Lou Ross Vision History

•           1961 Born with Glycoma

•           1964 Measles led to cataract in both eyes.

•           1964 Legally blind right eye

•           1966 Blind left eye (retina detachment by cataract)

•           1966-1968 3 surgeries to remove cataract on both eyes.  Dr. Norton at Baskin Palmer Institute Miami, FL

•           1972 Experimental surgery to remove cataract and install buckle in right eye.  Dr. Charles Schepens Mass General.

2012 - 2019 Patient of Dr. Leon Herndon Duke Eye Center glaucoma

2013 - 2019 Patient of Dr. Sharon Fekrat Duke Eye Center retina specialist.

•           2015 Outer laser treatment to relieve pressure in right eye.  Dr. Louis Pasquale at Mass Eye and Ear, Boston, MA.

•           2017 Outer laser treatment to relieve pressure in right eye.  Dr. Leon Herdon at Duke University Hospital, Durham, NC.

•           November 2019 – April 2021 Patient of Dr Timothy Murray Coral Gables, FL retina specialist dealing with bleeding in right eye.

•           April 2021 – present Patient of Dr. Veronica Graversen Fort Myers, FL retina specialist dealing with bleeding in right eye.

April 14, 2022 – present Patient of Dr. Palmon of SW Florida Eye Care, Fort Myers, FL cornea specialist handling right eye failed cornea.

July 12, 2022 – Full cornea transplant surgery in right eye. Dr. Palmon of SW Florida Eye Center, Fort Myers, FL.

Right eye had been stable from 1972 - 2014 when slow vision loss began.

Cloudy vision:

Cloudy vision became more pronounced in 2019.  Dr. Fekrat tried a series of eye drops that sometimes would improve my vision but did not last.  Blood in right eye always remained. 

Starting November 2019, Dr. Timothy Murray (Miami, FL) has been injecting Avastin 2.5mg every 6-8 weeks.

4/5/2021:

Dr. Murray informed me that I had a deep scratch in my cornea caused by extreme eye dryness.  This is the first time he mentioned any issue with my cornea even though I had been going to him every 6 weeks for injection in my right eye.  I began receiving Avastin injections in November 2019.

4/14/2021 Switched eye care to Doctor Graversen of Retina Health Center in Fort Myers, FL.

Dr. Graversen applied a patch to my right eye in attempt to heal cornea for 2 weeks.  This was unsuccessful.

Dr. Graversen sent me to a cornea specialist Dr. Stevens of Tyson Eye.

Oxervate

May 2021:

Met with Dr. David Stevens of Tyson Eye in North Fort Myers to deal with cornea scratch.  Dr. Stevens tried a disc in the eye with medicine that might fix the scratch.  After a week, we found the scratch was mostly healed but not completely.  We then tried a contact lens with medication.  After a week, the scratch was back to its original size.  Dr. Stevens removed the lens and prescribed Oxervate. .

6/10/2021:

I was approved for Oxervate and started the 8 week treatment 6 times a day.  Cornea scratch diagnosis Neurotrophic Keratitis.  Oxervate dispensed by Accredo Pharmacy via mail order.

Oxervate is applied 6 times a day for 8 weeks.  Each drop comes in its own vile to be used only once.  You take the vile out of the box and insert a dropper.  After applying the drop, vile and dropper are thrown away.

7/17/2021:

I have been on Oxervate for 5.5 weeks.  The scratch seems to be healed.  However I need to finish the 8 weeks of Oxervate to ensure healing is complete.  Oxervate causes eye irritation, pain in eye, and a great deal of tearing.

8/6/2021:

Completed 8 week course of Oxervate.

8/11/2021:

There is an apparent infection in right eye.  Dr. Stevens prescribed antibiotic oral and eye gel medications.  Erythromycin  and Clindamycin HCL 150 mg.

The cornea seems to have a substantial amount of calcium build up.  So I may need a procedure Limbal cell transplant and/or Chelation.

8/16/2021:

Met with Dr. Martinez  atBascom Palmer Institute in Naples, FL.  Observed concave calcium over cornea damage.  Discussed options such as Stem cell which keeps cornea clear.  Limba cell transplant requires stem cells from close relative or left eye.  My left eye is not functional and I have no remaining family.  Chelation could work but risk of unhealed cornea and would need to be reapplied about every year.  Dr. Martinez prescribed Moxifloxacin 0.5% for right eye infection.
Dr. Martinez said the infection in my right eye was "pink eye". He did a test to see if it was "pink eye". The test came back negative, however Dr. Martinez disagreed with the result and insisted it was "pink eye". He did nothing useful for me whatsoever.

