A Sight for Sore Eyes

LIVING WITH POSTERIOR LENTICONUS -  Our Journey

He has cataracts.

Those three words devastated me. Today, 6 years later, these three words anger me.

Patient:  Sex:  Intact male. Age at time of diagnosis:  2 years, 1 month. Owner owned.

Saturday, April 7, 2001:  The patient was presented to a Board Certified veterinary ophthalmologist at a renowned veterinary hospital (hereinafter referred to as the “hospital”) for a second CERF (“clearance”) exam. It took just seconds for the ophthalmologist to diagnose him with bilateral incipient/immature cataracts, or “mild Posterior Lenticonus.” Posterior Lenticonus is, as explained to me, an inherited congenital lens abnormality typically found in Samoyeds, Alaskan Malamutes and Siberian Huskies. Rather than being oval shaped, the lens is cone shaped, with the apex pointing toward and sometimes adhering to the posterior lens capsule – hence the name “Posterior Lenticonus.” Over time, cataracts develop (usually between 1 and 3 years).

A surgical resolution was discussed. I was given literature to read and a videotape to view.

Patient was prescribed Pred Acetate 1%. I was instructed to apply one drop to each eye, 2 times a day to reduce mild inflammation.

I was advised to contact the dog’s breeder.

I began researching this condition. If I didn’t extract the lenses, complications such as glaucoma, retinal detachment or the development of intraocular adhesions could result. Also success rates are better when cataracts are removed in un-inflamed eyes or in eyes in the early stages of cataract formation.

Sunday, April 8, 2001:  The patient’s primary veterinarian came by my home to examine the patient’s eyes. She confirmed the existence of bilateral cataracts. Attempts to console me were unsuccessful.

Monday, April 9, 2001:

• I requested to take 20+ vacation days to care for my dog during his recovery. My employer granted my request.
• I contacted the patient’s breeder.
• Patient’s primary veterinarian consulted three colleagues. All three ophthalmologists agreed that surgery on a dog with incipient/immature cataracts was indicated.
• Patient’s primary veterinarian consulted the diagnosing ophthalmologist (hereinafter referred to as “diagnosing ophthalmologist”). Diagnosing ophthalmologist, one of the foremost veterinary cataract surgeons in the United States, expressed confidence in a successful outcome.
• I contacted the AKC. I was advised to retire my Champion as the AKC considers all cataracts to be hereditary.
• I contacted Vilma Yuzbasiyan-Gurkan at Michigan State University and arranged to have the patient’s DNA collected for use in their study (AKC Grant No. 1637).
  

Saturday, April 14, 2001:  Patient was presented to another veterinary ophthalmologist for evaluation/second opinion. This ophthalmologist concurred with the diagnosis and, to his credit, advised breeder to stop breeding the patient’s parents. He, to my amazement, dismissed the problem as inconsequential and presented the following arguments against surgical intervention:

• The dog may not go blind.
• A dog does not need eyesight.
• Cataract surgery is unsuccessful and the dog will probably become blind within a year.
• Cataract surgeons profit monetarily by this surgery.
• Let the dog get glaucoma and later, when the eyes are enucleated and he is free from pain (glaucoma is exquisitely painful), he will be so grateful. (Direct quote.)
  

This ophthalmologist was, obviously, not aware of the recent advances made in canine cataract surgery. I found his arguments uninformed and inhumane. Point being, it’s good to get several opinions. I eventually consulted 7 veterinary ophthalmologists and this ophthalmologist was the only one opposed to surgery.

Tuesday, April 17, 2001:  Patient was presented to the hospital for a follow up exam and tonometry. His intraocular pressures were well within normal range. To evaluate the health of his retinas, an appointment was made for an electroretinogram and ocular ultrasound. I was advised to have the patient’s blood drawn and analyzed and that he be current on all vaccinations. Because steroids can delay healing (and he would be prescribed postoperative steroids), neutering would have to be postponed until at least 6 months after surgery.
 

Saturday, April 21, 2001:  Patient was presented to his primary veterinarian for the following:

• A complete physical examination.
• Blood analysis (well within normal ranges and negative for Von Willebrandts).
• EKG (normal).
• Vaccinations, as applicable.
  

Friday, May 4, 2001:  Patient underwent electroretinography and ocular ultrasound. Cost in 2001:  $375.

• Patient’s retinal functions were well within normal limits.
• Patient did not have any retinal detachments.
  

Patient was deemed to be a good candidate for cataract surgery. Surgery was scheduled for 8:30 a.m., Wednesday, May 23, 2001, (the corneas needed time to heal from the electroretinogram). I was instructed to increase his Pred Acetate 1% drops to 4 times a day beginning on Monday, May 21, 2001.

