The Outer Limits

Ophthalmologist’s critical diagnosis saves peripheral vision.

Photo by Jordan Pysz.

Robert and Elizabeth Welch

With its drivers responsible for moving more than 70 percent of all the country’s freight, the trucking industry has long been considered the lifeblood of the US economy. For more than 25 years, Robert Welch was one of the cells in that bloodstream.

“I was stationed in Delaware, Ohio at the Pittsburgh Plate Glass Company manufacturing facility there,” Robert, 82, remembers. “From there, I hauled just about everything the company made – all of its glass and paint products – all over the United States and Canada.”

Robert retired from the trucking industry in 1998 and moved to Florida five years later in an effort to escape what he referred to as the “frozen” north. Several years later, something odd happened while he and his wife were on their way to run some errands.

“I think the best way to describe what happened is to say that I suddenly began to have something like tunnel vision,” Robert explains. “All of a sudden, my vision started closing in on me from the outside. I couldn’t see anything off to the side anymore.”

Robert’s decades of professional experience behind the wheel paid him a huge dividend during that harrowing episode. Despite his impaired vision, he safely steered his car to the side of the road, where he stopped and handed the driving responsibilities to his wife.

That minor change did nothing to improve Robert’s vision. Hours later, after the couple returned home, Robert was still struggling to see anything beyond what was right in front of him. A couple days later, his wife called her eye doctor, David E. Hall, MD, of Pasadena Eye Center.

A Deeper Dive

Dr. Hall is a board-certified ophthalmologist, which means he is a licensed medical doctor specializing in vision care and treatment of the eyes. As such, he is qualified to diagnose and treat a wide range of conditions. That proved beneficial for Robert.

“Ophthalmologists are tuned into the entire body, so when Robert came in saying he was feeling a bit disoriented and was suffering from this loss of peripheral, or side, vision, I knew I had to look a little deeper than usual,” Dr. Hall says.

That deeper look began with Dr. Hall conducting a visual field test on Robert. Used to detect glaucoma, stroke or potential brain issues, a visual field test produces a computerized map of the patient’s entire scope of vision, highlighting any blind spots.

Photo by Jordan Pysz.

Robert’s vision is as good now as it has ever been.

The test confirmed Robert’s complaint of experiencing something akin to tunnel vision, the results showing that, out of both eyes, he could not detect or see anything on the outer half of his normal field of vision.

“After receiving the results of that test, I looked inside Robert’s eyes, and nothing was turning up there,” Dr. Hall reports. “I knew then that we needed to look further back, between the eyes and the back of the brain, where the vision ends up in the occipital lobe.”

To get that look, Dr. Hall ordered an MRI, the results of which revealed the cause of Robert’s tunnel-like vision. It was a tumor that was growing on his pituitary gland and pressing on his optic nerve.

“The nerve fibers for the outer half of the vision for each eye cross right on top of or right next to the pituitary gland,” Dr. Hall educates. “If something is pressing on those nerves, like a tumor, it’ll be the peripheral vision of each eye that’s affected.

“That’s what was happening with Robert. His visual acuity, or ability to see clearly straight ahead, was normal, but he had a classic loss of temporal, or outer-half, field of vision in both eyes, which is typical of the symptoms we find with a pituitary tumor.”

After receiving the results of the MRI, Dr. Hall faxed them over to Robert’s primary care physician, who in turn referred Robert to a neurosurgeon. Soon thereafter, Robert underwent surgery to remove the tumor from his pituitary gland.

Because of its proximity to the brain, the entire pituitary tumor could not be removed during surgery. Enough of the tumor was removed, however, to relieve Robert of his symptoms, which have not recurred since the surgery.

“The tumor is checked every year, and so far, it hasn’t grown a bit,” Robert states. “And ever since they took part of that tumor out, I’ve been able to see just fine. I see clearly, and my peripheral vision is back to normal.

“My vision is probably as good now as it’s ever been, and I have Dr. Hall to thank for that. He does a great job. He was the one who discovered that tumor, and I see him regularly now for check-ups. I owe a lot to him.”

A Far Sight Better

From teller to manager, Barbara Cherry spent nearly 30 years working in the banking industry.  In that time, she held just about every job someone can. Every job, that is, except the position of bank president or vice president.

“I did everything else but never quite reached that level,” confirms Barbara, who is now retired and living comfortably in St. Petersburg, where the bulk of her activities revolve around a church group performing charity work.

“I like to crochet, and I’m part of an organization at the church that does a lot of crocheting and knitting for the birthing clinics in the area,” she says. “We also make sleeping mats for the homeless.

“In addition, I’m involved in a couple of Bible study groups. One of them meets at my church on Tuesday mornings. The other gets together on Thursdays at a church out in Seminole. I’ve covered a lot of territory with those two groups the past five years.”

Covering that territory became a little more difficult for Barbara a couple years ago after she learned during her annual vision examination that she was beginning to develop cataracts.

“At the time I learned about the cataracts, the doctor told me they were still too immature to do anything about,” Barbara adds. “I was aware of them, though, and sure enough, as time went on, I began to notice the effects.

“I noticed at first that it was becoming a little bit harder to read. I needed a little more light to read than I had before. Then I began to notice halos around the lights at night when I was driving and a little more glare than I was used to seeing.

“I cut back on my nighttime driving after that. When I went in for my annual eye exam late last year, the technician said, Wow, your vision has really changed a lot, and he asked me when my next driving test was.

“I told him it was in March, and he said he was concerned that I might not be able to pass the vision test. It was after that that Dr. Hall looked at my eyes and said it was time for me to consider taking those cataracts out.”

