Guest post – Harry’s null point surgery

Ian is sharing his thoughts and experiences as his son undergoes Anderson Kestenbaum surgery this summer to address the head turn associated with his null point.

In this post he recalls the day of the surgery:

We had to be there at 8.00am and Harry was in really good spirits. He went down to the operating theatre about 10.45am. Then it was the waiting game for my wife and me. He was wheeled in to the room from recovery around 2.00pm, much to our relief. He was very groggy still and couldn’t open his eyes, but we were hugely relieved to hear that he had opened them and had been able to see the anaesthetist standing over him. That was my first fear as a parent overcome. Could he see? Tick. Yes, he could.

Harry felt sick after the operation. Apparently that’s common for people who’ve had surgery on their eyes. He was sick around 4.00pm and also felt dizzy. At this stage they were considering keeping him in overnight. Harry hadn’t opened his eyes yet, as they were really sore. The consultant who operated on him came to the room and got Harry to sit up on the bed and look at me holding some large letters about 4-5 metres away. Harry could open his eyes only for a few seconds before they hurt too much, but, again, to our relief he was able to read what was in my hand, albeit it was a bit blurry at this stage. Even more pleasing was his head posture. Immediately it was noticeable that he was looking straight at me. No head turn. Another tick in the box and another of our fears overcome. After this he seemed to come round and we got him home that night.

His eyes were so sore to look at. He has been super brave, but we know they have been really painful for the first 2-3 days in particular. He has been able to open his eyes only for a second or two. The rest of the time he’s been lying with his eyes shut, as this is more comfortable. His eyes did look very sore. Not a sight for the squeamish.

Null point surgery is not for everyone. Please seek advice from your ophthalmologist. The Nystagmus Network does not endorse or otherwise any particular medical treatment. We are simply sharing one family’s experience.

Guest post – questions for Harry’s consultant

Harry and his parents had many, many questions before finally deciding to go ahead with null point surgery. Here are just some of the questions the family asked, with the answers they received from the surgical team:

  • Is this a complicated procedure?

Yes. Operating on eyes in general is complicated, but when 2 eyes are to be operated on at the same time it is a complex procedure.

  • How long does the surgery take?

From going down to the anaesthetist to coming back from recovery takes about 2 and a half hours, between 1 and a half and 2 hours for the actual surgery

  • What are the risks involved?

The null point may not be picked up again by the brain in its new position, meaning we lose the one thing Harry has to control his nystagmus.

Double vision can result from the eye realignment not being exact.  Damage can occur to vision during the operation. Plus there are all the usual risks associated with surgery. In addition the consultant was keen to point out that there is a chance that we go through the surgery and, over time, Harry’s eyes move back to their original position.

  • What is the recovery timescale?

Everyone is different, but expect soreness for the first couple of weeks, which will ease over time. Full and final results of head posture will be known around 2 months post op when all the swelling has settled down and the brain has worked out its best position to see.

Null point surgery is not for everyone. Please seek advice from your ophthalmologist. The Nystagmus Network does not endorse or otherwise any particular medical treatment. We are simply sharing one family’s experience.

Guest post – Harry’s null point surgery decision

15 year old Harry has undergone the Anderson Kestenbaum procedure this summer. Parents often ask what null point surgery involves. Thorough consultation with the ophthalmologist and the surgical team are key.  Harry’s Dad, Ian, asked us to share his son’s experience.

Ian, writes:

My son, Harry is now aged 15 and was born with idiopathic nystagmus. Luckily for us all, Harry has relatively good vision and has a null point which enables him to control the nystagmus and see. The downside to this null point is that he has a 40 degree head turn.

My wife and I made a decision when Harry was young that we would not consider surgery on his eyes and that if this ever happened it would be because Harry wanted to and was of an age that he could sensibly make that decision.

As Harry grew up he tried wearing glasses with prisms to help straighten his head posture, but a combination of constantly losing them and being conscious about wearing glasses with prisms meant that this wasn’t a particular success.

Harry went to the opticians about a year ago on his own and during his chat with the optician the topic of head posture came up. The optician made a referral to Ophthalmology. Over the next 12 months we had multiple meetings with the senior ophthalmologist and after many discussions and questions we agreed to pursue the Anderson Kestenbaum procedure for Harry.

