PVD... Again

On Sunday I started having streak-like flashes at the top of my vision and in the right-corner of my eye. By Monday I had a string-like floater and specks floating in my eye so I called the clinic and made an appointment to see an ophthalmologist. I knew my usual doctor wouldn't be in the clinic until Wednesday but I didn't want to wait. 

My eyes were first examined by a resident doctor who checked my retina for holes. She told me that my retina looked fine but that I was experiencing PVD and went on to explain what it was. I'm already familiar with PVD but I didn't interrupt. She also said it was unlikely my retina would tear. I guess she said that to make me feel better but having experienced this years ago, I didn't feel better. 

After the resident doctor, one of the clinic's ophthalmologists also examined my eyes and also explained what was happening with my eye but while she examined my eye with the slit lamp she noticed a tug at the center of my retina. Finally! The phantom flash made its appearance during an eye exam. 

She told me that my retina may or may not tear but if I experienced symptoms of detachment to come back to the clinic. She also said I was experiencing PVD due to my age which may have been true but because I've been experiencing these issues for almost two decades I disagree with her but I didn't say anything. I don't usually debate with doctors unless I feel they're insisting on a procedure I don't want. I knew she wasn't familiar with my vision history but clearly she could see that I have very high myopia which is the reason for the PVD. 

After the eye exam she told me to return in a month to see my usual doctor. When I got home from the exam I noticed a Weiss ring floating in the corner of my eye. It's kind of scary how quickly things progressed in just a few days.  

"It's like having a tangle of hair constantly floating inside my eye but I can't remove it." 

It has been over 18 months since my last eye surgery and in that time there had been no vision issues. But in November of 2020, just before Thanksgiving, I started experiencing new flashes but in my right eye. They aren't the type of flashes I used to get in my left eye which looked like streaks of light or lightning flashes that would appear at the top of my vision. The flashes in my right eye are a bit difficult to explain, but they remind me of the lens flare effect or  flashbulb effect you would see in photographs (example of lens flare in the photo below). They appear at the center of my vision and they have a blueish hue. They appear suddenly then quickly dissolve from the center outward. 

Photo by Tygarfield

When I experienced the first flash I thought it happened because I sat up too quickly after bending down so I didn't worry about it. I didn't expect to see it again but it happened again, several more times. They started to appear more frequently and by the end of December they were occurring almost every day for at least 6 times a day.  Then I started to worry, because I thought about retinal detachment and wondered if the flashes were occurring in my macula which is the central part of my vision. I've also read in the past that macular degeneration can occur in some cases of pathological myopia.

In January (2021) I saw my ophthalmologist and explained as best as I could what was happening. He asked me how often I saw the flashes and how long they lasted. I told him about how they would appear frequently on some days but not everyday and how they lasted for about a second. He examined my eyes but he didn't find any signs of possible detachment which was good. I scheduled an appointment to return to the clinic in April and during this appointment he still didn't see anything wrong which was again a good thing, but there was still no answer as to why I was experiencing these flashes or sparks in my right eye. He said there was no sign of tugging, but he wanted me to return to the clinic in three months since this was an ongoing  issue. I was scheduled to return to the clinic the first week of July but since there was nothing new happening with my eyes at that time I decided to reschedule the appointment for August but in June I did see the cornea specialist. 

My appointment with the cornea specialist was a follow-up exam for my left eye which received the IOL (intraocular lens due to cataract surgery) in 2019. I spoke to the cornea specialist about the flashes in my right eye and he said that what I was describing sounded like migraine flashes (which I've heard before the last time this happened) and upon examining my eye he said that everything looked normal to him. At this appointment I also received a new prescription for glasses which revealed that my prescription had changed again, but not for the better, which is something I'm really concerned about.

It's funny how I see these flashes so often but each time I go to the eye doctor nothing happens. I wonder if the doctor thinks it's all in my head. Phantom flashes.

Over time I've received many questions and comments about my glasses and vision issues. I've been asked things such as:

"Why don't you get thinner lenses for your glasses?" 

"Why don't you get laser (LASIK) surgery ?"

"Why don't you just wear contact lenses?"

"Why don't you try healing your myopia?" 