I began making casseroles and freezing “dinner” portions. While the patient was recovering I wouldn’t be able to make dinners. I began making sure that I would have a month’s supply of dog food, treats, vitamin supplements, flea/tick control meds, etc.

Thursday, May 10, 2001:  Diagnosing ophthalmologist telephoned me to answer any questions I may have, to confirm that she did not anticipate any complications and to assure me that she was confident that she could help my dog.

Monday, May 21, 2001:  I watched my dear dog press his muzzle against the dining room wall to find the doorway. The diagnosing ophthalmologist said that his vision was severely diminished; but I had never realized until then how handicapped he had become. I now knew that I had made the right decision to proceed with the surgery. Should he ever fall down a stairway or get “loose" and be injured, I would never forgive myself.

I prepared a “recovery” room – a quiet place where we would live for the next month. (Excessive activity and barking could increase the risk for postoperative retinal detachment and suture breaks.) We needed to be separated from the rest of the family – my husband and my other Sammy.

My two dogs have their own “room.” In this room are their crates, their grooming equipment and an adjacent bathroom. I decided that this room would become the “recovery” room. I moved one of the crates into the “master” bedroom – this is where my other Sammy would stay during the day while my husband was at work. I brought down a mattress and bedding from upstairs, my husband connected a television to cable and brought up the downstairs phone. I gathered clothes, reading materials and an alarm clock. I made sure that I had pens and paper to use to chart his meds. I blocked the doorways with two large (but moveable) pieces of furniture. I disconnected the doorbell and, to prevent anyone from coming to the back door, locked the front gate.

I taught my husband how to do the laundry.

I groomed my beautiful boy.

Tuesday, May 22, 2001, 7:00 pm:  Patient was admitted to the hospital.

We had never been separated. I wondered if he was scared and if he thought I had abandoned him. It was a long night.

Wednesday, May 23, 2001, 8:00 a.m.:  I arrived at the hospital to observe the surgery and to be there in case anything went wrong.

8:00 a.m.:  The patient was “prepped” for surgery. This means that his muzzle, eyes and area surrounding his eyes were shaved.

The operating room is sterilized and “prepped.”

8:30 a.m.:  The patient is brought into the operating room and anesthetized.

9:00 a.m. – 12:30 p.m.:  Surgery to remove both cataracts by phaceomulsification was performed. IOLs were placed inside the emptied lens capsules to replace the natural lenses.

Staff at the hospital brought me milk and brownies. The pharmacist kept me company.

12:30 p.m.:  The diagnosing ophthalmologist told me that the surgery was successful and that he could now see out of both eyes. The patient was being taken to ICU where he would remain until Friday p.m. I could visit him; but we agreed that it was best that he stay quiet. The diagnosing ophthalmologist would contact me if there were any significant changes to his condition.

12:30 p.m. – 8:30 a.m.:  The angles of the patient’s eyes were measured again (a measurement was taken prior to surgery) – they remained deep and wide. His intraocular pressures were measured periodically. They remained normal (no transient glaucoma). Patient’s primary veterinarian went to the hospital to check up on him.

8:30 p.m.:  Diagnosing ophthalmologist telephoned me on his medical status – which was very good. Emotionally, however, he appeared scared and needed to be sedated. He was, after all, very young and, for the first time in his young life, separated from me and the rest of his family. I spent the entire evening worried about him.

Thursday, May 24, 2001, a.m.:  Diagnosing ophthalmologist telephoned me on his status. She was going to discharge him that evening; but the morning’s postoperative exam showed that one of the corneal sutures required repair. Because he had already eaten his breakfast, they would need to repair the corneal wound the following morning (May 25, 2001). He would need to spend another night scared, sedated and separated from his family.

Friday, May 25, 2001, a.m.:  Patient was readmitted to surgery to re-suture his cornea. Surgery was successful.

Friday, May 25, 2001, 7:00 p.m.:  Patient was discharged.

His appearance was shocking. His face looked so sore from being shaved (there were razor burns on his muzzle) and the outside corners of his eyes were sutured shut. Staff at the hospital decorated his E-collar with colorful animal stickers.

Postoperative medications/administration:

• Pred Acetate 1%:  1 drop in each eye every 4 hours.
• Neopoly-G:  1 drop in each eye every 4 hours.
• Artificial tears:  1 drop in each eye every 4 hours.

5 minutes must elapse between drops.

• Cefalexin 500 mg #21:  1 capsule 3 times a day.
• Prednisone 20 mg #20:  Once daily, with food.
•  
  

Cost in 2001:  $2,500 (includes 3 postoperative visits).

