Choroidal serous retinopathy

On 3 April 2018, I went to see my ophthalmologist. This is something I do regularly.

In 2005, I experienced an odd visual problem. Yes, 2005 was a long time ago, but I still remember it well. I was on my first teaching prac at the time. One evening, when I was trying to write up my day's notes and prepare for the next day, I noticed a strange spot in my vision in my left eye. There seemed to be a small ‘bubble’ distorting whatever I was looking at behind that spot. Something a little bit like this…

Ok, it's hard to draw. That's not quite right but it gives you some idea. Anyway, I put it down to my stress and tiredness (prac teaching is very hard work) and went to bed. The next morning it was still there, but it seemed to gradually fade over the following days.

Then a few years later, I noticed another interesting effect in the same region of vision in my left eye. A kind of wrong-colours and shimmering effect. You can read about this in a blog post I wrote in 2009, including another attempt to show you what I saw with an edited image. My ophthalmologist at the time (not the one I saw recently) suggested it was some kind of retinal pigment epithelium (RPE) defect, but wasn't sure what might have caused it.

Over the following few years, I noticed another patch appearing in my right eye, closer to the centre. The visual appearance changed gradually. Both eyes now have several spots with problems, some bigger than others. Let me try another vision-map like the one in this progress report blog post from 2011.

Ok, that's not perfect either, but again it should give you some idea. Notice that I've drawn this as I see it, which is actually opposite to how things are normally done in the medical field. Normally these things are done ‘as the doctor sees it’ looking at you.

The shimmering has now reduced but occasionally reappears; when it does, it usually lasts a few days. Colours are not right in these areas. Lines and shapes are distorted through them. I also see some reduced-contrast flare if there's direct sunlight falling across my eyes (eg. if the sun is rising or setting to the side).

Anyway, when I went back to the ophthalmologist recently, he made a suggestion about what might have been going on. He said it could be something called choroidal serous retinopathy (CSR). I looked this up and I think it does describe my symptoms. (Actually, most of what you'll find with a google search is central serous chorioretinopathy, which is basically the same thing only near the fovea, which is the part of the retina behind the centre of where you look—the + signs in my diagram above.)

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What evidence is there that this might be my problem? I'm glad you asked. Here's part of the OCT scan taken of my retinas at my ophthalmology appointment in April:

Ok, so maybe you don't know how to read one of these. I already had some idea since doing some research after my first OCT years ago, but reading this page helped enormously—go read it if you're interested in more detail than I talk about here.

1. These images are ‘standard’ medical imaging, so my left eye is on the right, and my right eye is on the left.
2. The small thumbnails at the top are retinal photos with lines indicating how the machine scanned my eyes. The middle row is a horizontal scan (cyan arrow in thumbnail). The lower row is a vertical scan (magenta arrow in thumbnail).
3. N/T in the middle row is Nose/Temple. Looking left to right, the right eye scan goes from temple (side of face) to nose (middle), then the left eye scan from nose (middle) to temple (side). The centre of the page shows the head of the optic nerve, corresponding to the blind spot. When you look for it in your vision, the blind spot appears towards the outside from the centre, but remember the image on your retina is inverted; the nerve is actually closer to your nose.
4. Similarly, S/I in the bottom row is Superior/Inferior, ie. top/bottom. That is, the top of the retina is on the left in the scan, and the bottom on the right. Again, remember that this is the opposite of what you see: the top of your retina sees the bottom of your vision, and vice versa.
5. Finally, the dip in the middle of each scan is the fovea. The centre of your vision has much higher resolution (actually ‘acuity’), meaning many more light detecting cells. The shape of the retina here is to make room for this.

Now we're ready to look for evidence. Here's the part of my left eye scan between the fovea and the optic nerve:

The highlighted sections (and maybe also the bit with a dimmer highlight) correspond approximately with where I see visual issues in my left eye, out from the centre towards the blind spot. The left-most section highlighted here certainly looks to me (a non-expert) like the OCT examples for RPE CSR from this page I linked to above.

And here's my right eye scans near the fovea:

Again, the highlighted sections correspond to my visual issues in my right eye, just outside and below the centre (so inside and above the fovea on my retina).

Whew! That was pretty technical.

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So what does this all mean? Well, interestingly, two potential causes stood out for me from my research: stress and steroids. (Actually, they're correlated with CSR, but not necessarily causal.)

Stress. My life is quite stressful. Teaching is stressful (and prac teaching, when I first noticed a problem in my vision, even more so). I'm also a middle leader at work (head of faculty). And I'm studying part time. Maybe I need to reduce my stress. But how—what should I change?

Steroids. I've been using corticosteroids for asthma since I was a teenager. I use corticosteroids to reduce my rhinitis. I also use topical corticosteroids at times to treat eczema and a variety of related skin problems. Probably not something I can easily avoid.

I'm back

It's been a while (ok, a few years!) but I've decided to come back here. I've been doing so much reading, for my studies. And I've been doing so much consuming—maybe even too much. I've deactivated my Facebook account for now (gasp!) to stop myself wasting so much time there. Instead, I want to create. I need to get better at essay-style writing (for my studies) and the best way to get better at that is to practice: that is, to write.

I don't know how much time I'll be able to set aside for writing. But I want to do more. I want to write more.

Land ownership

Today was settlement day: We now own 4+ acres of vacant land in Logan Village!