I know some people don't understand why anyone would go through the stress of being highly myopic and wearing chunky glasses when there are so many options out there that can fix the problem but it's not always as simple as some may think. 

Why Don't You Get Thinner Lenses?  

This question is kind of funny because the first time I was asked the question I was actually wearing glasses with high-index lenses that were about 20% thinner. I guess some people, especially those who don't wear glasses, don't understand how high-index lenses work for higher prescriptions. 

I've worn high-index glasses for many years though the lenses in my glasses are still noticeably thick even at 30% thinner. My glasses are much lighter than regular plastic lenses but because my prescription is so high, my glasses can only be thinned to a certain point. Another thing to understand about high-index lenses for higher prescriptions is that the thinnest part of the lens is the center while the sides of the lens will still have some thickness.

Why Don't You Get LASIK Surgery?

Lasik is not an option for me. LASIK surgery is a procedure where the cornea is reshaped to correct the refractive error. In cases of myopia this procedure works best for people with simple myopia or those who have a stable prescription. Lens replacement surgery would be a better option for a person with high myopia but I've been told that in my case it's not recommended due to the serious risk of retinal detachment.

Why Don't You Just Wear Contact Lenses? 

This is the question I receive the most along with the comment, "With vision like yours, you should really be in contact lenses." 

I think that people who say this are just trying to be helpful as they assume that contacts lenses are the solution to my glasses but again, it's not that simple and to be honest, though it might be surprising... I'm not a big fan of contact lenses.

I wear them sometimes but they are not a huge priority for me. I know that's weird when there are people with simple myopia who NEVER leave the house without their contact lenses but when it comes to wearing contact lenses I have some comfort issues. I have yet to find contacts that I can wear longer than a few hours before my eyes start to become irritated. I guess this is due to having issues with dry eyes and allergies in which eye drops and re-wetting drops don't seem to help. 

Another issue is I find contact lenses to be too much of a hassle with the cleaning and disinfecting, along with the time it takes to put them in. Some days it's easy and some days it's not. Overall I simply prefer my glasses over contact lenses because I can get up, put them on and just go. But it has been suggested by a couple of eye doctors that I wear contact lenses for better vision.

Why Don't You Try Healing Your Myopia?

There's a lot of information on the internet and in books about healing
myopia by using exercises but it's important to understand that there's a
big difference between simple myopia and pathological myopia that many
people don't realize. They are very different, so currently, there is no
cure for pathological myopia. The only option available as I mentioned above is lens
replacement surgery. Issues such as elongated eyes and degenerative changes to the eye that can develop due to pathological myopia can not
be reversed. 

I would love a cure or quick fix for my vision issues but I have to work with the options I have and the most convenient option for me lately is wearing my glasses which include high index lenses with expensive really nice frames.

photo credit - Marta Branco

I was recently reminded by my mother about my vision issues as a child, one issue in particular I had was crossed eyes. I had somehow forgotten about this though my ophthalmologist asked me if I'd ever had crossed eyes as a child and I'd told him I hadn't. But yes, I did and when my mother reminded me it all came back - the patch I had to wear over my right eye in order to strengthen the left one and how I would struggle with her every time she tried to put it on my face because I absolutely hated wearing it.
 

I also remembered that just before starting kindergarten I received my first pair of eyeglasses. Even back then my glasses prescription were heavy (thick lenses) which looked very awkward on a four year-old or anyone to be honest. It seemed that I couldn't go a day without someone pointing, staring, or asking questions about my glasses. One question I was asked most often  was, “Are you blind?"

No one understood my vision issues then and for years I didn't understand it either. The only thing I knew, because I constantly heard it from my mother and the eye doctors, was I had poor vision. I was very nearsighted or highly myopic and needed to wear corrective lenses in order to see clearly. One thing I often wondered though was why my vision was so much worse than everyone else I knew who wore glasses, even those with high myopia.

As an adult, still trying to understand my vision issues I started searching for information about high myopia but I couldn't seem to find answers but to be honest I wasn't sure what I was searching for other than "high myopia" and "thick glasses."

There were a few articles available and blogs where myopia patients discussed how horrible it was for them to have high myopia at -6.0 diopters which made me wonder what they would think of having double or even triple that number. 