Please see Ian’s next post for just some of the questions the family had and the answers they received from Harry’s consultant.

Null point surgery is not for everyone. Please seek advice from your ophthalmologist. The Nystagmus Network does not endorse or otherwise any particular medical treatment. We are simply sharing one family’s experience.

Harry pre op.

Introducing Harry’s story

This is Harry. He’s 15 years old. He has nystagmus and, as you can probably tell from the photo, he also has a fairly marked head turn associated with his null point. This summer, Harry and his parents decided it was right for him to undergo surgery.

Known commonly as ‘null point surgery’, because it seeks to move the null point to a more natural, central position rather than off to the side, the Anderson Kestenbaum procedure is sometimes suggested by ophthalmologists where head turns are very marked. Medical professionals do not claim that the surgery can cure nystagmus, simply that it can enable the patient to look straight ahead afterwards.

The procedure involves detachment and reattachment of the eye muscles. As with any surgery, there are risks involved. The result is usually a more natural head position so that the patient can look straight ahead to focus on faces and objects. Sometimes they report that they can read a line or so further down an eye chart. Follow up surgery is sometimes needed to refine any correction. Some people perceive a slowing of the eye movements as a result of surgery, though this is thought to be anecdotal and could simply be due to the change in the position of the null point.

Harry has now had his surgery. His family asked the Nystagmus Network to share their story. Over the next few days we’ll be posting reports from Ian, Harry’s Dad, as Harry recovers from his null point surgery.

Null point surgery is not for everyone. Please seek advice from your ophthalmologist. The Nystagmus Network does not endorse or otherwise any particular medical treatment. We are simply sharing one family’s experience.

How amazing is Sara?

A guest post from Sara’s Mum …

This is my daughter Sara. She’s 17 now and born with albinism and nystagmus. Her sight is badly affected, but nothing stops her!!! She is in mainstream school, a huge circle of amazing friends and lives for sports. She has an all Ireland silver medal for camogie (an Irish sport) she plays rugby and Gaelic and is a coach for children in sports. Her next venture is to navigate in a tarmac rally with her daddy next month. She is a very positive and amazing child (in my eyes). Just posting this for all the new parents out there who may be worrying a little xx

How amazing is Macy?

Like lots of children, Macy has nystagmus as well as more serious health problems. Here’s her story, as told by her Mum …

In January 2016, Macy our baby girl suffered a sudden out of hospital cardiac arrest at 3 months old. After being resuscitated twice, once by paramedics at home and again at Wigan hospital, she was transferred to Alder Hey Children’s Hospital in Liverpool. The following hours/days/weeks are mostly a blur. 

Macy was so poorly, she spent time in isolation in PICU, with one to one nursing care. At the worst time in our lives those nurses/consultants were exceptional. She then spent weeks on the cardiac ward, which was probably harder than PICU as she was conscious and in pain and it was just unbearable. She was subsequently diagnosed with Dilated Cardiomyopathy, Cone-Rod Dystrophy and Nystagmus.

Macy is still seen regularly at Alder Hey by a cardiologist, neurologist, ophthalmologist…the list goes on.

After genetics testing, Macy has since been diagnosed with an ‘ultra rare’ disease called ALSTOM Syndrome, which is an inherited autosomal recessive syndrome characterised by the onset of obesity in childhood or adolescence, Type 2 diabetes, often with severe insulin resistance, dyslipidemia, hypertension and severe multi-organ fibrosis involving the liver, kidney and heart. Alström syndrome is also characterised by a progressive loss of vision (Cone-Rod Dystrophy) and hearing, a form of heart disease that weakens the heart muscle (dilated cardiomyopathy). This disorder can also cause serious or life-threatening medical problems involving the liver, kidneys, bladder, and lungs.

Nystagmus is just one of many of Macy’s symptoms, but she doesn’t let any of them stop her!

How amazing is Michael?

