If it hadn't been for a former member of the Board of Regents, State of Iowa, Lewis Casson might be blind.

Instead, his vision is normal.

The former Regent is Marvin Pomerantz of Des Moines.

"Marvin is a very good friend of mine," explains Casson, who operates a popular restaurant in northwest Iowa's Lake Okoboji region. "When he found out my left eye was blind for reasons that no doctor had been able to explain, he insisted I see the UI Neurosciences specialists at University of Iowa Hospitals and Clinics. I'm certainly glad I did."

Casson ended up with something he had not gotten elsewhere-a diagnosis-along with expert care from UI's internationally recognized neuroscientists.

His care team included UI neuro-ophthalmologists Randy Kardon, MD, PhD, Andrew Lee, MD, and Julie Falardeu, MD, oculoplastic specialist Keith Carter, MD, and radiation oncologist John Buatti, MD (who recommended a treatment protocol so Casson could receive radiation therapy in Spencer, Iowa, closer to home).

Casson was diagnosed with Graves ophthalmopathy, a condition in which the body's immune system reacted against his eye muscles, causing excessive enlargement and swelling. The resulting compression from inflamed and oversized eye muscles blocked the transmission of vision from the nerve to the brain, causing loss of vision.

Casson's remarkable recovery was paved with disappointment, including two surgical procedures to eliminate the dangerous pressure being exerted on the optic nerve.

The first and second procedures-in which doctors enlarged his orbital space by removing the thin orbital bones surrounding his eye muscles-seemed to fail since vision did not return to his left eye. However, special eye imaging techniques showed that permanent nerve loss had not yet occurred, indicating his vision still might return.

A year later, Casson began to lose vision in his other eye, the right eye, as a result of the same autoimmune process caused by Graves disease that had affected his left eye. Doctors in UI.s neuro-ophthalmology and oculoplastics clinic recommended and performed a third surgery, this time to enlarge the space in the right orbit.

Casson also received high-dose oral steroids similar to what he received at the time of the left orbital surgery a year earlier.

Within a month, the vision in Casson's right eye had returned to normal. Incredibly, the vision in his left eye also improved from the second course of high-dose steroids.

"We continued high-dose steroids and within a few months, the vision in his left eye returned to almost normal, which was quite miraculous," Kardon says. "His eye muscles in both orbits were then treated with low-dose radiation to prevent re-inflammation."

Since then, UI ophthalmologist Ron Keech, MD, has corrected eye misalignment caused by Graves orbitopathy, and Casson now has normal vision with both eyes working together.

"It was amazing," Casson says. "I received unbelievable care!"

For more information about UI neuro-ophthalmology, patients and family members should call UI Health Access toll-free and ask for Carmen Musser, call 319-356-2548, or e-mail carmen-musser@uiowa.edu.

For consultation or referral, physicians should contact UI Consult.

UI Optic Nerve Center
UI's neuroscientists are experts in treating patients with complex conditions like optic neuropathy, which causes loss of vision due to damage of the optic nerve. When tumors or other causes of damage to the optic nerve are involved, patients receive care in the UI Optic Nerve Center within the Department of Ophthalmology and Visual Sciences, one of only a few centers in the U.S. that provide centralized, comprehensive evaluation and treatment. The multidisciplinary team includes specialists in neuro-ophthalmology, orbit and oculoplastic surgery, neurosurgery, neuroradiology, adult and pediatric neuro-oncology, and radiation therapy.

The Center's strengths include:

• A "virtual clinic" involving many different neuroscience specialties
• Comprehensive evaluation in a single visit
• Advanced testing of optic nerve structure and function
• Availability of new and emerging therapies
• Known nationally for innovation
• Patients come from far and wide, many for second opinions
• Hometown follow-up care often recommended

TO MAKE AN APPOINTMENT: Patients need a physician referral. Referrers should call UI Consult and ask for Kelly Hochstetler, neuro-oncology nurse coordinator, or call Hochstetler at 319-356-7606.

Keeping the Vision
Expert eye care from UI neuroscientists helps Lewis Casson fully enjoy the restaurant business with his wife, Julie Roth. "It was amazing," he says. "I received unbelieveable care."