Down the Rabbit Hole

Hey, back to the article Lin sent, Clinical Endpoints, etc. I now have another question: what scale is my retinologist using to classify me as ‘advanced’? Turns out there are two rating systems in use. One is the Wisconsin Age-Related Maculopathy Grading System and the other is the Beckman Initiative for Macular Research scale. If you are rated on the first one you would be advanced if you had foveal involvement. In the second one any type of GA, foveal involvement or no, you are considered advanced.

I have foveal involvement at least in my left eye so for me, it is actually a moot point. If you have been told you have advanced AMD, you might want to find out which scale is being used. It would appear – and again this is me surmising, not someone who knows something – a pronouncement based on the Beckman scale might not be as bad. You might still have a functional fovea.

Moving right along, lunch!? Be back in about 20!

We are still getting vine-ripened tomatoes out of the garden. In October! Weird…but yummy. Remember to stop and smell the roses, or in this case, taste the tomatoes, on your Journey. Neither one requires decent eye sight!

Back to work. We have talked about optical coherence tomography (OCT) before. I did not know it was not invented until 1996 and not improved to be of any ‘real’ benefit until 2003. One more reason this is not your parent’s AMD. At least the doctors and technicians can see what they are looking at much better now!

I think I said this before, too, but OCT screening can give views in 2 and 3 dimensions. You get depth as well as width and height measures of your lesions, or in my terms, divots. In GA OCT (and an ABC…XYZ to you, too!) you can see sharply delineated regions of degradation in both RPEs and photoreceptors and your choroid poses – gasp! – naked for the camera.

The article also mentions choriocapillaris and thinning and apposition of the overlying nuclear layer. Hold a moment for the translation for the rest of that. What did I EVER do without my iPad?

The capillary lamina is also called choriocapillaris. It is a layer of itsy bitsy blood vessels immediately adjacent to Bruch’s membrane. My assumption is it is below the retina but above Bruch’s membrane The drawings in Wikipedia are too small for me. [Lin/Linda: I can’t find a much bigger picture but this one shows that it is below Bruch’s membrane.]

Apposition means next to. The inner nuclear layer is, again according to Wikipedia, my highly professional source, a layer of the retina made up of closely packed cells of the three following types: bipolar cells (I wonder if they have mood swings? Ouch. Bad psychology joke), horizontal cells and amacrine cells.

Amacrine cells? No clue. That will just have me falling down another layer in the rabbit hole. I am quitting before I meet the Queen of Hearts. Off with their heads!

I will try to get through at least part of the rest of this article later. Maybe impossible but, hey…..

“Sometimes I’ve believed as many as six impossible things before breakfast.”

Lewis Carroll, 1865

Written October 8th, 2017

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