It’s hard to believe it was 25 years ago when Kirby Puckett suddenly lost vision in one eye, leading to his retirement from baseball. To this day, we still have patients requesting eye examinations for sole purpose of making sure they don’t have the Kirby eye problem – which involved much more than just his eye.

Kirby Puckett sadly lost his vision and his life to vascular (blood vessel) disease leading to stroke. He died of a massive cerebral (brain) stroke, but it was also a stroke in his eye that caused his sudden loss of vision. As many people read in the press, Kirby Puckett did have untreated glaucoma with eye pressures in the low 30’s (normal is 10-22) which can cause a slow loss of vision usually over decades.  However, the combination of increased eye pressure and vascular disease can cause a Central Retinal Vein Occlusion (CRVO or stroke in the eye) resulting in sudden and permanent vision loss.

Was Kirby’s vision loss preventable if detected early? If Kirby’s eye pressure had been checked at an eye examination and treatment started, the chance of CRVO would have been reduced. Also, examination of retinal blood vessels during the eye examination could have revealed other risk factors for CRVO. Regular physicals and labs to test for high cholesterol, blood pressure, and other risk factors for stroke are also important preventative measures.

Why are patients with vascular disease and high blood pressure/cholesterol at higher risk for CRVO?

Patients with vascular disease have chronic hardening and narrowing of blood vessels.  These narrow blood vessels are then susceptible to blockages by blood clots or cholesterol plaques.  The light sensitive retina which lines the inside of the eye is very dependent on proper blood supply and drainage from the central retinal artery and vein. These blood vessels are also susceptible to narrowing and blockage with vascular disease.  In a patient with glaucoma, the high eye fluid (not blood) pressure pushes down on the retinal blood vessels, further narrowing them and increasing the chances of a clot or plaque getting lodged and causing a blockage.  A good analogy would be stepping down on a running garden hose which has lots of pebbles mixed in the water. High blood pressure damages blood vessels throughout the body, creating conditions where they can burst or clog more easily.

Treatment of CRVO

After a CRVO, blood cannot exit the retina and the backup of stagnant blood causes hemorrhaging and retinal damage.  The retina is central nervous tissue which does not regenerate so vision will rarely be normal again. In some cases, new blood vessels will grow into the starving retina in an attempt to “feed” it. Sounds great, but these new blood vessels are very fragile and can leak under the retina, detach it, and cause further vision loss.  Laser treatments may be used to stop these new blood vessels. Hence the laser treatments that Kirby received probably did not improve his vision but just prevented further vision loss.

CRVO and Cerebral (Brain) Stroke and Heart Attack

Patients with a CRVO also have a significantly higher chance of developing a cerebral stroke or heart attack. Lifestyle and diet changes (no Kirby Burgers) and high blood pressure control are needed to prevent further vascular disease. Kirby apparently did not follow his doctor’s advice and died of a cerebral stroke ten years after his CRVO at the age of 45.

For a video presentation of a CRVO, please press play on video below.

http://fyi.rendia.com/YDzvxa

Dr. Steve

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