IJFT Prognosis and information

I have some questions re: juxtafoveal telangiectasia. Knowing what you know about juxtafoveal telangiectasia, what would be your thoughts to a case like this -- I understand that you cannot state for sure as you've not seen the patient, but I'm just wondering: Right Eye: Intraocular Pressure - 18 ; Vision - 20/30 ; O.U.: juxtafoveal telangiectasia (what does O.U. mean by the way?) -- Left Eye: Intraocular Pressure - 19 ; Vision - 20/60; subfoveal choroidal neovascular membrane I've looked up both juxtafoveal telangiectasia & subfoveal choroidal neovascular membrane on-line to try to get a better idea of what it all actually means. From what I've read in several places there are 3 groups of juxtafoveal telangiectasia; however, I have no idea which this is. Since it's a 51 year old female I'm guessing it's type 2 (from what I've read about the descriptions but the doctor never explained that there were multiple groups). What I do know is that the person cannot drive -- cannot read the signs. The lines on the road are constantly wavy/moving (even though from the state says 20/25 is perfectly fine to drive and you "only need one eye to drive." I know what effects the patient experiences: cannot read any type of print (type size, etc.) , cannot see a straight line (everything is constantly moving and/or wavy), even stairs are difficult because of the movement (the stairs tend to appear moving). Physical things appear distorted (even when looking at faces they seem somewhat distorted.) It's been explained as something like when going through the mirror house at the fair -- that's somewhat of how she sees. This all makes working difficult, any "basic" job isn't so basic when you can read the print, read cashier buttons, etc. not to mention you can't drive to work. Do the effects that I've described above sound common for the situation? Again, from what I've read it doesn't really go into detail to say for sure. If not, is there something that you'd suggest being tested for? If so, is there any sort of treatment other then observation that you'd recommend looking into? What are your thoughts on the driving, is there anything that you'd recommend or is this an unfortunate loss cause? What about working, would this be a loss cause, as well? What are your overall recommendations? Are there are local (Oakland / Wayne County, MI )specialists that would specialize in juxtafoveal telangiectasia that you'd recommend? I look forward to your reply.

Answer:

Thanks for writing. I will try to answer your questions. O.U. means "both eyes". O.D. means "right eye", and O.S. means "left eye". The classification of idiopathic juxtafoveal telangiectasia (IJFT) is best covered in the article by JDM Gass MD, Ophthalmology 100:1536-46, 1993, which can be found in Pubmed (Google that word to get the link). To summarize for you, involvement of both eyes usually will mean that the affected patient has group 2A. Many eyes with group 2A disease have good chart vision, often 20/20, although they still have annoying symptoms as you eloquently described. The median vision for these patients is 20/40 (that is, half are better than 20/40, and half are worse), and no patient in a large series of 92 patients had both eyes with worse than 20/200 vision. The subfoveal choroidal neovascular membrane of the left eye that you describe is unfortunately a rather common occurrence in IJFT. This is an abnormal growth of blood vessels arising from the choroid (a normal, separate blood vessel layer under the retina) and penetrating upward to spread just beneath the retina, causing damage from leakage, bleeding, and scarring. When this happens, one of various types of laser treatment may be recommended, sometimes supplemented by injections of triamcinolone, a steroid, into the eye. The exact recommendations depend on the details of each case. The various disabilities from the disease that you describe are very real, and often more severe than one might imagine from the chart vision recorded in the doctor's office. Sometimes, larger print, larger computer monitors, bigger fonts, and better lighting help, but even with the optimal conditions, the symptoms can be discouraging, and I sympathize with your dilemma. I know of no quick fixes, unfortunately. As for driving and job disability, this is quite case specific, and I would refer you to a retina specialist in your area. There are many good retina specialists in Michigan. Please ask you primary eye doctor for specific names. I suspect that you have read the brochure on the website under Information, and have seen the sample photographs in the Photo section. If not, please check there for more information. Best wishes in your treatment and outcome.