Tuesday, September 4, 2012

New Eye Doc

My husband took Gili to a new eye doctor in Kfar Saba - Dr. Noyman., who's name we got from Gili's school last year. It was a very good experience; very different from the overly "efficient" treatment in Schneider. I asked him to write down everything he remembered.

We arrived at Dr. Doron Noyman’s office at 4:15 for our 4:20 appointment.  The secretary keeps our information on a 5x7 index card which goes in his old fashioned file system.  He writes down all the important things we did for his internal records on these cards.  We had to wait around 30 minutes to see the doctor as there were several other appointments around the same time.
Dr. Noyman speaks excellent English and I saw on the wall he spent 3 years in Los Angeles at an eye institute.  He started out by asking about Gili’s medical history and looking over her past appointment summary sheets. 
The first test he did was to see if Gili could follow objects.  He noticed that she sometimes followed but then would lose interest.  She was quite good at grabbing close objects so that was a good sign he said.
The next test he had a toy mouse that was mounted on the wall.  He would activate the mouse to see if Gili looked at it.  She did notice the toy.  When he covered up her right eye she tried to move around to see, but when he covered up her left eye she didn’t have a reaction.  He said that this shows a weakness in the left eye.
He calls cross eyes “squinting” and said that he did notice Gili doing it intermittently but he said that she wasn’t doing it at such an extreme angle that he would recommend surgery to correct it.
Gili then got her eyes dilated with drops and we came back 45 minutes later for a refraction and cataract test.
The refraction test showed that she had a slight astigmatism and had slight weakness in her far field vision.  In an adult this would require lenses, but because Gili doesn’t really use far field vision (i.e. for driving a car) he doesn’t recommend glasses.
The cataract test came back negative, though he said that cataracts can occur in CMV positive children.
He saw the scar in her left eye and described it as being right in the middle of the retina.  This is known as a macular scar and was due to the virus attacking the eye while Gili was developing.  He said that it is a significant scar due to it’s central location and is contributing to reduced vision in her left eye. 
Even though Gili does have multiple vision problems, there are no treatments he can recommend that will be effective.
Dr. Noyman suggested that we only need to come back on an annual basis if we feel that there may be a change in her visual ability.

Dr. Noyman said that macular scarring is very common in kids with CMV, but, unlike in cases of toxoplasmosis, if does not "flare up." By the time they found it at 2.5 months of age it was already innactive. The doctor said it is definately effecting her vision and it is about the third of the size of a scar that would cause her to be completely blind.

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