 |
Fred
Brack Raleigh, NC |
|
|
|
Fred
Brack Raleigh, NC |
|
In December of 2007, I had surgery for a detached retina, a serious eye condition leading to blindness if not immediately addressed. I was told it can affect anyone over 30. This condition is universally classified as a medical emergency, so be sure you understand the symptoms! This is my experience. [Updated October-December 2012 for follow-on problems in the other eye.]
One Saturday in November, I noticed "floaters" in my right eye. Most everyone has floaters now and then, but they usually arrive one at a time and disappear after awhile. A sudden influx of floaters didn't seem right, so I (pardon the pun) kept my eye on the situation. When I awoke Sunday morning, I had hundreds of floaters. They were small, mostly transparent (or out of focus), but they seemed to have a reddish color. What was more disturbing, however, was a very large floater in the bottom center of my eye. It appeared to be like a piece of translucent seaweed, swaying in the ocean with the tide. I knew it was time to call the doctor.
After answering a series of questions, I was told I had PVD: Posterior Vitreous Detachment, a condition most often affecting those of us over 60. The vitreous fluid sack in the eye had detached at one or more points from the back of the eye (where the retina is); and in doing so, some blood droplets had entered the eye (the round, reddish floaters), along with some material which had pulled away with it (the "seaweed"). I was told I needed to be seen the next morning. (Because my regular ophthalmologist was on vacation, I was seen by a covering physician.)
Upon my visit, the PVD diagnosis was confirmed, and I receive laser treatment during the visit. I sat in front of a table with a chin and forehead rest just like that used during an ordinary eye exam. My eye was dilated and numbed with drops. The doctor looked into a microscope on the other side of the table and fired a laser at the holes in the vitreous lining, with the intent of sealing (cauterizing) them, to hopefully stop any further bleeding or tearing. The laser was very bright (green). It was not painful, but it made me squint my good eye in "defense." The laser was fired repeatedly (up to a dozen times in quick succession) at each spot. I was pronounced good to go, no medicines required, call if any problems. Life went on as usual.
Three weeks passed uneventfully. It turned out that I had an annual eye exam scheduled with my regular ophthalmologist three weeks later, perfect timing for a follow-up visit to my PVD treatment, the treating physician said. The day before, I sensed new floater activity, darker this time. The next day, upon examination, my ophthalmologist cut the visit short, saying I had developed new "tears" in my retina, in a totally different location, and that I needed to be seen by a retina specialist immediately. She setup the appointment for that afternoon. So much for afternoon and weekend plans...
I was seen by Dr John Denny, of Retina Associates P.C. in Raleigh. After examining my eye, he sat back and said it was a more serious situation than he had hoped for, and it would require surgery (as opposed to just more laser treatment). I had developed eight tears in the vitreous lining, three of which affected the retina so far, which was pulling away. (Fluid seeps through the hole, and the resulting affect on the retina is described as peeling wet wallpaper.) If I did nothing, the retina would continue to pull away, and I would lose my vision. As it was, I was fortunate that the retina had not torn away from the center of the eye, because once that happens, restoration of central vision is not possible.
When the retina pulls away from the surrounding layer, sometimes there is bleeding, which leads to floaters, a good sign that something is wrong. Sometimes vision is not affected at all at first. And sometimes, as in the case of a friend of mine, the symptoms are loss of peripheral vision -- a shade, of sorts, in part of the field of vision. When this happens, full restoration of view is in jeopardy, but possible. A retinal detachment can occur for no reason at all (such as in my case), but it can also be influenced by trauma, diabetes, inflammation, or heredity. It occurs in about one person in ten thousand.
To see a photo of retinal detachment, please visit the following page, whose image is copyrighted: http://www.allaboutvision.com/conditions/retinadetach.htm.
There are several options for treatment, including laser surgery, freezing the areas involved (cryotherapy), and something called a scleral buckle, which compresses the eye. But my course of treatment is officially called Vitrectomy with Gas and Laser. (A variation, pneumatic retinopexy, is less desirable, in my opinion, as it is a two-step process, performed in the doctor's office without sedation, and very uncomfortable.). Here is the process, as best I understand it. I had this surgery the morning after my visit to the doctor.
The costs associated with this surgery were $4900 for the surgeon and $8850 for the hospital.
