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by Genghis


A retina with retintis pigmentosa

For those of you who aren't yet familiar with Jim Knipfel's fascinating writing, click here. For those of you erudite motorcycle jockeys who are familiar with Jim "Slackjaw" Knipfel's writing, you know from Jim's books and columns, that he suffers from retinitis pigmentosa, which is a degenerative eye disease which decimates vision over time. Jim has eloquently documented the course of his retinal disease over the years in his writing. Jim's elaborate descriptions of his personal battle with "RP," do justice to the unimaginable devastation that RP can render to a sufferer's life, that the words of this humble reporter could not aspire to. I therefore, heartily refer you to Jim's books and "Slackjaw" columns for edification. What I can do however, is shed light from the doctor side, for Jim is our patient in the ophthalmology practice, in which I'm the manager. In this accounting of my clinical experiences with Jim, I'm not exposing confidential information without Jim's knowledge, for Jim writes quite openly regarding his battle to keep his sight.

Jim first presented in our office about twenty years ago, when his retinitis pigmentosa starting a moderate decline. His visual acuity then was a relatively good 20/40, which is good enough to pass New York State's driver's vision test. Jim at that point, had yet to fall victim to the loss of peripheral vision, which is a hallmark of retintis pigmentosa. Over the years, there was nothing that we---we meaning our staff and our fearless leader, Doctor Jeanne L. Rosenthal---could do for Jim, aside from being cheerleaders and helpless bystanders, as there is no effective treatment for the progessive onslaught of RP. There was nothing we could really do for Jim's vision, until recently that is. Over the years, Jim had also began to develop cataracts in both eyes. A cataract is a media opacity that occurs in the lens of the eye. The lens of the eye is a crystalline clear lens that we're all born with, that eventually becomes more turbid as we age. When it becomes opaque to the point where it interferes with vision, then we call this a "cataract." This was the state of Slackjaw's affairs, when his cataracts became so advanced, that the visual acuity in both of his eyes reached the legally blind level, which is worse than 20/200. Ah ha! At last there was something concrete we could do for Jim, which was to surgically remove his cataracts!

It is medically imprudent to remove both cataracts at once, so Jeanne operated on each eye with an interval of several months, between each eye's operations. A couple of days ago, Jim came for one of his last postoperative visits from his surgeries. Just as I was about to bring Jim into my room to check his vision, Jeanne intercepted me and said, "Scott, bring Jim into my room and I'll check his vision. I put a patient in your room who you have to schedule emergency surgery for." This other patient was a diabetic who had a vitreous hemorrhage (a vitreous hemorrhage is a bleed that fills the entire eye and renders the eye totally blind) who needed a procedure called a pars plana vitrectomy with endolaser. You see, Jeanne not only does cataract surgery. She also does exotic retinal surgeries such as this and retinal detachment procedures, which are the most complex and challenging eye surgeries imaginable. Because I had to work with this vitreous hemorrhage patient on his surgery, I was unable to see what Jim's vision turned out to be. When I checked Jim's chart later, I saw that Jim had a distance vision of 20/70 in each eye! This was fantastic.

More importantly to Jim, he attained even better near vision, which to a writer is of paramount importance. In cataract surgery, the surgeon implants an artifical lens that replaces the natural lens of the eye, and therefore replaces the function of the lens of the eye, which is to focus light and images on the retina, which then transmits these images to the brain via the optic nerve. The brain then interprets these, as "vision." The artificial lens, which is known as an "intraocular lens," comes in various powers. Deliberately selecting a given power of intraocular lens allows the surgeon to fine tune the specific distance from the eye, at which vision is maximized without eyeglass or contact lens correction. For Jim the choice was easy: he wanted to maximize the vision at computer screen distance. This allows Jim to maximally see what he's writing on a computer. It meant that as a professional writer, Jim's most important sense---his vision---was restored and maximized so that he can write the most effeiciently. Write on, brother! I can appreciate this, as I'm a writer too. Surely I'm a hack compared to Jim, in fact---Jim is the writer I want to be when I grow up. Hey man, I'm happy for Jim. Later.