 Then the moment came when I finally got some answers. It was during my first visit to see the ophthalmologist due to detachment. After the examination was done my doctor said that there was a lot of pathology around my eyes. I didn't know what he meant at the time so I made a mental note to look it up. I could have just asked him what he meant but at the time I was more focused on details about the surgery. Later that evening I searched the medical term "pathology," along with word "myopia" and found "Pathological Myopia."

Pathological myopia is an extremely high amount of nearsightedness that causes a major alteration of the shape or globe of the eye, which may lead to profound vision loss. In the United States, it occurs in about 2% of the population and is the seventh leading cause of legal blindness. Thirty percent of all cases of pathological myopia occur at birth.  Sixty percent of patients are diagnosed with the condition between the ages 6 and 13, and it continues to progress throughout life.  Eye Associates  

I'd finally found the answer I'd been searching for - Pathological myopia (also known as Degenerative myopia) was the reason my issues with myopia was so different from others. I had never heard of Pathological myopia until earlier this year. In searches I'd done in the past I found a lot information about Retinal Detachment and Age-Related Macular Degeneration (AMD) but nothing about pathological myopia which seems strange since pathological myopia is associated with those other disorders. 

None of the optometrists I'd seen in the past had ever mentioned pathological myopia to me. I don't know if it was because they all assumed that I already knew so they didn't bring it up or if it was because they didn't know about pathological myopia either, but whatever the case I'd been pretty much left in the dark, figuratively.
 

About a month ago during an appointment with my ophthalmologist I asked him if pathological myopia was something I was born with, which is another question I've always had. I've read many articles that say myopia is a condition possibly caused by too much close-up work, not enough sunlight, and reading in poor lighting but the doctor explained that my vision issues had nothing to do with too much close-up work, sunlight, etc., he said that in my case I most likely inherited it.

Finding out that my vision issues are more severe than I realized is scary because pathological myopia is a potentially blinding disorder, which I experienced with detachment but I am glad to finally know what it is I'm dealing with so I can learn more about it as well as what to expect and what I can do to save my vision.

Photo by Mufid Majnu

At about 8 months post surgery I returned to the retina clinic for scans, photos and an appointment with the ophthalmologist. My eye doctor informed me that my recent scans looked good compared to what they looked like before. I assumed he meant that they looked better compared to what they looked like when I first came to the retina clinic back in February. 

I looked over at my scans on the computer screen and I saw what appeared to be very visible blood vessels which, in my unprofessional opinion, looked abnormal, even for my already abnormal eyes. Just before I could ask about the scans my doctor told me that I have choroidal neovascularization (CNV) which are abnormal blood vessels that are growing behind the retina of my left eye. 

We discussed the distortion in my vision which had increased. The distortion and CNV was a concern for him because the newly formed blood vessels could cause serious issues such as re-detachment but he assured me that my retina was still good and attached so I shouldn't worry.

He also mentioned injections, anti-vascular endothelial growth factor (anti-VEGF) therapy and wondered if I would benefit from them. At the mention of the word "injections," as in sticking a very sharp needle into my eye while I'm fully conscious, made me feel very sick. I don't know what the expression on my face was but he laughed and said that I shouldn't worry because there was a possibility that the blood vessels would die off.
 

In the mean time I did my research on Choroidal Neovascularization:

CNV is the development of abnormal blood vessels in the choroid layer of the eye. The choroid is the layer beneath the retina. One of the dangers of CNV is that the blood vessels can break and leak blood into the retina causing vision loss. A chemical in the body known as vascular endothelial growth factor (VEGF), causes the creation of the abnormal blood vessels. Anti-VEGF injections are used to stop the formation of the blood vessels by blocking the chemical. This treatment can go on for over a course of months.

From wikipedia -"CNV has also been associated with extreme myopia or malignant myopic degeneration, where in choroidal neovascularization occurs primarily in the presence of cracks within the retinal (specifically) macular tissue known as lacquer cracks"

Update: March 2018
During a drop-in appointment with one of the Fellows at the retina clinic I was informed that the blood vessels had indeed died away.

