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Routine eye exam, rare diagnosis

This image shows deposits of cholesterol on the back of an eye affected by Coats’ Disease. The rare, congenital disease, only found in about one in 100,000 people, is caused by abnormal blood vessel development behind the retina. The affected blood vessels leak blood content into the eye leading to partial or complete retinal detachment if not treated. (Courtesy photo)

This image shows deposits of cholesterol on the back of an eye affected by Coats’ Disease. The rare, congenital disease, only found in about one in 100,000 people, is caused by abnormal blood vessel development behind the retina. The affected blood vessels leak blood content into the eye leading to partial or complete retinal detachment if not treated. (Courtesy photo)

DOVER AIR FORCE BASE, Del. -- I recently made an appointment with the optometrist on base. It was my first eye exam in more than 10 years, and it couldn’t have been better timing.

Over the course of a couple weeks I began to notice abnormal eye strain that wasn’t getting any better. At one point I was even having difficulty achieving and maintaining focus – it turns out I needed glasses – but that wasn’t my only problem.

Maj. Carli Murphy, 436th Aerospace Medicine Squadron optometry flight commander, found a possible hemorrhage in my retina, completely unrelated to my eye strain, and referred me to a specialist.

I’m not much of a hypochondriac … but I have a hemorrhage in my eye? What does that even mean? Am I going to lose my sight? What happens if I hit my head? Will it get worse? All of these thoughts and questions were buzzing around in my head while I waited for my follow-up with the specialist.

A few weeks later, I was sitting in the specialist’s clinic with a handful of elderly patients waiting for my name to be called.

“You’re the youngest person I’ve ever seen here,” one of the patients told me, which wasn’t actually all that comforting.

My name was called and they started doing all the routine tests. The specialist started looking around at my retina with a blinding light, and he diagnosed me on the spot with a rare, one-in-100,000 illness called Coats’ Disease.

According to the Coats’ Disease Foundation: “Coats’ Disease is a very rare condition found in children and adults where there is abnormal development in the blood vessels behind the retina of the eye. The blood-rich retinal capillaries break open, leaking the serum portion of the blood into the back of the eye. The leakage causes the retina to swell, leading to partial or complete detachment of the retina. Coats’ Disease progresses gradually and affects central vision. It is almost always unilateral (affecting only one eye). If caught early, some level of vision can typically be restored. If not treated until its later stages, complete loss of vision can occur. In the final stage, enucleation (removal of the affected eye) may be necessary.”

What a diagnosis.

The next day, I was in Salisbury, Maryland, for specialized imaging of my retina. They gave me an injection that allowed them to take an image similar to a CAT scan of my retina, and had the interesting side effect of turning my urine the color of Mountain Dew. A few minutes and a pain-killing shot in my eye later, and I was receiving laser eye treatment, which the specialist was confident would correct the problem.

As I continue learning more about the disease, I’m realizing just how perfect the timing was.

According to the Coats’ Disease Foundation, the disease is painless and slow to develop. Any impacts to the vision aren’t usually noticed due to the gradual onset of symptoms. By the time symptoms are generally noticed, irreparable damage and vision loss have already occurred.

Man, am I lucky.

The affected area of my eye is way off to the side, so it doesn’t affect my vision at all. And, even though most cases are reported for children – with only about a third of patients showing symptoms after the age of 30 – my condition was caught in the early stages, before any real damage was done.

What’s more, Murphy performed a thorough exam beyond simply diagnosing my need for glasses. She examined my retinas even though I wasn’t presenting any symptoms.

I wish there was a way to quantify just how lucky I was to have a one-in-a-100,000 disease that didn’t negatively impact my sight and was caught before it did.

And, it all started with a phone call to schedule an eye appointment.

Murphy said the optometry clinic is self-service, and they’ll see patients whenever they experience a problem or for regular checkups.

All Tricare Prime beneficiaries, to include active duty and reserve military members, their dependents and retirees, can be seen at the Dover AFB optometry clinic; however, priority is given to active duty members.

“You get automatically reminded that you have to get your dental exam once a year, but there is no requirement in the Air Force for eye exams,” Murphy said.

The American Academy of Optometry recommends annual eye exams for adults, screenings for children at 6 months and an eye exam before kindergarten.

Not every eye exam will uncover a rare, asymptomatic disease, but even gradual changes in eyesight can cause eye strain and headaches.

“Your brain is fantastic,” Murphy said. “It gets used to everything. It gets used to seeing a little bit blurry, and it isn’t until you get glasses that you realize you could have been seeing better.”

Murphy and the optometry flight advocate the importance of eye health for all first term Airmen and everyone new to the base. She tells all incoming Airmen to schedule an appointment if the last exam was more than three years ago.

“You just don’t know what’s going on until you get an exam,” Murphy said. “A lot of patients are masking symptoms. Of all the new people who come to us only because we told them they should, about 25 percent of them could benefit from glasses.”

It reminds me of a quote from Brian Regan, a comedian I enjoyed when growing up, “how could instantly improved vision not be at the top of your to do list?”

“We work hard in the military, and we have medical benefits for a reason,” Murphy said. “Make sure you take advantage of them and know that you’re healthy, because your eyes are important.”
Air Force Medicine


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