Five Minutes to Midnight: A Disorientating Diagnosis of Glaucoma

Just over a year ago, a glaucoma specialist told Duncan Craib he was “five minutes from midnight”: unless urgent action was taken, he’d likely be blind in two to three months.

Most eye care professionals would assume that people like Mr Craib are aware of the need for regular eye health checks. He’d grown up in a medical family, completed university, lived in “all corners” of the globe, and was working as the CEO of Boss Energy, where all employees receive free routine medicals. He’d recently been through the Medicare funded health check for 45–49-year-olds and come through with flying colours.

Yet because his vision had always been 20/20, he’d never thought to have his eyes examined by an optometrist. And he had he never heard of glaucoma – until his shock diagnosis.

The signs came on swiftly during the Christmas period of 2022.

“We were on vacation, staying with my in-laws at their beach house down south in Western Australia. The glare on the ocean was bothering me a lot; to the point where it was noticeably painful,” Mr Craib recalled.

“I asked my mother-in-law, who has worn bifocals since being a child, who she would see about an eye check or getting glasses, and she said the best thing to do would be to go to Perth, to the Lions Eye Institute.”

It was the beginning of a life-changing journey that Mr Craib said has altered his priorities and instilled a deep respect for the power of vision.

Having called Lions Eye Institute and explained his symptoms, Mr Craib was squeezed into an appointment date a couple of months out, in mid-March. But in the lead up to the appointment, his symptoms worsened.

“In February, I was working on the (Boss Energy) mine site itself in Honeymoon – about 80 km northwest of Broken Hill. It’s an isolated mine site. You basically fly in and fly out and you’re there for two weeks stints. And it was during one of those stints that I was speaking with my wife, Catherine, saying, ‘gosh, I feel poorly’. I was experiencing nausea and headaches. But I wasn’t physically sick. It was nothing I could put my finger on.

“So, I was trying to work out what on earth was going on. No doubt we were working hard, and in those times, you sometimes push your own personal awareness to the side. You just get on; you keep going. And it passed. I think that’s what I was doing.”

When he turned up at Lions Eye Institute a few weeks later, expecting a visual acuity test, Mr Craib was surprised by the battery of tests he was put through.

And then a specialist said, ‘You better take a seat’.

“I sat down and he said, ‘It’s five minutes to midnight. You are likely to go blind in the next two to three months. We need to move quickly, you’ve got very heightened (intraocular) pressures in your right eye (56) and in your left (38) that we need to get on top of. You’ve got what’s called glaucoma’.

“And I said, ‘How do you spell that?’”

The unsuspecting patient

Having come from a medical family – his father was one of the senior general physicians at Fremantle Hospital and his mother a medical secretary in community service – Mr Craib had grown up among doctors and medical specialists. And while the conversation around the dinner table often swung back to health and medical ailments, he said he had never heard talk about any eye conditions, other than the usual need for glasses due to presbyopia.

“I’ve always been to the dentist two or three times a year minimum. I always get the physical health check-ups as you do in mining, and when I reached my late 40s, I did the Medicarefunded health check. But I had never seen an optometrist. I’ve always had 20/20 vision, so for me, there was never really a care or pain.”

However, having been diagnosed with openangle glaucoma, Mr Craib reached out “to all the aunts, uncle and cousins around the world” to try to find any family history.

Mr Craib said there was nothing, until one aunt told him, “Oh, your grandmother, my mother in her 80s, discovered glaucoma and she was treated for it. But being a proud old lady, she never admitted any personal issues”.

“That was just life. These were people from the Great Depression and World War Two. They’re tough and she was certainly a strong willed lady, a loving and intelligent lady, just not one to admit physical fault… you just march on,” Mr Craib said.

Disorientating and confronting

As a relatively young man, with two children aged 11 and 13, leading an exploration and development company that is about to reach a major milestone in Australia’s uranium mining history with a producing mine, Mr Craib said being diagnosed with glaucoma was “disorientating”.

“You’ve gone in to check your eyes and then suddenly you get hit with this. You get told, ‘you need to be back here this time tomorrow, so we can check if we need to rush you into an operation because you’re right on the verge of losing your sight’.