Four months ago, as I lay face down for those two and a half weeks of healing with a gas bubble in my eye, many of the past issues surrounding my vision problems started to come back to haunt me:

•   The stares, rude questions and comments
•   Constantly being called blind
•   Not being able to fit in
•   My disgust with my abnormal vision 
•   Mentally fighting myself to exist
  

Then I thought, and as if I hadn't dealt with enough - my retina detaches. 

I wondered, as I often do; has anyone else has gone through these issues because of their eyesight? Has anyone else ever felt as if they had to struggle mentally?

As a child I didn't know that I had high myopia. All I knew was that I needed glasses to help me see clearly. I understood that I had vision issues and that some people with vision issues wore glasses but I didn't think there was anything different about me.

Back then having to wear glasses was considered a bad thing so some kids who wore glasses would hide them or break them on purpose so they wouldn't have to endure being called "four-eyes" by other children. For me it was a lot more than just being called "four-eyes" because I had to wear glasses with a heavy prescription which were referred to as "coke bottle" glasses (eye glasses with thicker lenses that resemble the bottom of a coke bottle) which were just plain horrible. 

I was called names like four-eyes, grandma, blind girl, tri-focals, and a few other unkind things that I won't mention here.

I often felt like I was being punished for having poor eyesight. I often say that my vision issues are kind of like the middle child of vision issues because I was too "blind" to fit in with the "normally sighted," and with those who wore glasses but at the same time not "blind" enough for anyone to care about my struggle with my eyesight. I just could never ever show signs of not being able see well. It was assumed I couldn't see due to my glasses which wasn't always true but I could never admit it even in the slightest way.

At times I felt like I was broken and discarded. I was disliked, ostracized, and criticized, as well bullied and often physically threatened by my peers just because I had vision issues. It was really insane.

The stress of going through these things often weighed heavily on me mentally as well as emotionally from childhood to adulthood - the constant negativity that surrounded my vision issues seemed to affect me in every part of my life. Even when I wasn't being bothered about my vision, in my mind, I believed that I was always being judged for it by everyone around me. 

I couldn't seem to escape the negativity or change the fact that I had these vision issues and so because I felt that I couldn't control any of these things I became very depressed.

After a number of years, thankfully I started to learn about what I could control - which are my feelings. I stopped worry about fitting in, or being normal, whatever normal is. I learned to accept my "difference."  I also learned to accept that to some people my difference would always be unacceptable which was not my fault or concern. I stopped worrying about what people might think about me and often reminded myself "what others think about me is none of my business."

As I lie face down staring into my pillow thinking about these things I didn't feel too broken, but just a bit cracked around the edges, as I must admit that this experience (retinal detachment) did set me back emotionally as I again wished that my vision was normal. I wished that I didn't have to go through theses things - the physical issues that I've experienced as well as the worry of what could happen with my eyes. 

But as usual I really try to continue to have a positive outlook on things and remind myself that its also okay not feel okay at times.

weiss ring photo credit-imagebank.asrs.org

When your vision is blurry it's not only confusing, it's also frustrating. Now imagine having another issue on top of that - PVD- Posterior Vitreous Detachment. One morning (June 2014) I sat down to watch television and noticed that something was different about my vision. I couldn't see the tv clearly, so I did what I usually do; I took off my glasses and wiped them off but I still couldn't see the screen clearly. 

To clarify, when I say things weren't clear I don't mean my vision was blurry or foggy. It was like I was looking at a picture but part of the picture was kind of shaded out. I blinked my eyes but nothing changed but I did realize that the issue was only in my left eye. Later that day I tried to read a book, and noticed that the letters on the page looked kind of distorted as I could only see parts of the letters, again due to my left eye.


At first I shrugged it off and thought it would clear up eventually because sometimes I do experience visual distortion. I thought maybe while I slept the night before that I'd put too much pressure on my eye as I do sometimes which causes a weirdness with my vision that usually clears up in a day or two, but as the days went by my vision didn't clear up.

Bright light hurt my eye and I could see a dark gray spot when I looked at things like white walls, white pages, and especially the sky. Since this issue was in my left eye which is my weakest, I started become very worried. 

I went from trying to be positive and hoping for the best, to having moments of fear that I was slowly going blind. I finally went to see an optometrist. He dilated my pupils and examined both my eyes and then told me that what I was seeing was a huge floater  due to Posterior Vitreous Detachment. 

