|
One day last July, 14-year-old Sylvia Penner shared some scary news with her parents: she couldn't see very well.
"Sylvia couldn't focus and she was seeing gray spots," says her mother, Melinda.
It was the beginning of a medical mystery that would ultimately take the Penners from their hometown of Knoxville, Tennessee, to the retina experts in the Department of Ophthalmology and Visuals Sciences at University of Iowa Children's Hospital.
After visits to three local specialists, it appeared that Sylvia was experiencing bleeding behind the retina, possibly because of an unidentified blood disorder. When she began having severe headaches as well, a neurologist suggested the problem was migraine-related.
Sylvia began taking migraine medication and baby aspirin.
Her vision problems ended, temporarily.
"In December we changed Sylvia's migraine medications and added one for acne," Melinda says. "She was still taking aspirin. Everything seemed OK."
It wasn't. Her symptoms returned with retinal bleeding that was worse than ever.
While no one had said so, the Penners knew the culprit might be central retinal vein occlusion (CRVO), a dangerous blood clot in the eye.
"Based on what I learned through an online support group," Melinda says, "we decided the best possible place for Sylvia to be was The University of Iowa."
Sylvia's father, Greg, made an appointment in the Retina Clinic for two days later ... a feat of timing that seemed to Melinda like an "absolute miracle."
During a two-day stay, Sylvia was seen by a team of eye specialists that included:
- Karen Gehrs, MD, a retina/vitreous disease specialist
- Young Kwon, MD, PhD, a glaucoma specialist
- Sohan Singh Hayreh, MD, PhD, DSc, a leading authority on ocular and ocular vascular disorders
Hayreh's research has challenged conventional wisdom on CRVO management. In fact, the emeritus professor's studies have shown that anticoagulant agents like aspirin or Coumadin actually increase retinal bleeding with devastating results, often converting benign CRVO into blinding CRVO.
The UI team concluded that Sylvia was suffering from CRVO and ocular hypertension, complicated by her medications and active lifestyle. Ocular hypertension can cause development of CRVO.
"The low blood pressure (possibly due to migraine medications that were making her blood pressure too low when she exercised and was sleeping) combined with CRVO resulted in slowing the blood flow in her eye to the point that it started to worsen the retinal damage," Hayreh says. "Rather than dissolving the blood clot, the aspirin she was on just made the hemorrhages within the retinal tissue worse."
Sylvia was instructed to stop taking aspirin and adjust her migraine medications. In addition, she was told to minimize her physical activities, and seek follow-up care from specialists at Vanderbilt Medical Center.
"We are so grateful," Melinda says. "We now know what the problem is and how to treat it. Most of Sylvia's vision problems are improving and she is learning to drive. Everyone at Iowa was amazing. We couldn't be happier!"
For more information:
- Parents of children with a known pediatric retinal or ocular vascular problem should have their current eye doctor or pediatrician arrange a referral with a UI retina or ocular vascular specialist.
- Parents seeking an appointment to have their child's eyes evaluated to determine if a retina problem might be causing their child's visual symptoms should call UI Health Access and ask for the pediatric eye clinic.
--Michael Sondergard
Central Retinal Vein Occlusion (CRVO)
CRVO is caused by a blood clot in the central retinal vein, which slows blood leaving the retina. There are two types--the relatively benign non-ischemic , and the ischemic , which carries a high risk of glaucoma, bleeding inside the eye, and blindness. Although CRVO typically occurs in older adults, younger patients occasionally develop the condition. In these cases, CRVO is usually non-ischemic . Rarely, it can be associated with leukemia or serious blood clotting disorders. However, CRVO often occurs in younger patients for no known reason and, fortunately, usually improves spontaneously. |
