not easily intimidated, as I read the CV of Dr. Steve Charles on his website, I wondered if I had any chance of getting his care. He was a physician and design engineer and had generated market-leading sales for companies that had developed, manufactured, and sold his surgical systems; his ingenuity had led to various critical techniques used in retinal operations. He had performed an estimated 38,000 vitreoretinal surgeries, more than anyone in history.
There was a contact form on the site, which I filled out and submitted. I assumed that I might hear from a clerical assistant in a week or so on my remote chances of getting in to see Dr. Charles within a few months. Instead, in less than five minutes, in the dead of night, I had a personal email from the doctor himself.
I had written, "I have had multiple surgeries to repair my retina. It started out with a tear that became a detachment, and none of the surgical efforts of my doctor to reattach it have been successful. I have been facedown with gas for many weeks, several times, and have endured silicone oil and multiple laser surgeries. I don't know what to do. Can you offer me any advice?"
"Yes, please come see me in Memphis," he wrote. "I am sorry this has happened to you. I am copying my assistant, and she will put you on a VIP list so you can get a quick appointment."
"Really? I'm not any kind of a VIP, Dr. Charles. But I'd sure like to have you look at my eye."
"You are a VIP to me because you need care and need it fast. Let's get you to Memphis as soon as possible."
My expectations were not high when my daughter and I walked into the Charles Retina Institute only a few days later. I had researched problems with the retina and the use of lasers and oils and gas, and I was fairly confident that my options had been exhausted. I did not know much about Charles beyond the fact that my surgeon had told me he was the best available, probably in the world. I had learned a bit more about him from his website. Now, I was sitting in a somewhat darkened room with my eye dilated, anticipating my exam. The fact that my pupil could still be dilated and my iris continued to look relatively colorful and liquid gave me some hope that my eye's health remained viable.
"Do you think he can fix it, Daddy?" my daughter, Amanda Noelle, in her mid-20s, had asked. She had never known me to experience a health problem beyond sniffles or an upset stomach, and she had never seen me in the grip of any personal fear.
"I don't know, baby. If anyone can, I think he is the guy."
I was summoned for a series of photos that attempted to capture the state of my retina, then taken down a long hallway into an examining room and invited to sit. I could hear the doctor's voice down a hall that ran parallel to the corridor I had just traversed. I assumed he moved from exam to exam along this private passageway. As his voice came closer, I tried to brighten my grim perspective.
"This is the gentleman who came up from Texas," said his assistant, Sabrina Newsom.
"Oh, yes, my online friend. The author. Well, let's have a look."
Steve Charles was unimposing, a bit over six feet tall with an athletic presence, but his unmistakable confidence filled the room. He used his thumb to press my upper eyelid against my brow and then swung his light over my eye to examine the retina. He could get no view to the retina because of blood in the eye, and he subsequently used an ultrasound to get an accurate image. My doctor back in Austin, unable to effectively use ultrasound to see my retina, had been struggling for several weeks to give me a long-term prognosis.
I had resolved to see Dr. Charles after I reached an emotional low point: On my way to one of my last appointments with Dr. D. I was so distraught that I pulled into an empty parking lot and cried while sitting in my truck, a grown, gray-haired man lost in personal grief among an expanse of outlet stores. Laughter would have been a more logical response in that setting. After I regained my composure, I called my friend Greg in Houston. We had been as close as brothers for decades, and he instinctively understood my fear for my eye.
"Nothing's working," I said.
"I thought everything worked these days. Laser and whatever else they do. Retina detachments are treatable, aren't they?"
"Yeah, they are, but ..."
"But what?"
"I don't know. Maybe I've just got bum genetics. Or even a bad doctor. He seems competent, but contradictions turn up in his prognoses, and he isn't really consistent in what he tells me."
"Well, you need to figure that out, buddy. You can't have someone incompetent messing with your eyesight."
Greg was right, of course. I had been worrying about these same issues for almost four years, since I had discovered a problem with my retina. Sitting in front of the television one afternoon, I had noticed dark flecks floating through my field of vision. They appeared almost like insects, but floaters had long bothered me, and I did not think I was experiencing a potentially serious issue with my eyesight. Perhaps, I thought, a few more floaters had accumulated as I had aged.