“They gave me a series of eye drops and I remember walking out of there – I’m not sure what time it was – but the light outside was blinding. I had to sit down for an hour before I could go anywhere. It was a very disorientating few hours. The whole prospect of potentially losing sight when you’ve got such a young family was very confronting.”

Back at home that evening, Mr Craib went online and landed on Glaucoma Australia’s website. He phoned the helpline number.

“I just thought, ‘I’ll reach out and see what this is all about’. I was curious and I was lucky. Sapna Nand (Glaucoma Australia’s resident orthoptist) answered the phone, and she was amazing. For 30 minutes we talked through it and I think her main message was, ‘you’re not alone. Thousands of people have been before you’.

“I think it was more that reassurance of what you’re going through, others have experienced. She told me that treatments were medically advanced, and there are a lot of researchers and specialists in the field. And she told me that it was normal that they’re trying to stabilise my pressures.”

Mr Craib said having glaucoma explained in layman terms was very reassuring at a time when “I was still battling with even pronouncing the word glaucoma”.

“It was just a very, very human element to something that was quite frightening, especially as there were no family members or friends in my life with glaucoma that I could talk to.”

Trial and error

For Mr Craib, the news on his glaucoma to date has been relatively positive with regular eye drops successfully lowering and holding his intraocular pressures stable, however he knows surgery is on the horizon.

“I was checked daily, then weekly and now every two or three months. Surgery has been recommended, but I’m holding back for the time being, just because operating on my eyes seems a bit radical. But I think that, in time, this (the operation) is probably a sensible thing to do.”

Of the noticeable changes to his vision, which include peripheral vision loss and intolerance to bright light he said, “it has been enough to give me a fright – I don’t want to lose any more vision and I’m acutely aware that I have to keep taking the eye drops daily to prevent this from happening”.

However, it’s been a process of trial and error to find a routine that fits in with his schedule, which often involves travel through different time zones.

“Travelling in itself is a bit of a nightmare. I went to America twice last year and to Europe to meet with customers, and the first time I had my eye drops in my suitcase. When I got to my hotel, I found that because of the pressure changes in the hold, the bottle of drops had emptied through my bag. So, I was stressing – Australian prescriptions don’t work in America, I didn’t know where to find an optometrist, and time was limited because I had meetings and a conference to present at.

“Now, wherever I go, I’ve got two spares unopened, just in case it happens again.”

In terms of administering the drops he says it’s been trial and error to work out what works best. “But now, wherever I am I follow the same routine. I get up in the morning, have a shower, get ready to start my day, and then I put the drops in.”

Making health a priority

As for his ongoing health, he said this was now a priority.

“When you have this experience, you reprioritise your health – you can aim for financial wellbeing as a priority, but ultimately health is your true wealth.

“This has taught me that we tend to take our eyes for granted, and yet they’re probably the most important part of us; one of our most important senses and the most complex. But it’s not until something goes wrong that we begin to appreciate them. I’m a classic example of that.”

And it’s not only his own health that he is taking seriously. “I’ve made a point of telling my friends, my brother (who turns out to have the same physiological condition, just not as advanced), and my cousins; they’ve all gone and got their eyes checked. And it’s not just them, it’s the warnings for their children.”

Back at Boss Energy, where every new employee must do a thorough health check and all employees undergo standard health checks, he’s also trying to make a difference.

“I’ve been encouraging my work colleagues to get optometrist-led eye examinations when undertaking a health check.

“I would also like to see changes to the Medicare health checks. I remember the check-up I did when I reached my late 40s – it was quite an involved process with questions about cancer, prostate, blood pressure, heart history, etc. There was a question about any family history of eye problems to which I’d answered no, because there weren’t any that I was aware of. But I don’t recall any suggestion to see an optometrist for a check-up. If one thing could be changed, it would be to actually state on that form, that if you haven’t had an eye check up in the last few years, you should do so.

“Like my grandmother, I don’t want to be up there telling the world I’ve got a physical problem, but I think if it saves one person’s sight, it’s worth it. Already I’ve had people from around the world reach out and say, ‘oh, thanks for sharing your story, its valuable for others to learn of the risks and we’ve gone and had our eyes checked’.”

This article has been republished courtesy of Mivision.