Fast intervention with hyperbaric oxygen therapy helps student to retain eyesight

Posted Nov. 3, 2011

Barbara McCullough and her daughter Alyssa Tate. Hyperbaric oxygen therapy and fast intervention by doctors and staff of the Christiana Care Wound Care & Hyperbaric Medicine Center helped Alyssa Tait retain some vision in her right eye, after the sudden onset of a rare medical condition similar to a stroke inside the eye.

Word of a young University of Delaware student’s rare medical condition affecting her eyesight reached Christiana Care in a roundabout way. But the emergent, unusual care she received at the Christiana Care Wound Care & Hyperbaric Medicine Center was far more direct.

According to her mother, Barbara McCullough, Alyssa Tait was at the Division of Motor Vehicles to take care of some business on a Monday morning several months ago when she stood up, got dizzy and suddenly lost most of the vision in her right eye.

“She went to a specialist in ophthalmology-surgery in Wilmington,” McCullough says. The diagnosis was a central retinal artery occlusion (CRAO), a blood clot in her eye capable of causing rapid and permanent vision loss.

“CRAO is rare, comparable to a stroke in the retina, the part of the eye that enables us to see,” explains Wound Care Center Director Adrienne Abner, RN, MSN, CSW, MBA. “Vision loss from CRAO is usually dramatic and permanent.”

Hyperbaric oxygen therapy can decrease the swelling that causes the vision loss, Abner says. “Optimally, treatment guidelines for CRAO using hyperbaric oxygen therapy should occur within several hours.”

Word about Tait’s condition came through the community’s medical grapevine to the staff at Christiana Care, who reached out to the surgeon, Paula Ko, M.D. Tait was fast-tracked for an appointment to evaluate the potential benefit of hyperbaric oxygen therapy at the Lea Boulevard location in Wilmington. Medical Director Nicholas O. Biasotto, D.O., George Zlupko, M.D., who is certified in hyperbaric medicine, and John DeCarli, D.O., believed that hyperbaric oxygen therapy could help prevent further vision loss and even help restore some vision for Tait. With the support of Diversified Clinical Services Inc., a network of wound care and hyperbaric medicine centers, the Christiana Care staff had instant access to all evidence-based protocols for treating CRAO, as well as available consults from another hyperbaric-certified physician online. But both hyperbaric oxygen therapy chambers were booked for other patients on the day Tait was approved to begin therapy.

“We were able to get all the wheels in motion to have the patient start her first treatment Thursday evening instead of Friday morning as we first planned,” Abner says. “In a matter of hours we completed screening, evaluation, insurance approval and scheduling, which usually takes a week. So Alyssa began therapy in the chamber by 6 p.m. Thursday.”

This was no simple task given that the hyperbaric staff usually works weekdays from 8 a.m. to 4:30 p.m. The clinical window of opportunity to apply effective hyperbaric oxygen therapy was shrinking. Tait needed two treatments per day for 10 treatments.

“The nursing staff and doctors really scrambled to arrange for five straight days of therapy,” McCullough says. “They reshuffled personal priorities to do what they could to regain any portion of Alyssa’s vision loss.”

Tait noticed improvement in her peripheral vision the morning after her first treatment. After the sixth treatment, a repeat funduscopic exam showed a significant decrease in retinal swelling. Tait recovered a sliver of light in the middle of her field of vision.

“There is still permanent damage, but less significant than originally thought to be,” her mother says. “So far they have found no underlying medical conditions that caused the CRAO.”

As a mother, McCullough was concerned about how Alyssa would process the sudden vision loss and all the information—some of which could be hard to take.

“No one expects their 20-year old child to have a ministroke, but the Christiana Care staff was wonderful,” McCullough says. “They explained things in a simplistic and thorough way and sincerely cared enough to do whatever they could to make a difference for my daughter.”