Cessna’s Vision Problems

My wife, Cessna, has been having some vision problems, and since so many friends and family members have asked for details through email and all the social networks we’re on, I thought it might be easiest to publish the info here and just link to it. This is my version, not hers, so I hope you and she will forgive my inaccuracies.

For a number of years Cessna thought she had more floaters in her eye than normal. Three years ago her optometrist noticed some minor irregularities on her retinas, but no one thought it was anything serious. Cessna teaches Aikido so she rolls and falls a lot, and at one point she noticed a few flashes in her eyes and other irregularities. She had some tests by our HMO’s opthalmology department, which merely confirmed that yes, there was something on her retinas, but no big deal.

Then in June of this year she started having more serious things in her left eye: blobs of stuff, larger than the usual floaters, that more severely obscured her vision. She returned to opthalmology who diagnosed her with retinal vasculitis, inflammation of the blood vessels in the eye. They suspected the inflammation was causing a reduction of oxygen in the blood and the eye to therefore generate additional (undesirable) blood vesels as well. The blood vessels (veins, arteries or both) were leaking some blood into her eye, and that’s what was obscuring her vision.

The doctors started running all sorts of tests: x-rays, MRIs, blood tests, etc. They also performed eye angiograms using injected fluorescein dye, which enhances the image of the blood vessels and apparently can actually show the blood leaking. They confirmed their diagnosis, but Cessna had a pretty nasty allergic reaction to the fluorescein. She had a second angiogram and the reaction was so severe, even with a dose of Benadryl, the assistant was ready to administer an EpiPen.

Although the doctors were moderately confident in the diagnosis of her condition, they still didn’t know what was causing the inflammation so they didn’t know how to treat it. They told Cessna that if it didn’t go away (and it didn’t appear to be) she might need to start using immune-suppressant drugs like Humira to reduce the inflammation. These are nasty drugs for anyone, but Cessna doesn’t have a particularly strong immune system to begin with. The doctors also said they might want to inject Avastin directly into her eyes to halt the growth of new blood vessels. (Yeah, my thought, too.)

The optometrist suggested Cessna get the advice of a nutritionist, which she did. If there was anything that might avoid the immune-suppressant drugs it was worth a try, so Cessna had another slew of blood tests looking for food sensitivities. The result was that she started an incredibly strict diet in mid July. We’re not just talking gluten-free; we’re talking everything-free. It’s a diet based upon her specific sensitivities.

That’s the course she was following until a week ago, when her right eye (which was the good one) suddenly became completely occluded. She couldn’t see anything through the floating mass. We went to the opthalmic experts the same day and they told her it was blood — a lot of it. But the recommended treatment was the same: maybe the Humira, but just wait and see. Well, that’s a bad joke since she now couldn’t see well enough to drive or do many other things. And there wasn’t any indication it was getting better. In fact, it was getting worse.

We decided to go outside of our HMO and get second opinions from other local opthalmic gurus, and that’s what we’ve been doing for the past three days. Here’s what we’ve been told so far:

  • The diagnose is still retinal vasculitis.
  • They don’t know the cause, but there are still a few more tests that will be done.
  • If they can’t find a treatable cause, they may want to give her prednisone. But that’s a steroid with all sorts of bad side effects — Cessna had an aunt who died from taking it long term — so it can’t be used for more than a few months.
  • If that doesn’t work, then they’re talking about Humira, etc.
  • They used ultrasound today to determine that she doesn’t have any retinal detachment. (I got to see this in real time. It was an amazingly clear picture, taken through the eyelid and all.)
  • The blood in the right eye might dissipate by itself, but it’s going to take “months”. If it doesn’t, they’ll have to remove the blood surgically.
  • The doctors really want to see what’s going on in the right eye, but they can’t because the blood is in the way. Once it’s gone (on its own or via surgery) they want to do another fluorescein angiogram, but due to Cessna’s reaction she’ll need prednisone and Benadryl beforehand.
  • Once her eyes clear, the doctors also want to go in there with lasers and zap the extra blood vessels. Apparently she’s already permanently lost vision in those spots anyway, but it doesn’t sound like they’re too critical.

At this point Cessna’s hanging in there. It looks like she’s got another week of tests and doctor visits, and the extreme diet continues. The best news came today from the first doctor to tell her that he didn’t expect any of this to be permanent. He wasn’t sure, of course, but he told her she should expect to recover her vision.

Thanks to everyone for your good wishes. I’ll pass them on to Cessna.

Labs and Papers for Black & White

This post is a review of black-and-white printing on eight different papers from four U.S. photo labs.

I’ve been uploading my recent photos to Google Plus, where I’ve been getting good feedback and meeting great photographers. When I published this b&w image of Bubba’s Diner in San Anselmo, California, the comments were particularly enthusiastic. And then, totally out of the blue, two people said they wanted to buy prints. How cool is that? I didn’t get (back) into photography to sell my images, but why not? If someone can get pleasure from hanging one of my photos on their wall, that would be pretty cool.

Bubba's Diner, San Anselmo, California
Bubba's Diner, San Anselmo, California

How to sell prints to my first two customers? I quickly cleaned up my SmugMug portfolio at DougKaye.com — it still needs a lot of work — and upgraded to a Pro account so I could order the prints through there and even sell them directly. But before I accepted money for my work, I wanted to know what the prints would look like, so I decided to order prints of most of my portfolio images for myself. SmugMug uses two labs, and I opted for BayPhoto, which appears to be their more high-end lab. (The other, ezprints, is somewhat less expensive.) I first ordered a print on Kodak Endura paper, which SmugMug/Bay Photo refer to as their Lustre stock. When the print arrived, I was rather disappointed in the color and texture of the paper. So I turned to other photographers on Google+ and asked them what labs and papers they used for b&w. I got a few recommendations and then ordered prints from four labs (including BayPhoto) on eight different papers. Here’s a summary of my opinions, listed by the coolness/warmth of the papers, starting with the coolest. It’s not an exhaustive test, as I’m sure there are far more papers and labs out there. But if you’re thinking about black-and-white printing, this may be a helpful starting place.

