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." 

Cataract Update

I mentioned earlier this month that I received a new prescription for my eyeglasses and the prescription had changed. The new prescription is higher than the one I received last year so I asked the ophthalmologist (cornea specialist) why it changed and he said it was because it took time for my vision to settle after cataract surgery though I found it odd that my vision was at -15 three months after surgery then -18 a year later.

I recalled what a Resident doctor told me during my last visit, that a growth, referred to as a "secondary membrane," had formed over the implanted lens so I contacted the clinic and asked if that was the reason my vision had changed. I was told it was unlikely the cause but asked if I was having issues with the new prescription. At that time I hadn't received the new eyeglasses but when I did receive them, something didn't seem quite right with the left lens. I believed that the prescription was too high which I reported to the ophthalmologist and offered to give me another eye exam. During the next exam the results were pretty much the same.

Image credit: by 74images

YAG Laser

During the same visit, the ophthalmologist and I discussed me having posterior capsulotomy treatment (YAG laser surgery) to remove the membrane behind the intraocular lens and thought maybe it would help but not by very much. I asked what needed to be done and if there were any risks. He explained the procedure and told me it would take place in the clinic and that I could receive the treatment that day then return in a couple of weeks for another refraction.

I agreed to the procedure, my eyes were dilated and I sat in front of the machine while the doctor zapped a red light (laser) into my eye. The procedure took no more than 10 minutes. Afterward I had to stay in the clinic for about 30 minutes to ensure that I didn't have any side effects such as raised eye pressure or inflammation. I didn't experience any issues but I did end up having a headache and a lot of stringy floaters.

I returned to the clinic two weeks later for another refraction and the results were pretty much the same. It was really disappointing as well as frustrating because I can't see clearly out of my glasses. I don't understand it. The ophthalmologist suggested that I consider gas permeable contact lenses because they might give me better vision than eyeglasses. So, I guess I'll get new contacts in hopes they will help improve my vision.

Update:

I guess my vision is still changing because I am able to see a little better with the new glasses or maybe my eye have adjusted. And as before most of my vision comes from my right eye. It could

Photo by Mika Baumeister

The only thing I can say right now - which is pretty much what everyone else has already said -Things are looking very uncertain at the moment. Like many people I wonder when life will get back to normal but from where I'm sitting it doesn't look like it will be any time soon as children continue their education from home through virtual learning and many work remotely or not at all due to the pandemic.

Personally, I've been working from home while trying to keep myself, as well as my family, entertained and sane. Like everyone else I'm adjusting to the fact that this is now our "normal." We are living a "new normal" and the only thing we can do is the best we can to endure these changes; the lock down, the social distancing when we're out, the mask wearing - all these things, though frustrating, to keep ourselves and others around us safe.

An additional thing I have to do is keep my vision safe. Actually everyone should be doing that. Since I've been at home so much, I've been spending a lot of time on my phone and computer. My usage of both has increased due to work as well as boredom. I haven't had any issues with my vision, which is great, and I certainly don't want to create any issues, but I am concerned about vision issues that have no warning signs because who knows when I'll be able to see an eye doctor again.
 

I also wonder what the plan is for patient care going forward from all of this. Out of curiosity and partial boredom I've been watching live streams where doctors discussed future possibilities of patient care. I've heard talks about tele-medicine, virtual clinics using Artificial Intelligence (AI), and even the possible use of plexiglass cases to examine patients, but what I haven't heard in those particular meeting are questions/concerns from patients. I understand that doctors are the professionals as well as the ones providing the service, BUT patient concerns, especially during this time, are also very important and should be apart of the discussion concerning patient care. But that's just my opinion.

I know that at this point no one has any solid answers as to what things will look like in the coming months but I do hope in this new normal, as life resets, businesses plan to re-open, and the plexiglass goes up, that we keep in mind the total needs of those we serve.