8/20/2021:

Reported lingering issues with Oxervate to Oxervate manufacturer Dompe.  I noted the following:

Finished 8 weeks on 8/6/2021.  Used 6 times per day in right eye as prescribed for 8 weks.  For the duration of the 8 weeks, I had these side effects:

• Excessive tearing
• Pain in the eye
• Mild headaches
• Redness

Starting on 8/8 - 2 days after completing Oxervate, I developed what looks to be an infection in the same eye where Oxervate was used.  The infection caused pain in the same eye throughout the day.  Today is 8/20/2021 and from 8/8/2021 I experienced 5 nights where I simply could not sleep because of the severe pain in the eye when I laid down.  The pain subsided somewhat once I sat up.

I consulted with 2 eye doctors including Dr. Stevens of Tyson Eye in Fort Myers Florida who prescribed Oxervate.  I also consulted with my general practitioner Dr. Del Castillo of Millenium Physicians Group in Punta Gorda Florida.  The result is the following medications:

Moxifloxacin

Amoxicillin Clab 875 - 125 mg - twice a day for 14 days - for eye infection.

Fluticasone Prop 50 ncg spray - once spray per day for 30 days - for eye infection.

As of 8/20/2021, I have these issues in right eye where Oxervate was administered:

• Pain in right eye of various intensity throughout the day.
• Tearing in right eye.  The corner of the eye next to nose is usually wet with tears.  I also find tears around my eye which irritate the sores around my eye.
• Redness in right eye has never subsided since I started Oxervate.
• Swelling of the right eye and cheek has been pronounced since the end of Oxervate.
• Headaches throughout the day of various intensity.  Usually behind forehead above the eyes.
• Have developed scabs or sores on both eye lids.  These ache throughout the day.  The tears on the sores make it feel like burning or acid.

8/22/2021:

My experience with Oxervate has been rather awful.  I have been in discomfort to severe pain since beginning Oxervate and now 16 days since completing Oxervate.  I am limited to what I can do daily because I just do not feel well with the headaches and eye pain and irritation.  I am beginning to think this will never get better and I will be miserable for the rest of my life and yet no vision improvement.

Image from 8/14/2021:

08/23/2021:

Met with Dr. Stevens. 

Observed blood in front part of eye.  Lower eye lid swollen with blood.  Eye is draining pus.  Concerned could be a bacteriological infection.

prescribed Moxifloxacin 0.5% for right eye infection.

Prescribed Azithromycin 1 gm pwd packet for eye infection.

08/25/2021:

Met with Dr. Stevens.  No improvement and Dr. Stevens thinks the swelling is worse.  He consulted with Dr. Martinez of BPI and Dr. Mark Gorovoy of Fort Myers.  It was decided I should visit Dr. Gorovoy the next morning.

Cornea

8/26/2021: Met Dr. Mark Gorovoy an experience ophthalmologist in Fort Myers, FL.

Dr. Gorovoy conducted a thorough exam and revisited my vision history.  His conclusion is that I am having an allergic reaction (not an infection) to one of my eye medications.  Temporarily we are stopping. cosopt, Prednisolone , Refresh, and Genteal.  Additionally, stop all antibiotic medications oral, drop, and ointment.  He prescribed prednazone 10 mg tablets, 4 times per day for 3 days.  By the next morning Friday 8/27/2021, my eye was less red.

Dr. Gorovoy indicated on 9/1/2021 that the cornea scratch was NOT healed and therefore Oxervate did not work.  Dr. Gorovoy agrees that the cause of the allergy was Dorzolamide.  He was able to remove some calcium from the front of the eye.  Prescribed Timolol, Polymyxin, Dexamethasone, and Betadine.  Discussed cornea transplant but that it would be high risk procedure given the sickness of my eye.

09/10/2021: Gorovoy:

Skin around eye is clear.

I no longer have pain in and around eye.

Performed ultrasound however could not descern blood or scar tissue due to cornea being opaque.

Cornea swollen defused no calcium some deep vessels.

Allergy symptoms gone.

Cornea transplant may only last a year or 2.

Artificial cornea would last longer but could cause issues with glaucoma.

Either procedure is high risk due to my current eye condition.

October 2021 Dr. Perez– Duke Eye Center:

I reached out to Dr. Perez regarding KeraKlear.  After looking through notes and imaging determined I was not a candidate for KeraKlear.

11/02/2021 Dr. DaLuvoy – Duke Eye Center:

Examined by Dr. DaLuvoy at Duke Eye Center.  Her conclusion was the same as Dr. Gorovoy.  Any surgery would be of very high risk of further vision loss.  Dr. DaLuvoy performed 7 cultures to search for possible infection including fongal.  After 4 weeks, no infection was found.

