Sharing Mayo Clinic: Cincinnati Youth Choir's conductor has sight restored with collaborative care approach

Neurosciences

Sharing Mayo Clinic: Cincinnati Youth Choir’s conductor has sight restored with collaborative care approach

By
Dana Sparks

March 8, 2020

When doctors in Ohio told Robyn Lana they weren't sure whether a brain aneurysm they found behind her right eye socket was causing the vision problems she'd been experiencing, Robyn turned to Mayo Clinic. Not only did her Mayo care team identify the true cause of her vision loss, they fixed it.

In November 2018, Robyn Lana was faced with a serious and frightening problem. "I started losing the vision in my left eye rather suddenly," she says. "It came out of nowhere."

Robyn's failing vision affected all aspects of her life, including her work as founder, managing artistic director and conductor of the Cincinnati Youth Choir. "I travel around the country working with children's and other youth choirs, so my symptoms were really troubling," she says. "I couldn't drive myself to rehearsals, and had to cancel concerts and other out-of-state conducting gigs because my vision kept getting worse."

After testing by local care providers revealed Robyn had developed a brain aneurysm behind her right eye socket, she was hopeful that the cause of her vision problem had been identified and could be treated. Her medical providers, however, weren't so sure.

"They weren't convinced the aneurysm had anything to do with my vision loss, so they left it alone and told me not to worry about it," she says. But Robyn did worry. "It just wasn't a comfortable situation for me, so that's when I started doing my own research."

That research led Robyn to Mayo Clinic's Sharing Mayo Clinic blog, where she found the story of Judy Henderson. Judy also had dealt with vision problems, and they were found to be the result of a brain aneurysm that was successfully treated at Mayo Clinic by neurosurgeon Giuseppe Lanzino, M.D.

After reading her story, Robyn contacted Judy. "I reached out and asked her opinion of Dr. Lanzino," Robyn says. "She said: 'He's the best. He's wonderful. You have to go see him.'"

Robyn took that advice, scheduling an appointment with Dr. Lanzino at Mayo Clinic in Rochester as soon as she could. The appointment took place just as her vision was beginning to free fall.

"Dr. Lanzino saw me for the first time on Dec. 26, 2018," Robyn says. "By that time, my vision had rapidly declined to the point where I'd become legally blind in my left eye. The vision in my right eye was also starting to decline."

Double trouble

Imaging tests at Mayo Clinic revealed the underlying reason for Robyn's deteriorating sight. "The first day I met with Dr. Lanzino, he ordered an MRI and a magnetic resonance angiography. That's when he found a second smaller brain aneurysm behind my left eye socket, as well," Robyn says. "The two aneurysms were touching each other."

But the investigation wasn't over. Dr. Lanzino had to pinpoint which of the two aneurysms was primarily responsible for Robyn's vision loss and, thus, which one took priority. For help with making that decision, he brought in Harry Cloft M.D., Ph.D., a neuroradiologist and Tariq Bhatti, M.D., a surgical ophthalmologist.

"There's always some risk when you take on a case like this that the patient's vision could get worse. That was our primary concern."
Harry Cloft M.D., Ph.D.

"We each bring different things to the table," Dr. Cloft says. "I'm a radiologist, so I'm more imaging-focused. What I saw on Robyn's imaging was that the aneurysm behind her right eye socket was bigger and was pushing on her optic chiasm, which is where the optic nerves meet. So we thought that one was probably causing the most trouble. Also, the one behind her left eye socket has an artery that comes out of it and goes to her left eye, so we had some concerns that treating the left one could actually make her vision worse. Ultimately, we decided the best way for us to improve her vision was to attack the aneurysm above her right eye while leaving the one on the left alone for now."

Dr. Bhatti agreed. "Multiple discussions had us thinking the aneurysm behind her right eye socket and possibly the inflammation around it was what was causing her vision loss, and that we should go ahead and treat the larger of the two aneurysms," he says.

It was a decision the doctors did not take lightly. "There's always some risk when you take on a case like this that the patient's vision could get worse. That was our primary concern," Dr. Cloft says. "We were kind of between a rock and a hard place because if we didn't do anything, her vision was almost certainly going to continue to get worse. We had to do something to try and stop that from happening."

Plan of attack

The physicians decided to place a device, called a flow diverter, across the aneurysm on the right to redirect blood flow away from the aneurysm, causing it to shrink over time. There was a potential catch, however.

"As the aneurysm fills up with the blood clot that closes it off from the rest of the body after placement of the flow diverter, it might begin to swell before it starts to shrink," Dr. Lanzino says. "If you have swelling in a patient who's already having symptoms because of compression that the aneurysm is causing, that could become dangerous."

After Robyn returned home to Ohio following her flow diverter procedure, the aneurysm not only began to swell, but it also began to cause additional vision loss and additional worry along the way. That's when the role of Amy Theiler, a Mayo Clinic physician assistant on Robyn's care team, came front and center. "Amy specializes in treating patients with brain aneurysms, so her involvement in Robyn's care became critical," Dr. Lanzino says.

"I'm a walking miracle. I truly believe that. Since coming to Mayo Clinic, the vision in my left eye has been 100% restored."
Robyn Lana

Robyn and Amy talked by phone, and they were able to identify what was going on with the aneurysm. With Amy's input, the team decided to prescribe steroids to reduce Robyn's swelling and minimize the damage, while helping her through the initial stage of healing. Eventually, the aneurysm began to shrink and her vision started to improve.

"I'm a walking miracle. I truly believe that. Since coming to Mayo Clinic, the vision in my left eye has been 100% restored," Robyn says. The only residual vision loss I've suffered in my right eye has been very slight, but that should continue to improve with time, as well."

Culture of collaboration

With her vision on the mend, Robyn has returned to doing what she loves. "It's such a blessing to have my career back," she says. "I get so much joy out of changing the lives of young people through music. To be able to do that again, and have the energy and vision to go along with it, is amazing. I can't put into words how wonderful it is to have been in all of my doctors' care and to be where I am now."

"It was huge for us to have all the specialists we needed under one roof."
Giuseppe Lanzino, M.D.

Her Mayo physicians agree that Robyn's outcome would not have been possible without Mayo Clinic's culture of collaboration. "Robyn's story is not so much about the flow diversion procedure itself, but more about the strategy that was involved in her treatment," Dr. Lanzino says. "Knowing and understanding what the best course of treatment was for her and how to do it was paramount. It was huge for us to have all the specialists we needed under one roof."

Dr. Bhatti echoes that sentiment. "The fact that Dr. Lanzino and I could discuss Robyn's case while she was sitting right there in my office was huge. We did that several times throughout the course of her care," he says. "We're fortunate here at Mayo Clinic to have the sort of team-based approach to care that we do."

Thanks to that teamwork, Robyn has been able to get back to her life and her work without the fear of losing her vision. "Before my procedure, I told Dr. Lanzino that my goal was to be able to see well enough to still conduct a festival that I had coming up at Carnegie Hall, and I was able to do that," Robyn says. "Everyone at Mayo Clinic is so outstanding. My entire patient experience has been amazing."

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