Eye to eye . . .
"Is there nothing you can do?"
You wake up to find that your previously healthy right eye can see only a parade of colors. Weeks afterward, you’re trying – for the gazillionth time – to successfully reach out and grasp a glass of water. How do you feel? Jackie Carswell would answer that question in one word: grateful.
In 2010, after learning that both of her eyes were affected by end-stage “wet” age-related macular degeneration ( AMD), Carswell, in her mid-70s, asked her doctor, “Is there nothing you can do?” He replied, “There’s a doctor in Atlanta, doing some surgery that’s just been approved.”
Carswell’s acquaintance with Emory Eye began during a long session with Susan Primo, a nationally known expert in low vision. Well practiced in pinpointing the needs of people with visual limitations, Primo asked Carswell about her eyes, her lifestyle, her interests and personality, her vision-related goals. Carswell learned about a device approved in 2010 by the FDA, and available to eligible AMD patients: a tiny, surgically implanted telescopic lens. Other options also existed, Primo told her, describing low vision devices that could help Carswell see better.
“Dr. Primo gave me alternatives, so I could decide,” Carswell says. “She helped me understand that if I chose the implant, it was not going to be easy, but she thought I had the ability to do it. I still thank her for that.”
Primo, the first person to undertake systematic study of how the trial’s earlier participants were functioning four years after implantation, knew exactly which traits made a perfect candidate for the new device. There was no need to ask, “Are you optimistic? highly motivated? able to accept compromises?” Primo could tell. In Carswell, she and the other team members – cornea surgeon John Kim, retina specialist Chris Bergstrom, and occupational therapist Donna Inkster – had a best match.
Carswell was the first person in Georgia to receive the implant once it had received FDA approval; soon after her surgery, she and Inkster began the hard, slow work of rehab training. “One of the first things I started learning,” Carswell says, “was how to look at a glass of water, focus on it, and reach for it. Well, I’d reach, but it wouldn’t be there. So I just kept trying again.”
Along the road back to independence, she also created strategies for coping with her limited vision: Can’t distinguish the knobs on the stove? Cover the “off” knob with hot pink duct tape. Can’t differentiate the seedlings from the dirt? Put the plants in pots.
Can’t bowl as well as you used to? Just enjoy seeing how far the ball will go before it veers into the gutter. Can’t drive? Get by with a LOT of help from your friends. “I’m by myself, so I’ve had to figure out what I can do to get things done,” Carswell says.
Primo uses Carswell’s own word – grateful – to describe what she has learned from her patient’s rehab successes. “With her humor and upbeat nature, Jackie reminds me that there’s a better way to look at life – to accept what is and then to move on, being grateful for what we have.”
Today, with what friends call “that new little twinkle” in her eye, Carswell can focus her implant easily. She relishes being able to read the newspaper, or her Bible, or a book from a friend. Her fork never fails to reach her mouth; the toothpaste goes obediently onto the toothbrush. And both patient and doctor freshly recognize that there’s always something you can do: Remember that the glass – whether graspable at that moment or not – is at least half full.
“The patient and the physician: Everything of importance happens at that juncture. Patient care is our direct point of contact. It’s where we provide the greatest value, and it’s the epicenter for our other missions of education and research.”—Timothy Olsen.