You may have noticed that at the end of Part 1 I mentioned Doc’s request to have me examine his eye, in the singular. That was not a typo. In 1944, as World War II was still raging, Ira lost the vision in his left eye as a result of a military training accident. Apparently he developed sympathetic ophthalmia, a condition in which a nasty infection from one eye spreads internally to the fellow eye putting it at serious risk. The standard treatment at the time was to enucleate one eye but despite this, Army doctors couldn’t quell the infection. He was therefore placed on a relatively new antibiotic called penicillin, which worked well and safeguarded his right eye.
One day in 1970, Ira was vigorously cleaning his glasses when he realized the spot in his vision wasn’t on his lens. His ophthalmologist in New Jersey, Paul Liva, felt that Doc may have had retrobublar optic neuritis. This is the infamous condition in which the eye looks relatively normal because the inflammation is occurring downstream beyond the eyeball, hence the maxim that “the doctor sees nothing and the patient sees nothing”. Despite aggressive treatment with steroids, by the end of 1971 his best visual acuity dropped to the equivalent of 20/800, firmly in the territory of the legally blind.
At a loss for anything further to do, Dr. Liva referred Ira to Dr. Frank Walsh at the Wilmer Eye Institute of Johns Hopkins University, pictured above. Dr. Walsh is considered the Founding Father of Neuro-Ophthalmology, and authored the definitive textbook on the subject which has gone through many iterations but back in the day was simply referred to as “Walsh and Hoyt”.
I have a copy of Dr Walsh’s report dated January 26, 1972, in which he indicates that the appearance of Ira’s right optic nerve is normal except for “questionable pallor temporally”. His peripheral vision is normal, but there is a large central blind spot. Dr. Walsh concurred that Ira must have had retrobulbar neuritis, and wrote the following:
“Before having had our neuroradiologic examinations completed I regard the situation in this man as unusual and as meeting careful consideration, as an ultimate decision that unroofing the optic canal at the time of an exploratory might be justified. However, unless there is positive indication for such a procedure, watchful waiting would be in order and a decision would have to be made as regards recommending steroid therapy.”
Dr. Walsh was understandably reluctant to perform the unroofing procedure. It requires drilling down into the brain and is quite invasive. The following YouTube video of it is not for the faint of heart.
But Ira did not improve with a tincture of time, and several months later Dr. Walsh wrote to Dr. Liva in 1972: “I feel that this man may be approaching the stage when it would be reasonable to repeat all tests and even if they are not rewiring to consider exploration with unroofing of the optic canal. It is freely granted that such advice is radical. I have had a single case in which this procedure sufficed to give the patient normal vision … I realize, of course, that ‘one swallow does not make a summer'”.
To his credit, Ira decided to defer the procedure. Otherwise what subsequently happened with Minoxidil never would have occurred. Ira was soon to be blessed, but there is more of the story to tell …