The next morning, my bandage was removed, the surgery was declared a success (as far as repair of the tears was concerned), I was given a kit of eye drops to use for the next week, and I was told not to do any lifting or straining for a week and not to lie on my back (and initially lie only on my left side at night). This last instruction would vary by patient depending on where the tears were located. I have heard of patients who had to lie on their stomachs for a week or sleep in a chair, for instance. No jogging was allowed (not a problem!), and walking was fine. I was told to take over the counter medicine for any eye discomfort (and call if there were any serious pain). My eye was on and off scratchy for 10 days (from the stitches), but I only took medicine once. When I asked my daughter a few days later how my eye looked, she said "it looks like crap!"
At night, I wore I hard plastic transparent shield over my eye, to protect it. During the day I was urged to wear glasses or a patch for protection. I had visions of poking my eye, rupturing an incision, having the gas escape, and my eye deflating! I did as instructed.
My eyelid drooped a bit, and the eye was red for a couple of weeks. Over time, the redness subsided, and the drooping diminished. I was told that in cases where the drooping persists, a small surgery can fix the problem. Two of the incision points were noticeable, and redness will take some time to dissipate.
This type of surgery involving a vitrectomy can often lead to cataracts; but since I have already had cataract surgery in both eyes, it won't affect me. However, a having a detachment in one eye increases the odds of having the same thing happen in the other eye.
The first couple of days, vision was very dark in my right eye and totally unusable. Even after a week, I couldn't make out anything except dark and light shapes, not even enough vision to navigate safely through my own home, if I used just that eye. However, during this time, especially at night when I lay down, I began to notice formation of a fluid drop at the top of my visual field. It was the TOP because vision in the eye is reversed: I was actually seeing a fluid drop form at the bottom of my eye. Strange as it seems, I saw this formation at night in total darkness with my eye closed. I had very few flashes of light (a common side effect of this surgery), but I "sensed" a light at night, usually on my right side, and the center of the forming drop was reverse lighted, clearly showing me the outline. This light effect continued for weeks.
As my body continued to infuse an aqueous solution into my eye over the next two months, the gas dissipated as the amount of liquid increased. After about three weeks I had regained peripheral vision at the top of my eye (when I was in an upright position), even though it was somewhat blurry. The surface of the liquid presented as a dark line, and light reflected off the surface, shooting rays of light upwards into the field of vision. As I moved, the surface line would jiggle; and when turning my head to the side, the line would always remain parallel to the ground. Yes, the jiggling was annoying! Vision through the gas bubble on the lower part of the eye was extremely blurry and useless for anything more than a couple of feet away. Actually, the focal point through the gas bubble was about 1", and I could see dirt on my glasses and pores on my nose!
In another week, the line of vision dropped to the midpoint, and the distraction of this dual vision area was lowered somewhat (though the jiggling remained annoying), as I could actually see through the center of my eye where focus is maintained, even though the image was somewhat blurry. At this point, five weeks after surgery, the line representing the surface of the liquid began to curve downward at the edges, due to the shape of they eye. Eventually it formed a round bubble at the bottom of the field of vision. In some ways, this was more annoying than the curved line! The bubble got smaller and smaller until it disappeared completely 2-1/2 months after the surgery.
The extent of extremely blurred vision for a month or more makes you essentially one-eyed. The interference of the blurriness with regular vision in your other eye is managed by the brain to some degree, but I often wore a patch over my right eye to avoid the confusing imagery. This was true at least initially while using the computer and watching television, and often true when I was out and around. After five weeks, I generally didn't use the patch in the house or while walking.
Field of vision was a problem. You can get an idea of what this is like by closing one eye. Move your hand to the limit of vision on that side, then open that eye. Everything to the other side of your hand is missing in your field of vision. It may not seem like much, but that peripheral vision is important in daily life. Essentially you can't see much on that side of your body while looking straight ahead. On my first day food shopping, I walked into a shopping cart moving up on my right, for example. The second eye also admits a lot of light. While I could see things in focus with my good eye, I had to "work harder" at it, often wishing for a brighter image.
With only one eye, you lose depth perception. Close one eye and try to touch your finger tips together, for example. I poured a few drinks on the counter, missing the glass, before I adapted. I slowed down my reach-and-grabs to make sure my hand was placed properly when picking something up. You adapt.
Then there is driving. There are two basic problems. First is loss of vision on one side and to some extent, loss of depth perception (which doesn't matter much after a certain number of feet). This led, I rapidly discovered, to great discomfort in parking lots, especially covered parking lots. Anytime I used a parking lot, I tried to pull in to a spot such that I could head straight out when I left, avoiding backing up (too much head turning to try to see everything). The second problem is reflections of light off the liquid surface, and before that, the dispersion of lights (particularly at night) through the gas, where a simple brake light becomes a huge red exploding star! That's why I drove only with a patch the first month, and almost never at night.
