Doctor, when was the last time you performed an Amsler grid on yourself?

Issue: October 1, 2000

ByDavid B. Davis II, MD, FACS

A number of years ago, I read with astonishment the wonderful article in Ocular Surgery News by Herve Byron entitled, “Doctor, when was the last time you had an eye exam?” (June 1, 1996, page 13). Herve detailed his diagnosis of asymptomatic advanced glaucoma with intraocular pressures up to 50 mm Hg. He had not had an eye exam for more than 20 years. Fortunately, a combination of laser and medical therapies has controlled his glaucoma without further visual field loss.

After this illuminating article, my pressures and refractions, which were now checked routinely, were within normal limits. With 20/20 vision maintained, I saw no reason to have a dilated exam. After all, I had a perfectly normal retina when I was 35 and being dilated was just too inconvenient. I thought this way even though my father has macular degeneration in one eye (onset about age 83) and my maternal grandmother lost all her central vision from bilateral macular degeneration. She lived to be 103 and had, I think, good vision until her 80s.

Conscientious about patient care

So, dumb and happy with my good vision and intraocular pressures, I continued to advise my patients on how to diagnose and follow their macular problems, saw them yearly and had them routinely perform their Amsler grids. I was very conscientious about their care.

Seven years ago, at age 58, I encountered a patient with early macular degeneration. I explained how to perform the Amsler grid, but he was perplexed with my instructions and did not understand. So, I showed him on myself. I saw significant distortion and blind spots with each eye. I, too, had macular degeneration. I had my diagnosis, and, although it was significant, it had not yet involved the fovea.

Now, very conscientious about myself, I visited our local retinal surgeon and had photographs taken so I could see what they saw. To my sadness, I saw a retina loaded with many medium and large semi-soft drusen-like forms, which, when I performed Amsler grid, the metamorphopsia and blind spots correlated perfectly. I sent the photos to Alan Bird in London who stated it looked like dominant hereditary drusen. After extensive research, I have found none of my relatives with macular degeneration to have a similar picture, and my other close relatives who have no known macular degeneration did not either.

Alternative therapy

I became very interested in alternative forms of therapy and started on vitamins and antioxidants in reasonably high doses. In spite of this, I watched sadly as thee metamorphopsia and blind spots grew in size and number with each examination. Three years ago, I began lutein antioxidant therapy along with what I believe are other higher quality antioxidants. Although the Amsler grid has not improved, I have definitely noticed a slowdown in the progression of changes. In the past year, there has been, fortunately, no significant change. I am very aware that the course of macular degeneration can vary significantly, but I have become quite convinced that proper antioxidant therapy, especially lutein, may play a significant role. I am not confident to say that this alone will beat my disorder, but am beginning to feel that my time with good central vision is definitely expanding. I am continuing to study all new therapies (rheotherapy, etc.) and am hopeful that I can slow this down enough with my present treatment until something definite comes along that will allow me to have useful vision for the rest of my life.

So, like Herve Byron, I have learned a new and painful lesson. No matter how great a doctor you are, how asymptomatic you may be or how good your vision seems to be, only periodic, complete exams, including Amsler grid, will allow you to pick up an early asymptomatic ocular disease on yourself.

For Your Information:

David B. Davis II, MD, FACS, can be reached at 1237 B St., Hayward, CA 94541-2915; e-mail: dbd1029@aol.com.