A Sudden Detour for a Healthy Architect
In April, Heinz Richardson, 59, a director at the architecture firm Jestico+Whiles in London, England, embarked on a behemoth challenge: He and a team of cyclists began a ride totaling 4,437 miles through the United States, Ireland and the United Kingdom -- starting in Portland, Ore., and ending on Portland Place in London. The charity bike tour, P2P, served a dual purpose of raising money for three charities and giving the team of architects and urban designers a chance to see how the infrastructure of American cities supported cycling and environmental stability.
In late May, Richardson and the cycling team were trekking through South Dakota when the vision in his left eye suddenly became blurry. Richardson, a fit and healthy Briton, was cycling 70-100 miles a day with P2P and chalked it up to nothing more than the stress of constant travel and weather. He used eye drops, hoping it would clear up the blurriness. A week and a half later, the team arrived in Chicago for several days' rest. By that time, Richardson estimated he could only see about 20 percent of objects clearly and decided to do something about the persistent blur.
In Chicago, Richardson had no idea to whom or where to turn. At the recommendation of a hotel staff member, he and his wife visited the University of Chicago Medicine, where he was taken into the eye clinic and underwent a battery of eye exams. Seenu M. Hariprasad, MD, chief of vitreoretinal service, delivered the shocking results, which showed Richardson was suffering from an eye stroke, also known as retinal vein occlusion.
"My eyes are the most important part of my body because I'm not only an active person, but also a visual artist," Richardson said. "Four years ago I had Lasik surgery to correct my eyesight, so I thought maybe my blurred vision was a consequence of that procedure. I had no idea how serious my case really was."
Richardson's Dire Diagnosis"I knew right away I was in the hands of someone who is in the top percentage of retina experts in the country."
There are approximately 180,000 new cases of retinal vein occlusions each year. Richardson suffered from a subtype, hemiretinal vein occlusion, which affects half of the retina.
In a healthy eye, a central retinal vein carries blood away from the eye. Similar to a heart stroke, a blockage in the eye can be catastrophic, causing a build-up of blood in the retinal vein. The slow build-up can eventually force blood to leak into the macula, the part of the eye that allows one to see objects with clarity. The excess fluid in the macula can lead to swelling, also known as macular edema, which is the primary cause of blurred or loss of vision.
As a result, one of the most common symptoms suffered by individuals with retinal vein occlusion includes blurred vision. When left untreated, these individuals can suffer permanent loss of vision. Common risk factors include increasing age, diabetes and high blood pressure. In Richardson's case, Hariprasad points to transient high blood pressure as the most probable cause of his eye stroke.
"While every patient's case is unique, many individuals don't express too much concern over blurred vision, as they feel that vision loss is a normal part of aging. This is why it is of utmost importance that we educate the community about vision loss and disorders like retinal vein occlusions," Hariprasad said. "In Richardson's case, he was very lucky to have visited us when he did."
"I Will Cycle."
Richardson had a tough decision to make upon learning about his hemiretinal vein occlusion. Hariprasad posed two options: undergo a procedure at the University of Chicago Medicine or fly home to London immediately to seek treatment. Time was of the essence, as inaction from an eye stroke could render Richardson with permanent loss of vision. After his consultation with Hariprasad, Richardson took the next day to think about his options.
"After I left the eye clinic, I did some of my own research to learn more about Dr. Hariprasad. After I did a Google search, I knew right away I was in the hands of someone who is in the top percentage of retina experts in the country," Richardson said.
Hariprasad is a renowned authority with expertise in the treatment of age-related macular degeneration, retinal vein occlusion, diabetic eye diseases and other vitreoretinal disorders. He is actively involved in clinical research, having been principal investigator or sub-investigator in more than 40 national clinical trials evaluating new drugs, devices, surgical innovations and drug delivery for a variety of conditions. His work has contributed to the understanding and use of new medications to combat a wide variety of vitreoretinal disorders.
Right away, Richardson got on a three-way call with his London-based insurance company and an eye consultant for the insurer. Together, the three parties agreed he should stay in Chicago and undergo the treatment Hariprasad recommended."My whole journey to Chicago and then the University of Chicago has been amazing."
The following day, Hariprasad performed a same-day operation that involved an injection of Eylea into Richardson's left eye. Eylea, which was approved by the U.S. Food and Drug Administration (FDA) 18 months ago, is designed and approved to control the leakage of blood and swelling in the eye. Currently, the University of Chicago Medicine is one of a handful of Chicago institutions to have Eylea as a treatment option for retinal vein occlusion. Six days after the eye injection, Hariprasad was astounded by Richardson's improvement.
"I don't know if it's his excellent health from being a cyclist, but the recovery I saw in Richardson's eye over the course of six days is what I typically see in patients over six weeks," Dr. Hariprasad said. Although Richardson must follow up with a retina specialist in London for several additional injections, Hariprasad expects Richardson to make an excellent recovery and will most likely retain his vision.
Richardson explains the improvement from his own point of view. "Just one week ago I couldn't read, so the change has been remarkable," he said. "My whole journey to Chicago and then the University of Chicago has been amazing. It was not through previous knowledge that I landed here. Sometimes serendipity in life happens in a good way."
Richardson now intends to meet his cycling team in Pittsburgh and continue the rest of the way. "This episode put me back a bit, but I will cycle," he said.
A History of Excellence in Ophthalmology
The University of Chicago Medicine has a long history of excellence in ophthalmology. As recently as five years ago, there were no FDA-approved treatments for retinal vein occlusion. As a result, outcomes for patients historically had been very poor.
In 1971, Alex E. Krill, MD, and Frank W. Newell, MD, former chairman of ophthalmology at the University of Chicago Medicine, published one of the first papers investigating the use of retina laser photocoagulation to treat complications stemming from branch vein occlusions. Soon after, in 1974, Newell and J. Terry Ernest, MD, another former chairman of ophthalmology, published a classification scheme for branch retinal vein obstructions. Additionally, in 1985, Peter H. Morse, MD, a University of Chicago retina specialist, published research that explored the prospective rationale for and results of argon laser treatment for patients with branch retinal vein occlusions.
Through Hariprasad's retina service, the University of Chicago has been involved in five clinical trials since 2005. These investigations center around the use of new-generation steroids and anti-VEGF (vascular endothelial growth factor) agents to treat retinal vein occlusion.
"The volume of procedures, research and clinical trials that are done at the University of Chicago Medicine really elevates us as a Center of Excellence in the realm of ophthalmology," Dr. Hariprasad said. Most recently, Dr. Hariprasad is nearing the completion of his textbook, Management of Retinal Vein Occlusions- Current Concepts. This authoritative textbook is one of only a few written on this topic in the history of ophthalmology.
UPDATE: The textbook, Management of Retinal Vein Occlusions- Current Concepts, was published March 15, 2014 and can be purchased on Amazon.