Bay Photo’s Lustre is Kodak’s Supra Endura VC, a resin-based photographic paper finished with a “fine grain pebble texture,” which is too much artificial texture for me. SmugMug recommends it as a compromise between full matte and glossy and as a way to minimize fingerprints. I expect my prints to be matted and mounted behind glass, so fingerprints aren’t really an issue. This is the coolest of all six papers. It actually has a noticeable blue cast to it. I’d say it’s my least favorite of the batch. ($3.23 via SmugMug for an 8×10 color-corrected print. Direct from BayPhoto: $3.50, or $1.79 without color correction.)

Bay Photo’s Metallic (Kodak Endura Metallic VC) is actually a touch warmer than the Endura, which shows how cool/blue the regular Endura really is. The metallic is obviously very glossy and has a bit of a greenish cast to it. The whites and highlights are very reflective/silvery, hence the metallic moniker. I don’t think I’d be likely to use this paper. ($4.12 via SmugMug for an 8×10 color-corrected print. Direct from BayPhoto: $4.03, or $2.06 without color correction.)

Bay Photo’s Glossy (also a Kodak Supra Endura VC) is the third coolest paper, and still not particularly warm. The blacks are deep and there’s pretty good detail in the shadows. I’d probably use this for images where I wanted to emphasize the drama of a contrasty, particularly crisp picture. ($3.23 via SmugMug for an 8×10 color-corrected print. Direct from BayPhoto: $3.50, or $1.79 without color correction.)

MPIX offers a paper they call True B&W, Ilford’s True B&W. This is a silver photographic process, so there are no color dyes or inks at all. It’s yet another cool paper, almost as cool as the Bay Photo papers. Like the Endura Metallic, it has a slight greenish cast. Of all the printer/papers combinations, it’s the lowest contrast. There are no deep blacks and it has the least detail in the shadows. The opposite of Bay Photo’s Glossy paper, I might use MPIX’s True B&W when I particularly wanted a softer, gentler low-contrast look. ($2.49 for an 8×10 print)

I wasn’t really thrilled with any of these combinations, so I asked Matt Russell, a friend who shoots and sells a lot of b&w landscapes, about the high-end labs he uses. He suggested I look into West Coast Imaging and Digital Silver Imaging. WCI has a $250 minimum order, but they were willing to work with me on these tests. Obviously, you don’t want to order one or two 8×10’s at a time from WCI.

DSI uses Ilfospeed Resin-Coated paper with an Ilford Pearl (lustre) surface for their Custom RC prints. This is another lower-contrast combination, but not as low contrast as the MPIX True B&W. The blacks are also deeper and richer than the MPIX, but still not as deep as others. Furthermore the blacks are rather warm. It’s a very nice combination: a neutral paper with slightly warm blacks. One of the best. ($18 for the first 8×10; $9 for prints 2-10.) DSI also offers a less-expensive Direct to Print option (ie, not their Custom service) that delivers Ilford RC Pearl prints for much less ($4.59 for 1-9 8×10 prints; $4.19 for 10 or more).

DSI’s Custom Fiber Base prints are on Ilfobrom Galerie Fiber paper. This is fairly warm paper, but the blacks are actually cooler, similar to the MPIX True B&W. It’s a heavy double-weight semi-gloss fiber paper, about the same weight as the Ilford Gold. It’s in the lower-contrast category like the MPIX True B&W and the DSI Custom RC, but not as low-contrast as the others. The paper is quite warm, but the blacks are cool (again like the True B&W). The depth and richness of the blacks are excellent as are the shadow details. ($38 for the first 8×10; $25 for prints 2-10)

WCI offers Ilford Gold (Ilford Galerie Gold Fibre Silk), warmer still than DSI’s Custom Fiber Base. It’s a very heavy paper made with real rag and has a marvelous rich look to it without sacrificing good, deep blacks. ($12.22 for the first 8×10 of a single image; $10 for prints 2-9; $8.33 for 11-.)

WCI also offers Silver Rag (Crane’s Museo Silver Rag), a 100% cotton paper. It has slightly more rag texture than even the Ilford Gold. This is the warmest of all the papers I tested, with a slightly yellow cast. I would use this paper if I wanted a particularly warm look. Otherwise, I’d stick with the Ilford Gold. (Same price as WCI’s Ilford Gold.)

With the exception of the Ilford True B&W paper used by MPIX, all of the above have deep, rich blacks. It’s possible that a different print on the True B&W might not have such a low-contrast look. But while all the others have solid blacks, all but the two WCI combinations do so by increasing contrast and therefore losing some detail in the shadows.

There’s no question that the more costly prints from DSI and WSI are superior to the others. DSI’s Custom Fiber Base prints are downright expensive.

I’m sure your experiences vary and you probably have used labs and papers not listed here. Leave your reactions in the comments for all to see. DSI’s pricey Custom Fiber Base prints are perhaps the best of all for most of my work, but damn expensive. It’s the one option that starts to become more than a substantial part of the total (including matting and framing) costs. A 12×18 costs $88 plus tax and shipping. For most high-quality work, I’d probably chose Ilford Gold from WSI if I had enough work to justify their $250 minimum order. Otherwise, I’d probably go with DSI’s Direct to Print Ilford RC. For by far the fastest service and the lowest cost (and so long as I wanted a very crisp look), I’d use Bay Photo’s Endura Glossy. WCI’s Silver Rag is an option I’d reserve for those times when I needed very warm (almost toned) whites.