4/14/2022 Dr. Palmon – SW Florida Eye Care:

Examined by Dr. Palmon which included a 45 minute discussion regarding my cornea.  Discussed at length current situation of my failed cornea.  After discussing possible complications and risk factors of cornea transplant, we decided to proceed with the procedure.  Dr. Palmon was concerned about my retina status and so discussed issue with Dr. Graverson, and consulted notes from Dr. Fekrat.  It seems retina is securely attached to buckle and should not pose risk of detachment post surgery.  I was relieved   to know that if the retina was to detach that it would do so post surgery not during surgery.  Follow up on June 9 shows eye is sufficiently responsive not to need a procedure that would have had eye lid shut for several weeks.  Here are Q&A with Dr. Palmon:

5/13/2022:
Lou: Do you agree that a cornea transplant is HIGH risk given my situation? High risk meaning a failure of the transplanted cornea.
Dr. Palmon: I would consider your transplant moderate risk.
Your risk involves the chance of retinal detachment after surgery just from entering the eye.

Lou: Do you believe the transplant would hold and need not be performed semi regularly and thus not a hight chance of failure?
Dr. Palmon: Risk of rejection and failure of graft is higher than the general population which runs 10%.
Graft failure is related to rejection.
Which on primary grafts is 10%.
If you don't reject and your surface heals over the graft than it will hopefully last 20-30 years.

Lou: Would you perscribe prednisone post surgery as immune supressing eye drops? If so, does not this have the potential of high pressure and susceptible to infections?
Dr. Palmon: Prednisolone drops protect against rejection and will start 4x/d gradually tapering to once a day over the first 6 months.
It cannot be stopped because of the risk of rejection.
Glaucoma patients can respond to steroids with an elevated IOP which will need to be treated.
Risk of infection is low as long as the surface epithelium remains intact.

Lou: I have been told that I have unhealthy limbal stem cells and history of poor healing, isn't there a chance of not healing well after surgery leading to haze or scarring. Would this not then require a limbal stem cell transplant or keratoprosthesis? Not advisable option in a monocular patient?
Dr. Palmon: Poor limbal stem cells can lead to poor surface healing and need for limbal stem cell transplant but I did not see evidence of limbal stem cell deficiency.
Keratoprosthesis is done for patients who have multiple failed standard transplants of 3 or more which I perform in selected patients.
I would not recommend that in you.

Lou: There are no guarantees in life, but can you ensure that when I wake up after surgery or even after a few weeks, that my vision in my right eye will not be any worse? That is, I can still see light.
Dr. Palmon: I cannot guarantee anything because there is always the small risk of infection which can lead to loss of vision. Risk of infection is 1 in 1000-1200
 

7/12/2022: Full cornea transplant right eye: Surgery took 90 minutes. Should have been 30 to 45.
Cornea was 3 times normal thickness.
Transplanted cornea is very swollen which will reduce over next couple of weeks.
Surface cells should grow over cornea over a couple of weeks to heal cornea.
Dense Fibrotic Vascularized Membrane behind cornea. Thickess doctor had ever seen. Membrane teased out until back of eye could be seen. Cleaned out but a few blood cells remain which will be obsorbed.

Membrane caused by Rubiosis of the Iris. Caused by blood vessels growing in eye.
Could only see reflection of retina.
Stitches remain 3 to 12 months which causes vision distortion.
Keep eye covered during day and shield at night for first month.
Until cornea is completely healed (about a month), no swimming, lifting over 5 pounds, no straining, no exercise bike, partying, getting eye wet, etc.
Walks are ok.
Cautiously optimistic.

July 27: Dr. Palmon

Transplanted cornea surgery successful!
Surface cells have grown over cornea. This is very good news and after 2 weeks much faster than anticipated.
Fibrotic Vascularized Membrane behind cornea removed during cornea transplant has grown back. This causes light not to get to retina explaining why vision has not improved. Increasing steroid eye drop to hourly. If that does not remove the Membrane (scar tissue) then next option is laser and then surgery if necessary.
Swelling and bleeding has gone away.
 

August 17: Dr. Palmon

Fibrotic Vascularized Membrane has diminished about 25%.  Still no vision improvement.  Steroid eye drops every 2 hours. 

September 13: Dr. Palmon

Yag laser procedure to remove Fibrotic Vascularized Membrane.

September 27: Dr. Palmon

Laser procedure unsuccessful.

No vision improvement.

Have been applying prednisalone every 2 hours, genteal gel, and Refresh.

October 10: Dr. Graversen

Center of eye and pupil clear of membrane.
Retina is visible.
Minor bleeding detected so Avastin injection administered.
Still no vision improvement. I can still see bright lights and shadows.
Vision did not improved after cornea transplant or Yag laser procedure.
Dr. Graversen theorizes that some cells in optic nerve may have been damaged during cornea transplant thus limiting vision.
 

January 4, 2023: Dr. Schwartz of BPI Naples

I went to see Dr. Schwartz at BPI Naples today to discuss the burning sensation in my eye during Avastin injection. What I got was a totally different conversation then expected.
1. He would not do Avastin injection without Betadine. He says the risk of infection is high.
2. He said I did not need an injection today even though it has been 2 months since my last one.
3. He questions whether I will need Avastin injections any longer.
4. He thinks the Avastin is what is causing the burning sensation as my eye has so much irritation due to past procedures.
 

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