I was seen again six weeks after my surgery. While the doctor was very pleased with the healing, I was concerned about the fact that my iris was not reactive; that is, my eye does not react to light, closing down the iris -- it stays fairly wide open. As the amount of gas in my eye decreased and the amount of vision increased, the excess light became quite annoying, even with sun glasses. In mid-February, when the gas bubble finally disappeared, this problem remained unresolved.
To jump to the bottom line, my doctor said in consultation with other doctors that this complication is a "one patient in a lifetime" situation. Neither he nor my regular ophthalmologist can explain why it occurred, nor predict if it will ever go away on its own. A neuro-ophthalmologist declined to see me, feeling there was nothing she could do. I treat this condition with Pilocarpine Hydrochloride eye drops, available generically, one drop per day, and my iris contracts to about 1mm (from its normal 6mm) for 12 hours, while my left eye ranges from about 2mm to 5mm.
Vision is OK, except for peripheral vision in the lower part of the right eye, due to the laser repair to the retina. There is a sensation of gray fluff down there -- hard to explain. Most of the time I don't think about it. A regular eye exam shows my glasses prescription to be approximately the same as it was before, and I'm still using the old glasses.
Interestingly, several people have contacted me to say that they, too, have experienced problems with their irises/pupils after surgery. Additionally, one person said their eye refilled with fluid after only two weeks, but vision was quite blurred at that time. Another said they had to have the surgery redone, this time with oil in the injected fluid, requiring a separate surgery to remove the oil.
As for my own vision, I have stopped taking the Pilocarpine, because the glare has lessened. The iris has decided to stop down instead of open up. I generally find I need to use reading glasses first thing in the day because vision in my right eye needs correction. This improves as the day wears on. It does seem to me as though I'm not getting as much light into my right eye, though, and night vision in that eye is definitely not as good as the left. I've never gotten used to the impaired peripheral vision -- I am aware of it daily, though it is not overly distracting.
I awoke one day to find a new floater in my LEFT eye (the "good" one). It looked like an eyelash bent into a crooked reverse "C". I knew this couldn't be good, so I got an appointment with Dr Denny right away. He diagnosed PVD once again, this time in my left eye. He said that since I had a problem in my right eye, this indicated a perhaps hereditary vitreous weakness. He did about 100 laser "zaps" and sent me on my way with a follow-up appointment a week later, as I was now under watch status. (The laser zapping is mildly painful at times, but primarily just really annoying, looking at that very bright light.)
Three days later 15 minutes into a drive to the NC coast, as I came around a corner on a freeway entrance ramp, a lot of blue sky in front of me suddenly revealed hundreds of translucent floaters -- blood droplets from a new tear in the vitreous. I pulled off at the next exit and called Dr Denny's office. He had left for the day, but his associate, Dr Mudvari, would see me. Dr Mudvari was very thorough, and I spent about an hour in the chair getting about 200 more laser zaps AND a cryogenic treatment. For the laser treatment, he injected an anesthetic into the eye first (I didn't feel it), since he said it was in a more sensitive area than before. For the cryogenic treatment, he held a small wand with a ball at the end against my eye at various places around the back of my eyeball (he had an instrument to get in there from the side). He would push a trigger and I could hear the machine wind up and force some extremely cold liquid through the wand, and I could feel the cold -- a bit unpleasant, but tolerable. He sent me on my way with minimal restrictions, the biggest problem being that the dilation of the eye took about eight hours to retract, and I had to drive that evening to continue my trip. My wife wasn't happy, but I made it OK! My eye socket was sore though, and the lens was scratchy.
Four days later I had my prescheduled follow-up with Dr Denny, and he said things looked good -- no more zapping for the moment anyway. (I had my daughter drive me -- this driving with a dilated eye is not recommended!) I still had that original floater and maybe some other out of focus ones; the hundreds of translucent blood drops have not been bothersome and seem to be dissipating slowly; and residual pain from the prodding and poking by Dr Mudvari slowly gone down.
On a subsequent visit to Dr Denny, he said I needed another cryo treatment; but after that, he said things looked very good, and he did not anticipate further problems. The original out-of-focus floater is annoying as it moves in and out of view, and I occasionally get other black ones, so I just have to live with this.
And that's where we stand as I write this. I will update this information if something further develops. The doctors are optimistic. It is also good to know that all the doctors in Dr Denny's office now use the same procedure.