Diagnosis of Autoimmune Retinopathy: Becky’s Story, Part 2

Hello, again. It is Becky Jayakumar and part one of my autoimmune retinopathy (AIR) diagnosis is available here. Since AIR is a challenging disease to diagnose and manage, there have been some bumps in the road since my last post. Almost immediately after the previous post was published, my third CT scan of the chest showed 3 masses in my right lower lung, which were multiplying (originally one mass earlier in the year) and increasing in size. This prompted my doctor to re-evaluate my PET scan (tests for active cancer) from earlier in the year. While the lung spots did not show activity, they did notice that my thymus was active on PET scan and subsequently, I was referred to an oncologist. Ironically, my oncologist canceled the appointment as I was not yet diagnosed with cancer despite the rationale for the referral was that a biopsy was physiologically impossible. Through connections and asking favors, I got the oncologist to see me later that day.

At this appointment, she was gruff to say the least as I am sure she was mad that I pulled strings to be seen by her. She told me that I would eventually have cancer due to my autoimmune conditions to which I responded “but the question is do I have it now?” She finally looked at my imaging and stated I needed surgery immediately. She referred me to a local cardiothoracic surgeon. To spare some details, I ended up canceling my surgery with this surgeon as I was not comfortable with him (there are only about 100 of these surgeries per year in the US) and received a referral to Mayo Clinic to their thymoma group who scheduled the surgery for a few weeks later.

Luckily, the lung lesions were not cancer and were actually due to my liver migrating up through three diaphragm perforations. Hence during the surgery, they reconstructed my diaphragm and removed my thymus from my heart, aorta, and lungs. There was significant hope from my doctors that the removal of the tumor would halt the progression of my vision loss. Of note, thymomas are notorious for causing another paraneoplastic disorder and removal is often curative. Unfortunately, my vision loss significantly worsened post surgery then eventually a few months later returned to a more similar progression to prior to surgery.

Continue reading “Diagnosis of Autoimmune Retinopathy: Becky’s Story, Part 2”

Diagnosis of Autoimmune Retinopathy: Regen’s Story

Hello! I’m Regen and I wanted to share my personal story with the rare diagnosis of autoimmune retinopathy (AIR). As a 23-year-old college graduate, the only anticipated stress I had was the start of Physician Assistant school, my next step to eventually diagnosing and treating others. Never could I have imagined the personal medical journey that I was about to embark on.

Bothersome floaters that grew exponentially within a short time frame prompted me for an annual visit to the eye doctor. While my provider reviewed that floaters can be a natural process of aging, her tone changed to concern when my visual field returned with significant blind spots. A negative MRI and uncertainty of next steps led to a referral to Wills Eye in Philadelphia. Initially, I was diagnosed with pars planitis, an inflammatory condition for which I was prescribed steroidal eye drops. Regular monitoring had revealed favorable exams – however, my symptoms were not improving but rather accelerating to include afterimages and strange flashes of color. Infuriatingly, I was told that the stress of graduate school in conjunction with baseline anxiety was the likely cause of such visual disturbances. Feeling unheard and my intuition pushing me to continue to advocate for myself, I consulted with a neuro-ophthalmologist at Wills Eye. Ultimately, he escalated my case and led me to a retinal specialist who formerly diagnosed me with AIR. While I was thrilled to have my concerns considered, this was certainly not the diagnosis I wanted to receive. A rare condition with no cure or consensus on treatment, it was quite the opposite of what I was looking for. After a consult with Dr. Foster at MERSI, a further lab workup was positive for three anti-retinal antibodies and two anti-optic nerve antibodies, further conclusive evidence in conjunction with my prior diagnostic tests and symptoms. I was in denial, but three unanimous opinions and a negative genetic workup later – indeed the culprit was found.

Continue reading “Diagnosis of Autoimmune Retinopathy: Regen’s Story”