It was early 2024 when Tony Herman of Sun Prairie, Wis., started to notice he was losing his peripheral vision. He wasn’t that alarmed at first but started to worry once things began to appear fuzzier.
Eventually, Tony was left with “tunnel vision,” whereby he could only see straight ahead but nothing from either side.
After several months, Tony had lost close to 50% of his vision. His primary care provider found something suspicious after doing an MRI of Tony’s head. Doctors would soon determine that Tony had a tumor known as an adenoma on his pituitary gland, which lies at the center of the head and is attached to, but not part of, the brain.
Often called the “master gland,” this small but mighty gland secretes hormones that the body needs to function properly.
Today, thanks to his comprehensive UW Health care team, Tony is extraordinarily grateful. Now 53, he has regained all of his vision, which not only makes daily life immeasurably easier but also allows him to continue earning a living as a website designer and ski instructor.
Tony was referred to UW Health in May 2024, when he first saw Azam Ahmed, MD, a neurosurgeon who directs the UW Health Pituitary Tumor Clinic, which includes leading experts in neurosurgery; ear, nose and throat surgery; endocrinology (hormones); radiation oncology and radiology.
A key member of the team is ophthalmologist Judy Chen, MD, PhD, one of a handful of doctors in Wisconsin who specialize in determining how much of a patient’s vision loss might be caused by a problem with the optic nerves that transmit visual images from the eye to the brain.
In Tony’s case, Dr. Chen was able to confirm that his vision loss was caused by the pituitary tumor, which was pinching on his optic nerve that sits just above the pituitary gland.
While some pituitary tumors like Tony’s are serious, they are not cancerous, so they do not spread to other parts of the body. Many people — perhaps 10% to 20% of the population — might eventually develop a pituitary tumor; however, most individuals never experience significant symptoms such as vision loss or hormone level abnormalities.
Surgery done through his nose
Tony’s tumor, however, was large enough for UW Health doctors to deem him a candidate for a minimally invasive form of neurosurgery in which Dr. Ahmed — assisted by Dr. Ian Koszewski, an ear, nose and throat surgeon — removed the pituitary gland tumor from Tony’s head without having to open the skull.
Dr. Ahmed specializes in what is called trans nasal surgery, a procedure that allows him to access the tumor by operating with instruments that fit through the patient’s nostril.
Individuals who have surgery to remove a pituitary tumor typically take between six and eight weeks to fully recover. There are also several follow-up tests and visits needed, which are coordinated by Karla Hano, RN, the nurse navigator for the Pituitary Tumor Clinic.
“Our patients appreciate having one person they can contact to help ensure that all of their tests, bloodwork and follow-up visits get scheduled,” Hano said. “I’m also here to answer whatever questions may come up.”
As Tony’s surgery was approaching, his vision declined further.
“It looked like somebody’s hand was in front of my eyes. It was getting scarier, but Dr. Ahmed was very confident and comforting," Herman said. "I knew I had to have surgery, because eventually I’d go blind if I didn’t. Dr. Ahmed said he hoped that the surgery would improve my vision, but all he could promise was that it would not get any worse.”
There were no guarantees, said Dr. Ahmed, because of the possibility that the tumor was exerting pressure on the blood supply to Tony’s optic nerve. Patients with damaged optic nerve blood supply do not regain lost vision.
“Fortunately, this was not the case with Mr. Herman,” Dr. Ahmed said. “We were able to completely remove the tumor and take the pressure off his optic nerve.”
When he woke up in recovery, Tony literally couldn’t believe his eyes. He could see everything again. Left, right and straight ahead.
“It kind of hit me later how amazing this was, because there was no guarantee that my vision would improve at all, and I got it all back,” he said.
Because the pituitary gland is the driver of the body’s ability to secrete hormones, Tony’s blood was checked for any hormonal abnormalities. Aside from a small change in his testosterone, which is gradually returning to normal, Tony was producing hormones at normal levels.
“Dr. Ahmed and his team are top notch,” Herman said. “They are very knowledgeable and took good care of me. I would recommend them to anyone — go with the best.”