We started looking back in April. Our weekends for a few months there consisted of going out looking at various houses and blocks. Almost every place we saw had something wrong with it: house too small, land too swampy, neighbours too close. We found one place we liked in Logan Village, but God had other ideas: We were outbid by another buyer. We found another place in Logan Reserve, but the land was a bit sandy and we would have had to do some work to the house as well (building in underneath).

We kept going back to this one vacant block, on the hill on the eastern side of Logan Village. And in the end, we decided we should just buy it and build our own house. So that's what we're doing.

It's a steep block (about 26°). But the views are fabulous, out to Flinders Peak.

So now we just have to clear the lantana and other weeds, build some fences, design a house, get Council approval, …

We bought a zoo!

Saw this movie today with Laetitia. It's about a single father and his two kids who need a change from their noisy and stressful city life, so they buy a house on many acres .. that just happens to have a zoo.

It's also about a family struggling to cope with the grief of losing a wife and mother.

And it's also about courage, adventure and (of course) true love.

It's a beautiful movie. Do yourself a favour and go see it.

(And either movies are getting deeper or I'm getting sappy in my old age, but I cried - several times.)

Auckland and home!

We drove south back to Auckland along Highway 1. A toilet stop in Whangerei turned into a delightful exploration of a lovely park, including a chicken(!) and a pukeko wandering about. For my Australian friends, the pukeko is like a larger and less timid version of our moorhen - here, try this video. (Sorry, no sound; the only sound recorded by my camcorder was the mower in the background.)

Lunch was a picnic beside the road in Wellsford. Eventually we made it to the Airport Harbour View Motel, across the bay from the airport. Our room was spacious and clean with a galley kitchen and a large ensuite. Our hosts (“under new management”) were very friendly and helpful. Highly recommended, if you have your own transport (it’s a couple of kilometres from the Onehunga Mall).

We went out for dinner to the Curry Leaf Indian Restaurant in the mall, after discovering in response to our inquiries that they only cook in vegetable oil. The meal was delicious and good value for money. Also highly recommended!

In the morning we packed our bags for the last time and put aside all the things we didn’t want to take back with us - cooking items mostly, and a little left-over food. Our friends Jacques and Sarah came to meet us at the hotel and collected these things, and then we went with them to a café for morning tea.

Finally we went to the airport and returned our car. We had driven it 5525km in thirty days.

We left Auckland at a little after 3:00pm and arrived almost four hours later at 3:50pm, getting back the three hours we lost on the way to Christchurch a month ago. My parents picked us up from the airport, and we met Laetitia’s parents at the Loving Hut at Mt Gravatt for dinner together before going home.

Paihia

On Tuesday morning we drove north from Auckland. We turned off the main highway to go to the Kauri Museum at Matakohe, stopping for a picnic lunch in Paparoa, the town before that. We were very pleased to see a sign in the park in Paparoa celebrating Christmas as Jesus’ birthday.

The Kauri Museum is excellent. We spent about three hours there and felt rushed. Seriously, you could spend an entire day there! They have so much information and so many displays. It’s wonderful. Just do it!

However we were due in Paihia so we eventually had to leave. We took the back road north from Paparoa, after asking for directions and advice a couple of times. It was a lovely scenic drive, not only shorter than returning east to Highway 1 first but also had little traffic.

In Paihia we stayed two nights at the Marlin Court Motel at the eastern end of town. Our room was spacious with a full kitchen and ensuite; highly recommended. Dinner was cooked in the room both nights.

On Wednesday morning we checked out St Paul’s Anglican, an old stone church on the esplanade, before making our way to the Waitangi Treaty Grounds. Somewhat tired from several cultural experiences already we chose not to spend NZ$25 each to go in; instead Laetitia bought a very informative book for only NZ$20. We tried twice (once from each end of the road) to get to Mt Bledisloe but unfortunately the road was gravel, which our hire car insurance wouldn’t cover. We visited Haruru Falls just west of Paihia, noting the brown tint to the water and guessing that to be due to tannins from the trees upriver.

Laetitia bought fish and chips in town and we returned to our motel room to eat lunch and have a nap.

In the afternoon we drove across to the west coast. (So amusing to be able to drive across the country in less than two hours! Okay so you can only do it this close to the northern end.) We wanted to see Tane Mahuta in Waipoua Forest, the largest living Kauri in New Zealand. And it is amazingly big, 1250 years old and 50m high! Yet at 14m in girth it is only small compared to some of the older ones that once grew here (as we discovered at the Kauri Museum). Such a huge and beautiful tree. Well worth going to see.

Can you see me at the bottom of this photo?

On the way back we paused at Hokianga Harbour for some photos, as the cloudy, drizzly mist was a little clearer than it had been on the way through earlier, and we also turned off to see Rawene where the ferry goes across to Kohukohu on the northern side. We finally got back to our hotel at 7:00pm.

On Thursday morning we headed south again, the end of our holiday in sight.

North Shore Auckland

Monday night was spent at Albany Fairview Heights B&B in the North Shore area near Auckland. Our hosts Craig and Karen were very friendly and helpful and it was a delightful experience - highly recommended.

After a short nap we drove back into Auckland to see the view from the Sky Tower. Arriving at 6:02pm we serendipitously found a park on the street (Victoria St) only a block away in a section that was a Clearway until 6:00pm and then free parking (free!) until 8:00am the next day! Equally serendipitously we found a Loving Hut opposite the Sky Tower (also on Victoria St). We really like the Loving Hut in Brisbane (in Mt Gravatt), so we were very happy to give this one a try. It was quite nice, and all vegan of course, although not the same as the one we’re used to.

The view from 220m up the Sky Tower was, of course, spectacular.