My optometrist worked me into his appointment schedule the next day and ran a color scan of my retina. The machine he used was a non-mydriatic retinal fundus camera. That meant it provided detailed color images of the retina, the thin tissue that lines the back hemisphere of the eye and captures light for the optic nerve to process as moving images for the human brain. Non-mydriatic technology does not call for dilation of the pupils, normally required to expand the field of vision for ophthalmologists examining the retina and the interior of the eye.
"Hmmmm ..." said the young technician, who was recording the images as I tried to keep my eyelids open.
"What are you hmming about?" I asked.
"Oh, nothing, I'm sure. We'll get this to the doctor right away."
There was something, however, and as I waited for the optometrist, I wondered what the assistant might have discovered. My vision had never been good. From the time I was four years old I had worn what the other kids had referred to as "Coke-bottle glasses" with thick lenses to correct my nearsightedness. The shape of my eye was longer than optimal, and my point of focus was in front of the macula, the highly pigmented oval near the center of the retina, which is responsible for delivering the sharpest vision to the eye. I saw almost nothing with clarity that was more than a few feet distant.
"I think it looks like there is a retinal tear on this image."
The optometrist, a family friend who had built a busy practice, did not appear overly concerned as he stared at the computer. He pointed at a spot on the confusingly colorful screen where blood veins and shadows made comprehension almost impossible for the nonmedical observer.
"I guess I don't see it," I said.
"It's right here."
He laid his finger against a dark line that emerged against the whitish background. "I'm quite certain this is a retinal tear."
"Which means what?"
"You need to get to a specialist."
A retinal tear leading to a detachment of the retina would be problematic, and even debilitating, to personal health and employment if it were to go untreated. I knew little more than the high school biology basics of the human eye. I understood the functions of the pupil and cornea, the properties of the retina, and how rods and cones worked to distinguish the light and colors delivered to the optic nerve. But I had never heard of vitreous, the fibrous, clear gel that fills the interior of the eye. Vitreous is partially composed of millions of tiny collagen fibers that are attached to the delicate retina, and if there is a tear or a hole in the retina, fluid can leak under the retina and cause a detachment, leading to loss of vision. Or the vitreous can pull on the retina and create the same problem.
The optometrist gave me a card for a retinal specialist who had recently opened an office in North Austin. When I called the next morning and described my diagnosis, he said I should come to his office immediately and they would work me into his schedule. Although there was a sense of urgency in his voice, I did not quite understand the apparent concern. My eyesight was unchanged, and the previous floaters were no longer visible. In fact, I debated whether I should even bother keeping the appointment.
My health had always been robust, and injuries like cuts and broken bones had healed fast enough that doctors often were amazed. Once in my early 50s, after snapping both bones of my forearm while playing baseball and undergoing surgery to insert a plate, I was back playing catch and lightly swinging a bat less than three weeks later. Was it not possible that my eye might also heal and the retina reattach naturally along the line of the tear?
Philosophically, I have always chosen to avoid doctors, medication, and any type of invasive procedure, if possible. I'm not averse to doctors, though, and do not hesitate to run to their care when it's needed. Consequently, I saw no harm in having this specialist conduct an examination.
After my eye was dilated, Dr. D peered through the pupil to assess the health of the retina. His conclusion seemed a bit abrupt.
"We are going to have to put in some laser," he said.
"Okay, what does that mean?"
I ask doctors questions. Hell, I pester almost everyone for information, from strangers in airport bars to those I meet on the running trail. When it came to my eye, I needed to know almost as much as the retinal specialist. Nothing was going to be done to it until I understood the risks.
"You have a small tear. We will use the laser, here in the office, and put in laser spots around the tear. The light does a slight burn on the retina, and as it heals, it reattaches to the layer under the retina. The vitreous stops flowing through the tear and detaching the retina."
"Is this serious?"
"No, it shouldn't be. Most tears can be repaired with laser, and the patient's vision is never impaired."
"Okay, we can do this now?"
"Yes, certainly."
As I leaned back in the exam chair, I saw the doctor's degrees and training certifications framed on the wall. An Ivy Leaguer with about 20 years of medical training and residencies at university and municipal hospitals, Dr. D came across as low key but knowledgeable. It seemed natural for me to trust his skills and experience.
