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.
