Visual abnormality needs a second opinion

DEAR DR. GOTT: I am a 60-year-old female. My ophthalmologist diagnosed me with an eye condition called retinitis pigmentosa (RP).

I would like a second opinion. I know this is an incurable disease and I am rapidly going blind. Any information on slowing down the disease as well as diagnosing it would be greatly appreciated. If I am able to obtain a second opinion, what tests should I have to confirm the diagnosis? Should I have genetic testing done?

DEAR READER: You have damage to the retina, an area at the back of the inner portion of the eye that converts images to nerve signals and sends them on to the brain. Generally speaking, the cells that control night vision are likely to be affected; however, in some instances, retinal cone cells are damaged more.

Symptoms can appear in childhood, with visual difficulties developing years later. A person with retinitis pigmentosa may lose peripheral or central vision, and he or she may have difficulty seeing at night or when there is minimal light available.

Testing the retina is varied and may include dilating the pupils and examining the retina, determining visual acuity, performing refraction testing or retinal photography and a host of other possibilities. Protecting the eyes from ultraviolet light by wearing sunglasses may preserve vision. There are ongoing studies about the potential benefit of omega-3 fatty acids and one type of RP does respond to vitamin A. Your disorder will progress slowly. Peripheral vision is the first to go. Central vision loss is a late finding. You may also be faced with early cataracts or macular edema (retinal swelling). If you should develop cataracts that obstruct your vision, they can be removed surgically.

There are other conditions that behave in a similar fashion to retinitis pigmentosa. They include Laurence-Moon syndrome, Friedreich's ataxia, myotonic dystrophy, mucopolysaccharidosis and Usher syndrome. Therefore, I believe you are accurate in asking whether a second opinion is in line. My guess is that you are unsure whether your insurance will allow a second opinion because I cannot imagine your physician would deny you the privilege of confirming the diagnosis. Because this is a hereditary disorder, you might request genetic counseling to determine whether your children or siblings are at risk as well.

DEAR DR. GOTT: About 10 years ago, I was diagnosed with tardive dyskinesia, also known as TD. My tongue moved (wiggled) involuntary, continuously. A doctor said it would continue the rest of my life.

This was distressing so I decided to fight it. I pressed my tongue tightly in my mouth to stop the movement. Then one morning I awoke and realized my tongue wasn't moving. Then it started moving immediately. I thought perhaps it didn't move when it was in a state of relaxation.

During childbirth classes, I learned the technique of relaxing. When I relaxed my tongue with a conscious effort, it stopped moving. Eventually, the movement stopped.

I hope this method will help some people with this disturbing affliction.

DEAR READER: Tardive dyskinesia typically occurs after a patient has taken high doses of certain medications, over an extended period of time. It causes involuntary, repetitive tic-like movements - especially in the muscles of the face. TD is a result of damage to the body's systems that use and process dopamine, a biochemical substance produced in the brain. It functions as a neurotransmitter to regulate emotion and movement within the body.

There are several medications that can cause symptoms of TD to include those for nasal allergies, mental illness and digestive disorders such as heartburn caused by GI reflux. One such digestive disorder drug is metoclopramide, sold under the name of Reglan in the United States. In 2004, a study of the medication's effect on older women found an increased risk for developing symptoms of TD. By early 2009, the Food and Drug Administration issued a black-box warning to this effect.

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Treatment is commonly achieved through prevention in a couple of ways. The first is by changing the offending drug to another brand or lowering the dosage. Discontinuing the medication may be an option for some and often reverses TD, but sometimes it is permanent. As you so cleverly pointed out, it can be done through relaxation techniques. Some success has been noted for severe localized problems by using Botox.

Dr. Peter H. Gott is a retired physician and the author of several books, including "Live Longer, Live Better," "Dr. Gott's No Flour, No Sugar Diet" and "Dr. Gott's No Flour, No Sugar Cookbook," which are available at most bookstores or online. His website is www.AskDrGottMD.com. Copyright 2011, United Feature Syndicate Inc.