Recovery

When I left the hospital the vision in my left eye was crystal clear as everything appeared to be so much brighter than before, even brighter than the vision in my right eye. I really didn't have much pain other than light sensitivity and slight itching. In fact my eye wasn't even red and there was no detectable scar. When I returned to the clinic the next morning to see the cornea specialist he said that my eye looked really good, so good that it was hard to tell that I had even had surgery because there was barely any swelling.

Healing went very well and quickly. The only issue I experienced was seeing a shower of tiny black floaters in my eye a few days after surgery. I had an upcoming appointment for later that week but I didn't want to risk waiting if it was something serious so I went to the emergency room. 

The Residents in the E.R. examined my eye also thought there might have been a tear in my retina because of the floaters and possibly because of some other abnormalities within my eye. When the E.R. ophthalmologist arrived and examined my eye he informed me that there was no tear. He said the floaters I was seeing had probably already been there before the cataract surgery and that they were more noticeable because I could see out of my eye again.

I was happy to hear there was no tear but I know I hadn't seen those type of floaters before. Not even after my first eye surgery or even before the cataract developed, but two weeks after my visit to the E.R. the shower of floaters went away completely.

When I stopped taking the the prednisolone acetate drops there were no side effects, such as the ones I experienced last time -  the pain, swelling and redness. This was probably due to continued use of the ketorolac drops which are used to reduce eye irritation after surgery but whatever the reason I'm glad there was no withdrawal.

It has been almost six months since cataract surgery and my vision has been very stable with no issues at all.

As part of my final project for a university biology course last year, I delivered a school-wide presentation on the topic of vision health. I thought vision health would make a good topic because of what I've learned and experienced concerning my own vision. This project revealed a widespread lack of knowledge about vision health.

For example:

• When explaining astigmatism, a woman shared with me that she hadn't known what it meant to have an astigmatism though she had been diagnosed with it for years.

• A few students who wore eyeglasses due to being nearsighted didn't know what flashes were; neither did they know that having high myopia increases the risk of glaucoma, retinal detachment and other retinal disorders.

• A classmate, diagnosed with diabetes, who didn't wear glasses or contact lenses but often stated that she was "blind" (meaning she had a difficult time seeing clearly), didn't consider that her vision issues might be related to being diabetic.

• Many students heard of glaucoma but don't know what glaucoma is, what causes it and who's at risk.

• And many of the students admitted to experiencing some sort of vision issue but hadn't seen an eye doctor about those issues.

For my project I featured information about various vision issues such as refractive errors, glaucoma, and disorders of the retina. After talking to many of the students I found that a number of them didn't know much about their own vision issues and diagnoses.

Hearing these things didn't surprise me too much because about a year prior I didn't know any of these things either. I didn't even know the severity of my own vision issues, but what did surprise me was learning during my research for this project was that there are millions of people in the United States living with uncorrected vision issues because either they don't take their vision health seriously or because they don't know the importance of vision health.  

A big part of the lack of knowledge could be due to a lack of education and understanding that vision health should be a high priority just like any other health concern; that it's important to everyone whether a person has a visual disorder or not. 

I tell family, co-workers, clients, everyone - especially anyone who complains of vision issues or pain to get an eye exam and to get them annually because there are potentially blinding visual disorders that don't have warning signs, glaucoma being one of them.

During eye exams it's very important to ask questions and state your concerns to doctors for the sake of understanding. Ask questions such as - What vision issues am I at risk of? What does it mean? How will it affect me? And what do I do now?

Doctors can help as well by making sure patients understand their vision issues by asking questions to find out what patients know about their vision health instead of assuming that their patients already know. Even if a patient has lived with a visual disorder or impairment for years, it doesn't mean they have all of the facts. 

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.

Photo by irynamelnykphotos

Post-Surgery Recovery and Sugar Intake

During my recovery from retinal surgery I had been experiencing issues with inflammation in my left eye which was very frustrating because no one could tell me why it was happening. One crucial thing that I found out about post-surgery recovery and care is that a person’s diet plays a huge role in how fast or slow recovery will be and that the re-occuring inflammation I was experiencing could have been due to my sugar intake.