The vitreous, which is a gel-like substance that helps the eye keep its round shape, was detaching from the retina which brought about a huge and dense floater in my eye. I'm use to having floaters in my left eye and they usually don't bother me but this type of floater, called as a Weiss ring, was right in the center of my vision which was why I was seeing gray.

I asked the optometrist if there was any way to remove it. He answered-Yes and No. He said the procedure that would remove it was too risky for me. He said that I could lose my vision because the lens of my eye would have to be removed, and a liquid would be pushed into my eye to wash out the floater, then an insertion of air pressure, and something about having to keep my head in a weird position for a number of weeks. I thought that maybe he was trying to scare me...he had that type of personality so I gave him a look as to ask if he was serious and he said "Yea...Live with it, right?"

He suggested that I wait it out because the floater might just go away on it's own but weeks later it was still there, not as dense but it still affected my vision. I eventually became use to it and since there was nothing I could do about it, I had to do just what the doctor said - live with it.

I've often complained about not having "normal" vision and having to wear  glasses with a heavy prescription, so this has taught me a lesson which id be grateful that I can see.

(from May 17, 2014)

I recently needed a new pair of glasses and an eye exam. I usually go to Pearle
Vision but they no longer accept my insurance and paying out of pocket at their eye center is expensive so my husband found a different eye care center that accepted our insurance
to get new glasses and an eye exam.

To start, buying glasses has always been a challenge and expensive for me. I've mentioned in a a few other posts that my glasses are expensive because I have high myopia which means really thick lenses so in order get my glasses to look as normal as possible  pay out of pocket for extras they aren't always covered by my insurance. Extras such as high index lenses, tint, roll and polish, anti-reflective coating, etc. The total cost for everything including the frames can be between $400-$500.

If I don't pay for the extras then I usually end up with a pair of glasses that I pretty much hate, for example like the pair I received recently. The only half way decent thing about these new glasses are the frames. They are Tiffany in Black (no not that Tiffany).

One issue I have is the color of the frame. I picked them in brown, not black which is what I received. When I called about this I was told that they no longer had brown in stock which is something they should have told me weeks ago before they cut the lens to fit the frames. I could have tried another frame in brown but okay.

The lenses are CR39 which I was told were a type of high index material, which is what I usually get but come to find out weeks later that CR39 is just basic plastic. Either the technician didn't know the difference between plastic and high index plastic or she just told me any thing to sell me on the glasses knowing I didn't know the difference. This is why it's important to be educated on these types of things but I knew when I looked at them they weren't right because, though I have a high prescription, my glasses aren't usually so bulky and the way they are cut is awful. I know my lenses are always going to be thick but the circles in the center... I can't even explain what this looks like.

older glasses-lighter in weight and better cut lenses

The new glasses have no reflective coating, no polish, nothing. I asked if I could just pay out of pocket for a tint, coating and re-cut for a smaller frame to get rid of that weirdness on the sides but the answer was no. "You have to start over" and I'd have to pay for it all out of pocket because for some reason this particular place doesn't allow insurance in combination with out of pocket payments.

I started looking for places that would at least polish and tint them but the answer was still no. I would have to purchase a whole new pair of glasses directly from their store. I did find out that Walmart's Vision Center tints eyeglasses for $10 so I took them there but the lightest tint they had was too dark. I had no choice, and I knew over time the tint would break down and become lighter.

While I was at Walmart Vision Center I priced a new pair of glasses at approx $300, $250 if I don't get the transition lenses. I think I would have been better off going to Walmart from the start and I am seriously considering starting over because I really don't like these glasses.
 

Everyone else says the glasses look good and I even get compliments on the frames but I just can't get over the way they are cut. My 10 year old has even given me some advice  -"Mom the glasses are fine, why are you worried? You tell us all the time not to focus on looks but what's inside..."
Aww he's so cute...but we're talking about me here{laughing}.

Update:
I ended up keeping them. I accidentally broke my old glasses which means I'm stuck with these because I can't really can't wait another two weeks for a new pair of glasses. I can't see a thing without them but my next pair of glasses will be either coming from Walmart Vision Center which I've read really good things about or I'll just go back to Pearle and pay completely out of pocket for them.