A nystagmus Dad writes:

Michael is 19. In 1999 he was diagnosed with congenital idiopathic nystagmus at around 3 months of age. We immediately did an internet search to find out what nystagmus was. I couldn’t even spell it properly, but within a short time we found Nystagmus Network. This turned out to be a huge benefit to us. We were put in touch with people with first hand knowledge of the condition. I’ve still got my notes from my initial conversations with Katy and Claire and the messages we received from John, Sue, Vivien and all the team after becoming members were most reassuring. We attended Open Days and our understanding grew. In terms of raising awareness and helping us come to terms with it, Nystagmus Network really hit the mark.

It was through the charity that we learned of Professor Irene Gottlobb and her team at Leicester Royal Infirmary. We secured a referral and Michael had countless eye recordings with Rebecca McLean, tests, clinical visits and an operation to partially correct his null point.

As Michael grew up we noticed how little his condition seemed to affect him. He was always a good athlete, playing junior football from age 5, was in the Cubs and Scouts. He swam competitively. Nystagmus didn’t seem to hamper him. However, looking back, this was masked by his ability to adapt. He struggled with fast moving ball games like cricket and badminton and the concentration required when reading. Doing his school work greatly fatigued him and studying still does. All through his school years he received terrific support from his SENCo, who became a real support for his Mum and me. We cannot thank Marie enough for her support for Michael during his time at junior and senior school.

We were all so proud of Michael when he achieved stellar results for his GCSEs and then his A-levels. In 2017 he was accepted by St. John’s College, Oxford where he is just finishing the first year of his Physics degree. He thoroughly enjoys being at Oxford, plays football for the college and fully participates in all the ‘liquid’ social events intrinsic to college life.

Michael’s success is due in no small part to the dedication and hard work he puts in, which takes a lot of effort due to his nystagmus. He has natural ability and great focus (no pun intended) and this has enabled him to overcome his disadvantages. The extra time during exams was essential to him at school and now at Oxford. He has been lucky. His condition could have been far more severe, but he has worked within his limitations to achieve the best he can. Long may it continue.

He passed his driving test in 2017 – which was the one thing we always wondered about. He has to be careful driving at night and he will never be a racing driver, but as long as he can get from A to B safely, to enable him to get on with his life, that’s all we can ask for.

I hope others may find some inspiration in Michael’s story. He has had to accommodate a severe disadvantage, but, essentially, it hasn’t held him back. He has exceeded all our expectations. The measure of that is not a place at university, but that he has simply got on with it and done his best.

How amazing is Denni-Leigh?

A Mum’s story:

Denni-Leigh was born weighing 5.15lbs on a sunny June morning. She was a perfectly beautiful newborn baby. Only at about 4 weeks old the health visitor noticed that something was wrong with her eyes.

We were told that Denni-Leigh had congenital nystagmus, astigmatism and a squint and was extremely long-sighted. Being such a young mum and not understanding anything that they were saying to me, I was very confused and very shocked. As we went on going to more and more appointments we were told that Denni-Leigh would not be able to live a normal life and do the things other children do, like ride a bike, learn to read, go to mainstream school.

But my beautiful little girl just sat there smiling and that gave me the strength and the determination to make sure she wasn’t treated any different. So she started mainstream school, a little bit behind everybody else, but she was never put off by anything. She learnt to ride a bike at the age of 7. Then came the decision to send her to mainstream secondary school. I’m so glad I did. She has gone from strength to strength and has proved everybody wrong and is now sitting her GCSEs. One day she would like to be a lawyer and change the way people think about people with visual impairments.

She is registered as visually impaired, but that has not put her off doing anything if she puts her mind to it. She will get there in the end. If anyone asks her about her eyes, then she proudly says, it’s just me, I have wobbly eyes. She is the most amazing, kindest and most caring big sister to her 5 little sisters. I am so proud of the beautiful young woman my daughter has become and it’s an honour to be her Mum.

How amazing is James?

Nystagmus Dad, Robin, writes:

My 9 year old son, James, has OC Albinism and Nystagmus, but he and I started learning the guitar together about 3 years ago ( he obviously struggled to see the music and the strings on the guitar, but, when blown up, he can read the score and any annotation written on it).

We’ve been taking the Trinity exams together and in the Spring we both passed Grade 3, which he was very pleased about!

We’re still learning together, so hopefully that’s not the end of the story. Perhaps he could play a couple of tunes at the next Open Day!

Note from ed: James has a spot booked at Open Day 2018!