2-month post-op update - addendum

Dr. Rumery called me back to ask that I come back in so he could test the pressure in my eye (a quick and simple test) so we coordinated and somewhat sketchily / awesomely met up at the Dean Clinic on the West Side after hours to get me checked out before he went on vacation (thanks again, Dr. Rumery, for being so flexible and awesome!)

For those interested, after a numbing drop, Dr. Rumery used a hand-held applanation tonometer, which I find to be vastly preferable to the puff of air method:

It didn't look exactly like this one, but this picture was too awesome not to include

Anyways, good news:

• left eye: 8 mmHg (the one of interest)
• right eye: 11 mmHg

Background on this measurement and why it matters from the Ocular tonometry wikipedia page:

Tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients at risk from glaucoma.^[1] Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).

It's all in the genes

As part of the surgery to implant the plaque, I opted into another procedure called a fine needle aspiration (FNA) biopsy. It's exactly what it sounds like. The idea was to:

1. confirm the original diagnosis and 
2. find out more about the tumor (such as its likelihood to metastasize or kill me)

The first was quick to determine: the cells from the biopsy were consistent with a low-grade melanoma. Glad we did that whole plaque thing then :)

The second required more lengthy analysis. 3 chromosomes were analyzed: 3, 6, and 8. The results for chromosomes 3 and 8 were normal ("disomy"); chromosome 6 was "amplified," however apparently this region of chromosome 6 (6p and 6q) is not correlated with increased risk of metastasis (which begs the question why are we testing it, but I'm sure this result was heavily diluted for the lay person so the question is moot). It seems that monosomy of chromosome 3 or amplification of chromosome 8q are changes that are associated with an increased risk for developing metastatic disease. *Whew*, amirite?

TL;DR: based on genetic makeup alone (i.e. discounting size and location of tumor), there is a low risk that this will metastasize elsewhere for me.

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Some definitions from the result materials I received:

Chromosomes: visible rod-like structures in each cell of the body that contain genetic material. Normal human cells have 23 pairs of chromosomes. The chromosomes are in pairs (two copies) because one copy of each chromosome is inherited from your mother and father. There are specific genes located on each chromosome, and the number of genes varies for each chromosome.

Somatic: refers to genetic material that is found in a specific tissue or cell-type in the body. In genetic testing, when a DNA mutation is defined as a somatic mutation, there is very little risk of passing on the mutation to children. Most cancers have somatic mutations meaning a mutation occurred in a single cell that disrupted normal cell growth, which allowed a tumor to grow.

Disomy: refers to the normal number of two copies of a chromosome.

Monosomy: refers to an abnormal number of only one copy of a chromosome.

2-month post-op update

Ok, it's not quite 2 months, but due to scheduling stuff, I had my 2-month post-op with Dr. Rumery today.

Stuff we discussed:

My current meds

1. Tobradex Ophthalmic ointment - 3x/day, this is for comfort and as an antibiotic
2. Atropine - 1 drop daily before bed, this is to keep my eye dilated*

*Why are we keeping my eye dilated? Great question! This helps to prevent synechia. Basically, after surgery or other eye trauma, it's possible for your iris to become sort of stuck to your lens (in my case) or cornea. This is bad because it can cause pressure that can led to glaucoma. Keeping my eye dilated means my iris is a bit more withdrawn from the lens, at a position where it's at a slight distance from it and therefore less likely to become stuck.

My vision

Pretty good! With glasses for correction, my right eye is at 20/20, which is expected. My left eye is still not back at 100%. I've been worried about this, but this visit reassured me a bit.

You're probably familiar with an occluder (see image below), even if you don't know it by name: it's the thing you use to cover one eye so you can use the other for a vision test. They had a nifty one at my eye doctor that had a flap that rotates into place over the eye of interest, adjusting the opening from a Sacagawea dollar-sized hole to a series of pinpoint openings. This is awesome because it reduces the amount of light entering your eye. Meaning...

*drumroll please*

It simulates your eye in a non-dilated state! In other words, looking through the occluder with this flap engaged meant I was seeing as I would if my eye weren't dilated. And hearteningly, this improved my vision a LOT. While I'm not at 20/20, I'm close. This alleviated my worry that maybe I wasn't recovering well, or that my cataract was already brewing.

Fancy occluder

My retina and overall eye health

Pretty good! Nothing in particular of note, in either direction.

My cornea moisture

After putting a drop and some yellow (fluorescein?) dye in my eye, Dr. Rumery examined it using blue light, with which the dye is most visible. The idea is that the yellow dye attaches to areas of lower moisture on the cornea, meaning those areas are dry and perhaps indicative of poor corneal health or recovery. Good news: while I had a couple of areas that showed up under the blue light, they were small and faint. This isn't worrisome.

Bonus: for those who looked at the surgery pics, there was one where I was not at all sure what layer was sewn shut. Well, mystery solved: it was the conjunctiva, which is a layer on top of the white part of your eye (the sclera) that helps with lubrication. It doesn't normally extend over the iris/cornea, but was stretched to do so during the time I was wearing the plaque (apparently). Anyways, ♪♫ The more you know! ♫♪

I've gone back and updated the photos post with this info, too :)