I read that during the recovery phase after retinal re-attachment surgery, managing sugar intake is essential for promoting healing and preventing complications after surgery. Though I don’t believe I eat excessive amounts of sugar, I will admit that I do tend to turn to chocolate for comfort when I am experiencing anxiety or depression and during this entire process I have been experiencing a lot of depression.

Managing Sugar Intake

According to Healthline.com, Medical News Today and Retinarecovery.ca, processed sugar should be avoided after any eye surgery. High sugar consumption can weaken the immune system, making patients more vulnerable to infection, which can hinder the recovery process and lead to inflammation. It's suggested that opting for a well-balanced diet that includes whole foods, lean proteins, and fiber, while limiting the consumption of processed and sugary foods, can significantly support the healing process and overall eye health before and after surgery. Choosing natural sugar options, such as fruits, and avoiding high-sugar, processed foods is highly recommended.

Excessive sugar consumption has also been associated with other eye conditions such as diabetic retinopathy, macular degeneration, glaucoma, and cataracts. High sugar intake can also lead to elevated blood glucose levels, which, in turn, can contribute to the development and progression of these eye diseases. For patients undergoing retinal re-attachment surgery, controlling sugar intake is particularly important, because it can influence the overall success of the procedure and recovery.

According to Pristycare.com following a healthy diet that includes leafy green vegetables, fish, citrus fruits, carrot, berries, nuts and seeds can help improve eye health after retinal detachment treatment.

Outcome

After learning that my diet may have been affecting the healing process, I have made a conscious effort to slow down on the chocolate candy bars and find other ways to handle my stress cravings through this journey of healing. Diet plays a huge role in after-surgery recovery but it's extremely important to follow your doctor's recommendations for post-surgical care. Getting regular checkups, keeping up with prescribed medication, and avoiding activities that puts strain on your eyes are essential for successful retinal re-attachment recovery.

(Updated January 2024)

About two months after surgery during an appointment with the ophthalmologist, he informed me that all restrictions were lifted and that I could finally get back to my normal routine. As he put it "I'm finally letting you out of jail." He told me that I was able to go see my optometrist for contact lenses and that I was good to go back to work.

By this time my left eye was still very red though it didn't bother me too much, but it did seem to concern the optometrist I'd gone to see in May for a new prescription and contact lenses. She along with two other doctors, (since she wasn't familiar with scleral buckle patients she called in an ophthalmologist to look at my eye, then that ophthalmologist called in a Uveitis specialist) suggested that I see my ophthalmologist again to make sure everything was fine before moving forward with contacts. The uveitis specialist explained that she was concerned about my eye still being red and inflamed because it had been almost three months since surgery.

I went back to see my doctor in the middle of June which was the earliest appointment I could get and he too confirmed that I still had a bit of inflammation. He said that I could still move forward with contact lenses but to be on the safe side, I should wait and return to see him again in a couple of weeks.

Two weeks later, (July 5th) the doctor said that everything looked good, and that there was no more inflammation even though my eye was still red. He said unless I was experiencing pain I didn't need to return to the clinic to see him for a couple of months, but if I started having pain to go to the uveitis doctor.

I have to admit that I was starting to become really frustrated. The redness in my eye didn't bother me that much but I did find it annoying to have to go back and forth to the clinic and not get any answers as to why my eye was still red. At this point I decided to search the medical message-boards for some answers.

It turns out that the redness I was experiencing was due to the buckle causing eye irritation. 
 
The "scleral buckle " which is a silicone band that is surgically placed around the eye to repair detachment by pushing the sclera (outer white part of the eye) toward the retinal tear. It also helps to prevent re-detachment.

I read that it can take up to a year for scleral buckle patients to fully heal. Besides redness or "blood shot" eyes, there are other side effects that patients mentioned experiencing such as:

• gray/blue spots in the eye
• misshapen eye
• a noticeable lump in the eye due to the buckle
• the buckle clicking
• double vision
• pain and stiffness when looking too far to the right or left

Example of a scleral buckle wrapped around the eye