A follow up appointment was made for Tuesday, May 29, 2001.

To protect any sudden “jerking” of the head – which could cause the retinas and/or IOLs to detach – patient can no longer wear a collar (I eventually ordered a nice tracking harness from “White Pines”). I looped his leash between his legs and across his chest. I brought the patient home. I created a “medication calendar” and set an alarm clock. We settled into our temporary “home.”

Tuesday, May 29, 2001:  The patient was presented to the hospital for his first post-operative visit. The patient’s eyes were healing nicely and eye meds were reduced from every 4 hours to every 6 hours until next recheck (June 5, 2001). The Cefalexin and Prednisone were reduced.

Tuesday, June 5, 2001:  The patient was presented to the hospital for his second postoperative visit. The patient’s eyes continued to improve. Eye meds were reduced from every 6 hours to every 8 hours until next recheck (June 12, 2001). The sutures partially closing the patient’s eyes were removed. The Cefalexin and Prednisone were further reduced.

Tuesday, June 12, 2001:  The patient’s eyes had healed. I was cleared to return to work and the patient was cleared to rejoin his family. Eye meds were reduced from every 8 hours to every 12 hours for the next 2 months. The Cefalexin and Prednisone were discontinued.

Tuesday, July 10, 2001:  Patient was presented to the hospital for a routine recheck. Everything is fine. The eye meds would be incrementally reduced and eventually discontinued.

Tuesday, November 13, 2001:  Patient was presented to the hospital for a routine recheck. Lens protein regrowth (see “Secondary Cataracts” in the “Description of the Disease” section) was noticeable in both eyes. This regrowth was causing inflammation in his left eye. Surgery to remove the regrowth was scheduled for Wednesday, December 12, 2001).

Wednesday, December 12, 2001:  Surgery to irrigate and aspirate the lens protein regrowth was successful – although there was some intraocular bleeding (which eventually resolved). Because the retinas were visible, the patient did not need to have an electroretonogram or ocular ultrasound. Otherwise, this procedure involved the same pre- and postoperative care, medications and preparation as the original cataract surgery. Cost in 2001:  $2,000.

Again, the patient needed to be separated from his family (this time for a full four weeks because of the bleeding complication). This episode was extremely trying for me and my family as it happened over the Christmas holidays and because my mother-in-law was diagnosed with terminal cancer on Christmas Eve and I couldn’t give my husband the emotional support he needed and deserved.

In Summary:  The memories of these surgical episodes are still fresh and vivid. To this day, my heart aches and I still cry over how my dear boy looked the night he was discharged after his first surgery. A vet tech brought him out as I was paying the bill and receiving instructions on how to administer his medications. I turned around and there he was, sitting in a corner (with the tech by his side), waiting patiently. He’s a little Samoyed, barely 49lbs and the E-collar he was wearing looked too large for his little body. His eyes looked sore – the corners were sutured shut and the hair over his eyes and muzzle were shaved. I can only imagine what he was feeling. He trusted me to make the right decision. Did I? Was it worth it? I think so. The last line of his discharge papers read:  He can see out of both eyes.

Every time I look at my boy I realize how fortunate I am. My husband was so supportive and helpful and my other Sammy so accommodating. The patient’s primary veterinarian proved to be an excellent caretaker and a true friend. And, most importantly, my boy was such a compliant patient.

I was and am also extremely lucky to have the one of the foremost cataract surgeons in the United States care for the eyes of my beloved boy. He certainly benefited from her expertise and from her hospital’s state of the art equipment and resources. Six years later, he is doing well and getting into all sorts of mischief. His surgery is considered a “success,” and I am so happy with my decision to have his cataracts removed.

If you are reading this article, it’s because your dog that you love is affected or because a dog you know is affected. I am sorry, and I hope this account of my experience is helpful. To ensure a successful outcome, I encourage you to:

• Find an experienced veterinary ophthalmologist in a state of the art medical facility.
• Remove the cataracts while they are in the early stages of cataract formation and before the eyes become inflamed.
• Prepare your dog and home:
• Have your dog become accustomed to wearing an E-collar;
• Prepare a quiet place where your dog can recover (separated from other animals and family);
• Disconnect your door bells and restrict visitors during recovery.
• Get the support of your family, friends and employer.
  

Cataract formation secondary to Posterior Lenticonus is an undesirable inherited condition. It can result in serious, vision-threatening eye disease and is corrected only by very expensive surgical intervention and personal sacrifice.

We love dogs, we love our dogs and we love our breed. Let’s work together to eradicate this condition. We will be successful if we identify the carriers and affected dogs and use this information to breed responsibly.