Unfortunately, almost four years later, I was sitting in an exam chair at Charles Retina Institute in Memphis, hoping for a miracle. There was no way for me to know if my monocular blindness was a consequence of surgical incompetence or just the genetics of a long eye, since the longer the eyeball's shape, the harder it becomes for the retina to be flattened against the back after tears, holes, and detachments. Over time, Dr. D had tried a series of procedures that involved the removal of the vitreous, laser treatments, replacing the vitreous with silicone oil, and using gas bubbles. Not one had succeeded in fixing my right eye.
As Dr. Charles was conducting his examination that morning, he made a statement that I found astounding — and devastating.
"This shouldn't have happened to you. And if you'd been in my care, it probably would not have happened to you."
Whether opinion or simple fact, the assertion was almost impossible for me to process. I began to think I was a victim of incompetence and a medical system that demands too much of the patient. How is anyone supposed to know a surgeon's capabilities without hours of extensive research? Eventually, I would come to understand why Steve Charles was so assured and capable and what he knew that another retinal surgeon, even one Ivy League trained, did not. My immediate question, however, was whether he might still be able to give me back my sight.
When I had initially begun my research on his achievements, Dr. Charles struck me as an unknown yet historical figure. Probably no one person had a broader impact on vision and ophthalmological surgery than this doctor. His inventions of machines, tools, and new techniques were transformative for retinal surgery, and they have improved outcomes for thousands of people wanting desperately to see. And yet almost no one outside of his professional field knew who he was or what he had accomplished. I would come to know much more about Steve Charles. But I was already growing convinced that if anyone could give me back my eyesight, it would be this doctor.
And I just wanted to see.
CHAPTER 2
Giants in the Room
A uniquely American institution, Bascom Palmer Eye Institute (BPEI) in Miami has had a sweeping and profound impact on the advancement of eye care, and, in fact, gets credit for developing the critical vitrectomy procedure to repair most damaged retinas. Until doctors and an engineer at BPEI had designed the technology and the procedures for removing vitreous from the interior of the eye, most surgical interventions for the retina were arguably guesswork that used everything from needles to heat and even a type of rubber band. The arrival in Miami of a doctor from Germany after World War II, followed by an engineer from Australia, led to a revolution in how surgery was performed on the interior of the human eye. Steve Charles would be at BPEI to witness and participate in the dawning of these advancements.
The beginning of that story was recorded with a black-and-white photo. Even in the hottest Miami summers, Robert Machemer, M.D., was never seen without his lab coat while performing research or eye surgery. This day, in the humid, stifling garage at his home, where his work and image were about to be rendered onto film, was no exception.
The serious and bespectacled son of a Nazi battlefield surgeon, Machemer had thick, dark hair and long sideburns that suggested he might have been anything other than a doctor. In fact, he was on the verge of dramatically altering techniques for operating on the eye. The procedure was to become known as pars plana vitrectomy (PPV), the removal of the vitreous substance from the inner chamber of the eye by insertion of an instrument through the front, near the cornea. Vitreous is the clear, gelatinous material filled with fine collagen fibers that attach to the retina, the delicate light-gathering tissue that lines the scleral wall, generally behind the equator of the eye. Light passes through the vitreous and is perceived by the retinal tissue. Historically, doctors had limited success repairing detached or torn retinas because of complications caused by the presence of vitreous; it tended to stretch and pull at the delicate tissue, causing complications and damage. Machemer became convinced the clear substance was not critical to the eye's function, and he had a plan and a tool for the removal of vitreous.
Which is why he was standing over an upright egg with a drill in hand.
The photo really wasn't meant to be serious, according to Jean-Marie Parel, a Ph.D. physicist, who engineered another instrument that Machemer eventually used to enter the eye. "We just wanted to show you could drill inside of something delicate like an egg," said Parel in an interview years later. "When you turned the drill, it literally sucked stuff up out of the egg. Robert wanted to prove you could use the drill as a flute, and the egg yolk and white matter would come up. This was his way of showing we could do it ourselves — remove the vitreous from the eye in a safe and fairly nonintrusive way."
Parel had ended up in Miami after leaving his home in France and working at the University of Melbourne in Australia. He and Machemer had been recruited to join BPEI, a new research and treatment facility at the University of Miami, founded by Edward W.D. Norton, M.D., a stout Irishman with a gentle voice and a facility for identifying doctors with drive, skill, and scientific curiosity.
(Continues…)
Excerpted from "Give Back the Light"
by .
Copyright © 2019 James C. Moore.
Excerpted by permission of Greenleaf Book Group Press.
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