Going Blind on Mount Hood

A persistent wind, moderately high altitudes, the effects from a surgery 15 years ago, and a student who did not communicate that he was having issues.
David Shema David Shema
February 26, 2014

Mt Hood Palmer Glacier
Injury: Corneal Edema causing blindness in one eye
Cause: Lasik Surgery, altitude, drying wind

Leader

On June 2nd, on my climb of Mt Hood, one student suffered a corneal edema which caused temporary blindness in one eye.  He has since made a full recovery. He had Lasik surgery 15 years ago.  

We  arrived on Saturday afternoon and pitched tents at the "Alpine" campground at  5400', not far from Timberline. We got up at 9:00 PM to prepare for the ascent; the student in question was not able to get much sleep as it was early and still  light out. We started climbing some time around 11pm.

We had  clear skies and a persistent wind from the West (climber's left). The wind as  never so strong as to raise concern but also never really let up either. We always had some wind on our left. The student is a very strong hiker and  maintained a strong pace up to the top of the Palmer chair lift, where we  stopped to put on crampons and have a break. Above the chair lift his pace  slowed, and above 10000 (the Devil's Kitchen area) he was slower still. He did  remark that he was not at his best but did not mention any issues with his sight  and wanted to continue. He later indicated he would see multiple lights at night where there was only one but did not think much of it.  

We summited at sunrise, and during the descent with the sun rising the student realized that he was slowly losing vision in his left eye. The condition  worsened until he could not see out of his left eye. He was slow to descend but  was escorted by a rope lead the entire way. I was slightly ahead with another  student eager to descend who was feeling slightly nauseous. 

Rope Leader    

Around 4am, one basic student commented  that vision out of his left eye was fuzzy. I didn't think much of it at the  time, and I now regret that I wasn't more concerned at the time. Later on we learned that he experienced a high altitude corneal edema, and should have gone to a hospital right away.  

Fortunately, his vision is expected to make  a full recovery.  He was solely my responsibility at the time, so I feel bad  that I didn't bring him down the mountain sooner. In my training, I've learned  about AMS, HAPE, & HACE, but I had never heard of a corneal edema before and I did not recognize the symptoms as a serious problem.  

Leader

At 7500', while descending the ski slopes, the student  spoke with ski patrollers who examined him and suggested he descend quickly and  see a doctor. They arranged for a ski litter and brought him the last 1500' to Timberline. He was examined by more medics at Timberline and again advised to  see a doctor and to descend quickly. We debated whether to wait for an  ambulance. One ambulance had already arrived to attend to another party involved in a climbing fall (not related to our team); that ambulance was not available to us. We were told the next ambulance would arrive at least 30 minutes later so we decided to take him to Portland ourselves.   

I drove the student's car while he sat in the back seat. Another student came along to help with driving as I was quite tired myself; we did switch drivers about half way to Portland. As we descended from Timberline (6000') to about  1000' the student's vision already showed signs of improvement. He was able to count fingers on my hand although he said his vision was still blurry. We arrived at Oregon Health and Science University hospital where there is an eye  specialist. We were worried about a possible glaucoma but were surprised to hear the diagnosis: corneal edema. Apparently the doctor said the combination  of a quick ascent from sea level (i.e. Seattle) to 11000', the persistent cold and dry wind from a constant direction, and the student's prior Lasik surgery  contributed to this outcome. I got the impression that a corneal edema is rare  and that it is normal for the patient to recover once the swelling subsides. Note that only the left eye (the eye on the windward side during our ascent) was  affected. The right eye was not.  

After a few hours waiting in Portland the student's wife left Seattle to pick him up; I drove his car back to Seattle with the other student. The student went to work the next day and his vision continued to improve over the next few days. After two or three days his vision had completely returned to normal.

Student

Hi guys – I just wanted to follow up and let you know what happened to my eye and the lesson(s) I learned from this. By the way, I’m supposed to expect a FULL recovery, so there was no permanent damage.  

What I suffered was a high-altitude corneal edema. My understanding is this can only happen to people that have had lasik eye surgery (which I had probably 15 years ago). But  basically the wind, which was gusting heavily from the left, was hitting my left eye, and my eye couldn’t produce enough tears (the eye surgery and old age are  the main reasons for this), so the cornea swells, freezes, and causes a greyed-out blindness which gets worse and worse as you go higher in altitude. The first moment I noticed my eye was acting funny was on the way up around 8,000 feet when I wasn’t wearing any eye protection (probably not many of us  were since it was night time). As we proceeded, I was seeing flashes of light and people’s headlamps I was seeing quadruple. The eye specialist in Portland said this same thing happened to Beck Weathers on Mount Everest – I think he even wrote a book about it.

As we proceeded up the mountain, I knew my vision was impaired to some degree, but I didn’t realize how bad it was until daylight (and we were already at the summit). At this point, I couldn’t see anything out of my left eye but a complete “grey-out”. Depth-perception was a huge challenge on the descent as I was trying to calculate my next step, but my  rope partners took really good care of me and we made it down slowly and cautiously until we ran into the ski patrol.  
The biggest lesson   learned about this trip is that I should always communicate to the trip leader if I am suffering.  When we were roping up at 10,000 feet, I should’ve spoken up  and told him my vision was not doing well and I don’t think I should go. So the lesson really is when we’re on these climbs, don’t be afraid to admit to your leader or teammates that it’s just not your day and you shouldn’t proceed.  

Anyway, I really appreciate everyone’s concern and support – especially the climbers who took good care of me on the mountain and those who took good care  of me after the climb. You guys are all amazing.  P.S. I can climb mountains  any time I want, just need to wear goggles, glacier glasses, or clear protective glasses at all times even if it’s dark out.    

Seattle  Safety Officer     

According to the literature, those who have  had some types of Lasik refractive eye surgery (radial keratotomy –RK in  particular) are at an elevated risk of visual complications at high altitudes (above 9,000 feet). There is compelling evidence for myopic mountaineers that PRK instead of RK is their refractive surgical procedure of choice. 
[http://www.basecampmd.com/expguide/snowblind.shtml]