Dr. Hall has been treating Barbara for many years. Over that time, he has earned her trust to the point where she didn’t hesitate when he suggested the time had come to remove her cataracts.

“I said, Well, let’s go ahead and get it over with, because my husband has vision problems, too, and I was worried that if something happened to him where he couldn’t drive, we’d be in a difficult spot,” Barbara explains. “I knew it was the best thing to do.”

A Matter of Time

Photo by Jordan Pysz.

Arts and crafts are more enjoyable for Barbara following cataract surgery.

Barbara was certainly not alone in needing to make the sometimes-difficult decision to have her cataracts removed. After all, the natural clouding of the eyes’ lenses, known as cataracts, develops naturally in about 90 percent of all people 65 or older.

Cataracts usually develop from a breakdown of the eye’s lens fibers, a clumping of the eye’s proteins, or both and typically cause blurred vision, an increase in sensitivity to light and a reduction in color vibrancy.

Though cataracts tend to develop slowly over a number of years, they can be corrected quickly and easily through an outpatient procedure in which the natural lens is removed and replaced with an artificial intraocular lens, or IOL.

At Pasadena Eye Center, cataract patients are given an array of tests prior to surgery to evaluate the overall health of their eyes and their suitability for surgery. A test is also conducted to determine the most appropriate IOL for each patient.

Standard IOLs correct vision primarily for distance. Patients can also have one eye fixed for distance vision and the other corrected for reading, an option called monovision. A third option is premium IOLs that correct vision for both distance and reading or close-up work, eliminating the need for glasses of any kind.

“With Barbara, it wasn’t that big of a deal for her to continue using reading glasses, so she decided to get standard, or what we call monofocal, implants,” Dr. Hall reports. “For the most part, hers was a very typical surgery.”

The only exception was that Barbara had an astigmatism, which is another common condition that occurs when the cornea is not as perfectly round as it should be. Dr. Hall says about 80 percent of all people have at least a moderate degree of astigmatism.

“I can’t imagine there’s a better place to go for eye care.” – Barbara

“Since the majority of people have some sort of astigmatism, that’s something we’re always looking for when we do cataract surgery, because standard lenses don’t correct astigmatism,” Dr. Hall states.

“When we put regular implant lenses in, they correct everything else, such as nearsightedness or farsightedness, but they don’t correct astigmatism. We have something called a femtosecond laser that does that.

“The femtosecond laser resyncs or reshapes the cornea to make it rounder. That’s one of the big advantages of having and using the laser. Another is that it basically performs the first several steps of the surgery, including the incision.

“It starts by opening up the little lining around the cataract, the capsule. It then divides the hard center part of the cataract, which is known as the nucleus, into tinier pieces that are softer. That makes it easier to suction those pieces out.

“Because those pieces can be suctioned out more quickly, that shortens the procedure time. It cuts it about in half, and because we’re in the eye for a shorter period of time, there’s less irritation on the eye.

“The bottom line is that the femtosecond laser allows us to be a little bit more precise during the surgery, and because it eases the irritation on the eye and results in less inflammation, it leads to a better outcome for the patient.

“It’s especially helpful if the patient is diabetic because in some diabetics, healing can be a little slower. With the laser, however, the healing period is a little quicker, so it really is a very nice tool to have in our belt.”

Clockwork Procedure

Cataract surgery is usually performed one eye at a time, with the patient taking a one- or two-week break before having the second eye corrected. Barbara had her first surgery, on her right eye, during the first week of November of last year.

She had surgery on her left eye two weeks later, and she was so pleased with the relative ease of the surgeries as well as the outcome that she called the entire procedure an early Christmas present.

“Everything went like clockwork,” she enthuses. “I was afraid at first that I was going to have an anxiety attack or something during the surgery, but they make you feel very comfortable and at ease, and everything went really well.

“I remember seeing so much better after the surgery. It really does make a difference. You don’t realize how bad your vision has become until after the surgery, when you’re seeing so clearly again.

“I was still a little nervous when I went back for my last follow-up because I wasn’t sure if I was going to be able to read the eye chart, but I could read it just fine. I’m confident I’ll pass that driving test now. I’m just tickled to death about the outcome.

“I couldn’t ask for more professional and skilled people. The whole staff is trained in all aspects of eye care, so they have a good back-up system, and they all know what they’re doing and how to do it.

“You go in knowing you’re going to get the best care possible and come out feeling confident and assured that everything went just as you hoped. That’s why I highly recommend Dr. Hall and Pasadena Eye Center.

Print This Article
    • Pasadena Eye Center

      The doctors and staff of Pasadena Eye Center are dedicated to providing you with the highest quality eye care, and they offer the latest advancements in ophthalmology.... Read More

    • David E. Hall, MD

      David E. Hall, MD, is a board-certified ophthalmologist. He graduated from the University of Mississippi and received his medical degree from the University of Tennessee College of Medicine. He completed his internship at Erlanger Hospital and... Read More

    • Nathan R. Emery, MD

      Nathan R. Emery, MD, is a board-certified ophthalmologist. He completed his undergraduate studies at Brigham Young University, Provo, UT, before serving a two-year mission in England. Upon his return to the United States, he completed his medi... Read More

    • Dennis C. Ryczek, OD

      Dennis C. Ryczek, OD, is a Florida-certified optometrist. He attended St. Petersburg Junior College and the University of South Florida. He graduated summa cum laude with a doctorate in optometry from the University of Houston, TX, and c... Read More