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Michael J Kutryb, MD  
Male

Specialties: Ophthalmology, Cataract Surgery, glaucoma

Interests: Ophthalmology

Kutryb Eye Institute - Titusville
321-267-2020
Titusville, FL
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Glenn Beck's Macular Dystrophy Serious but Unlikely to Cause Blindness

Jul 20, 2010 - 14 comments
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macular dystrophy

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glenn beck

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blindness

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blind

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Corneal transplant

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corneal transplantation



Popular radio and television personality Glenn Beck yesterday announced that he could go blind from macular dystrophy, possibly even within the next year.  Macular dystrophy of the cornea is a rare, recessively inherited disorder of the cornea, the clear, focusing window to the eye.  It causes grayish-white opacities that can occur across the entire cornea.  The problem can begin as early as age 10 but generally worsens between the ages of 20 and 40.  As you can imagine the vision can be severely affected and in the very worst cases it can lead to complete loss of useful vision.  There are no medications to remove the cloudy areas and laser treatment would only be able to vaporize very surperficial lesions, leaving all the deeper cloudy areas untouched.

The good news is that the most severe cases can be treated with full-thickness corneal transplantation with a very high success rate.  Thank God for the many talented fellowship-trained corneal specialist ophthalmologists across this great country (and all the organ donors also!)  For now, I am sure that Glenn is probably having difficulty with his reading and possibly night driving.  The real problem is that the mild to moderate cases will cause lots of aggrevation and blurriness but may not get to the severity where transplantation is recommended.  It's kind of like having a bad heart and you get short of breath and feel weak and tired but you're getting by and you're not bad enough to go through the rigors and long recovery of an actual heart transplant.  For Glenn Beck, at some point down the road, his problem might get bad enough that corneal transplantation could be considered.  At present, I pray that his problem remains stable and he can retain reasonably good vision.

Add Chauffer to My Resume

Apr 30, 2010 - 4 comments

I think it was the comedian Larry the Cable Guy who popularized the saying "Git-er-done."  We used to love the Nike ad which said "Just Do It."  I had that one under my medical school yearbook picture.  Both phrases hit home with me because I try to be a man of action.  I find great joy in getting things done and I guess that's why I sometimes have a hard time taking it easy on vacation.  (That is something I'm really working on though - so I don't get burned out someday.)

Last week, one of my cataract surgery patients had to take a cab to the surgery center, since her family lived far away and she didn't have a ride. Her surgery went perfectly well, but I discovered that the surgery center had a policy of not releasing patients to go home in a cab by themselves.  After much discussion, no one could find anyone to come and take her home, so I had her wait 30 minutes until I finished my last case, and I took her home in my minivan.  She had a very safe driver (me), a very safe vehicle (5-star rated Sienna) and we had a nice little chat.

It's not something I do everyday.  I did the same thing last year for a cataract surgery patient that drove in by himself from out of town and stayed at the cute little motel near my office.  Sometimes you just have to get things done and it's nice to be able to help.

A Case of Hiccups During Cataract Surgery

Apr 20, 2010 - 2 comments

Just when I think I have seen it all, I see something new and a little inspiring. In surgery yesterday we had an older gentleman with a fairly severe head tremor.  I was expecting this and has used a whole roll of 3-M Transpore tape to stabilize his head (you know I keep them in business.)  What I didn't expect was the case of hiccups he developed right after we started his cataract surgery.  Not just little ones either.  His whole body shook each time.  I went about timing him between hiccups and found that it was every 11-13 seconds.  After waiting 5 minutes, it appeared that his movement would only be an issue for 2 parts of the surgery, the main incision in the cornea and the precise opening of the lens capsule.  I had convinced myself that I could do both maneuvers within the 10 second windows and was literally only millimeters away from the eye with the corneal blade when his hiccups miraculously stopped right then.  I think it's God's way of reminding me that I can't always rely solely on my own abilities. His surgery went perfectly well, by the way.

Worst Topamax Glaucoma Attack Yet

Mar 20, 2010 - 41 comments
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Topamax

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glaucoma

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Pain

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eyes

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vision

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blindness

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cataract

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side effects

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kutryb



     I have done my best to warm people about the sight threatening side effects from Topamax, but this last week I have seen the worst case scenario up close and personal.  

     This patient was a 65 year-old man on only 25 mg of Topamax a day for headaches.  It took us over 8 hours just to get the eye pressure under 50 (which is still about 3 times normal.)  He was rapidly losing vision from an attack of acute angle closure glaucoma IN BOTH EYES.  That is one of the most significant things that people don't always realize.  In my business it is extraoridinarily rare for an acute, severe problem to happen to both eyes unless there is some sort of terrible industrial accident, explosion or facial trauma.  Topamax, when it causes this extreme side effects, will almost universally affect both eyes.  What is the indicence?  I don't think anyone knows but I'll just throw it out there.  If I make a very gross estimate that there might be 2000 people in my city taking Topamax and I, personally have seen 2 attacks in one year, then that would put the risk at about 1 in 1000.  Please understand that I have no scientific evidence to base this rate on and that this is purely my very rough estimate from my experience only.  So take it for what's it worth.

     By the way the patient has improved dramatically but is still on four different glaucoma medications and one dilating drop.  He is nowhere close to a full recovery and I suspect that he will probably have long term negative effects from the attack.

     If you are on Topamax or considering taking it, please be aware that it can cause acute myopia, choroidal effusions, acute angle closure glaucoma and severe vision loss.  There is absolutely no way to predict who will get this side effect and it can occur even at very low doses.  If you are already taking Topamax and you notice any early signs of vision loss or eye pain please see an ophthalmologist immediately.