5 minute read
Team Roxy
Keratoconus. Cataracts. Mixed mechanism glaucoma. Cystoid macular edema. Any one of these diagnoses is tough to take, at any age. At 36, Roxanne ‘Roxy’ Riggio is familiar with them all, having endured countless exams, medical and surgical treatments over the years to address numerous threats to her vision.
As a young child, Roxy developed keratoconus, a condition that causes the clear front part of the eye, called the cornea, to bulge out into a cone shape, causing improper focusing of light onto the back of the eye leading to blurred vision. Eventually, she required corneal transplants in both eyes. She also developed high eye pressure (glaucoma), clouding of the lens of the eye (cataracts), and swelling in the back of the eye (macular edema).
For more than 20 years, these conditions were managed by an ophthalmologist near the family home in Livonia, MI, where Roxy lives with her parents Patty and Ron Riggio. Eventually, Roxy’s cascade of eye issues led her doctor to refer the Riggios to Kellogg for multidisciplinary care.
Her Kellogg care team includes glaucoma specialists Annie Wu, M.D., and Amanda Bicket, M.D., retina specialist Jason Miller, M.D., Ph.D., and cataract and cornea specialist Shahzad Mian, M.D.
“It seems crazy to have so many doctors,” Roxy says. “At first it was overwhelming. But now they’re like family to me.”
In the fall of 2023, Team Roxy put their heads together to solve the puzzle of a dramatic vision decline in her right eye. Her vision worsened to a level characterized as CF, or ‘count fingers,’ meaning she could barely make out hand gestures directly in front of her.
“In countless conversations and over a very long email chain, we all debated possible causes,” Dr. Wu recalls. “Was her glaucoma well controlled, or was increased pressure damaging the eye? Was it residual retinal swelling from past surgeries? Could there be a problem with her cornea transplant graft, or was there scar tissue on the artificial lens implanted during cataract surgery?”
Complicating their deliberations were difficulties examining and imaging Roxy’s eyes. “Opaqueness in her cornea and clouding on her artificial lens made it difficult to see what was happening in the back layers of the eye,” notes Dr. Mian. Because of her extreme light sensitivity, Roxy had trouble tolerating the typical imaging tools available in the clinic or even opening her eye.
The team determined that the best approach was to conduct a comprehensive exam under anesthesia. Since this approach is used to image the eyes of infants and small children, they coordinated with pediatric retina specialist Emily Eton, M.D., to conduct the exam in a specially equipped operating room in U-M C.S. Mott Children’s Hospital.
“With Dr. Eton’s assistance, Dr. Wu and I conducted the exam, then met with Roxy’s mom and dad right after to discuss what we saw and plan our next move.” says Dr. Miller.
“That was one of so many ‘above and beyond’ days at Kellogg,” recalls Patty Riggio. “Again and again, we’ve been impressed by the lengths this team goes to, all to help Roxy.”
The exam indicated that scar tissue on the lens was the likely culprit, requiring a procedure to remove it. Steroid injections were planned to reduce retinal swelling, but because they tend to raise eye pressure, Dr. Miller could not resume them until her glaucoma improved. Action was also needed to address haziness in her cornea transplant graft. To make things as easy as possible for Roxy, Drs. Wu and Mian operated in tandem, replacing the cloudy cornea graft and inserting a glaucoma drainage device (GDD) to reduce eye pressure in one session.
The team then debated the best approach to removing the scar tissue on Roxy’s lens. Typically, a tool called a YAG laser is used in the clinic. But this requires a patient to sit very still and look into a bright light—an uncomfortable proposition for Roxy.
“After her previous procedure, Roxy was able to sit at the slit lamp for removal of some of the sutures on her corneal transplant,” Dr. Mian says. “She therefore bravely agreed to let us try the laser treatment, and she did really well. We are all so proud of her.”
Roxy also needed a GDD in her other eye which was performed by another member of the team, Amanda Bicket, M.D. Recognizing another opportunity to simplify Roxy’s care, Dr. Miller recommended a steroid injection at the same time as the surgery to keep the retinal swelling down.
“Thanks to the GDDs, I no longer need the glaucoma medications that caused me so many problems,” Roxy says. “I feel so much more like myself now.”
With the new corneal transplant, Roxy’s vision improved from “CF” to being able to see fairly small letters on the eye chart (20/50-20/100). And since the removal of the film on her artificial lens implant, Dr. Miller can now see well enough into the back of the eye to manage her retinal swelling without any need for an exam under anesthesia.
“We’re so encouraged by Roxy’s progress in the right eye,” Patty Riggio says. “In the hands of this remarkable team and by the grace of God, she has gone from virtually blind in that eye, to seeing again.”
“We’re thrilled at Roxy’s progress in the right eye,” says Dr. Miller. “We are now working on rehabilitating the left eye, which requires a similar degree of complex steps and coordination. During this whole process, we’ve asked a lot of Roxy and her family. Their grace, patience and humor continue to impress and inspire us at every turn.”
