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

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.

Photo credit: Ashkan Forouzani

First, I have to take a moment to say -Thank you to all of the healthcare professionals for their service during this time. You have sacrificed and given so much of yourselves as you stay true to your commitment to healing patients and saving lives. I've had my ups and downs with medical professionals over the years but I have to give credit where credit is due.
Thank You, Thank You, Thank You! ♥
 

Concerning doctor appointments, I expected things would be very different with doctor-patient interaction during this whole Covid-19 situation. I had a lot of questions such as:

• Would doctor/patient relationships change?
• Will exams would be rushed?
• Would patient questions/concerns still be met? 
• How social distancing would work? 
• Would I be examined from inside a plexiglass box? (kidding)

The Cornea Clinic

Last month (June 9th 2020) I saw the Cornea specialist. This appointment had been scheduled a year earlier, due to the pandemic I thought it was going to be cancelled but the clinic started seeing patients again in June. This appointment was my one year follow-up exam since cataract surgery.

Honestly I have to say that I didn't notice that much of a change in the service I received. There were of course changes due to safety such as everyone having to wear a mask and the waiting time. My appointment was at 9:00 a.m. so the process started at exactly 9:00 a.m. as I did not have to wait in the waiting area. In fact there really weren't but a couple of patients in the waiting area. 

The only other change I noticed in the exam room was that the slit lamp had a plexiglass shield, which was expected. The technician, the doctor's assistant and the doctor were all still very courteous and I didn't feel like the examination was rushed. 

The doctor's exam didn't seem faster than usual, but all he needed to do was check my cornea which never takes long at all. He told me that my eye had improved greatly and then the exam was over. My time at Cornea clinic is usually about an hour, but at this visit it was about 40 minutes.

The Retina Clinic

Earlier this week (July 8th 2020) I saw my ophthalmologist. I originally had an appointment with the retina clinic in March but due to the pandemic it was cancelled, so before my June appointment I hadn't seen an eye doctor since October 2019. 

It had been a total of 9 months since seeing a retina doctor which is a long time for me because my appointments with the retina clinic are usually every 4 to 6 months.

In the retina clinic there were absolutely no patients in the waiting room and I was taken to an exam room as soon as I arrived. The ophthalmic technician took her time with her part of the exam then I was sent to photos/scan. The technician was pretty decent and they really can't rush their job anyway. Later I saw the ophthalmologist who's always courteous as well as thorough. 

I did notice a difference in this visit. My visits to the retina clinic usually takes about 1.5 hours to 2 hours according what needs to be done, including waiting time. This time the entire process took an hour.

For both appointments I didn't have a feeling of being rushed, and a shorter process was expected, but during one of the appointments I didn't address any of my concerns about my vision due to not wanting to take up any extra time even after the doctor asked if I had any questions. It just didn't seem like the right time to bring up a concern that might require a lot of time to discuss. It wasn't a question that needed immediate attention though I've been trying to get better at addressing my concerns with my doctors especially since I always encourage family, friends and clients to ask their doctors questions. But I'll be better prepared next time.

All together I was satisfied with the service I received and glad I was to finally see my doctors again. I hope other doctors visits, the dentist for example, go as smoothly.

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.

Two years ago, on the day before I had surgery for retinal detachment, my doctor informed me that I would develop a cataract in my left eye due to one of the procedures of the surgery which was the  vitrectomy (the removal of the vitreous from the eye). Cataracts form quicker when the vitreous is removed from the eye, this is because oxygen reaches the lens faster.

I admit I wasn't clear on exactly what a cataract was. For years not only did I think a cataract was a growth over the eye but I also thought it was something that only happened to people over the age of 60 years old. I later learned that a cataract is not a growth but clouding n the lens of the eye that can happen to anyone, at any age for a number of reasons.
I did hope that I wouldn't develop a cataract because I didn't want to deal with another vision issue but of course within in nine months after the surgery it did happen just as the doctor had said.

The Experience

I started to notice that the vision in my left eye was becoming slightly foggy. It was as if I was looking through dirty eyeglasses. At the early stage I thought that my glasses were smudged so I would constantly wipe them off in frustration but then I realized what was happening. 

He did explain that once the cataract started to interfere with my vision, if I chose to have surgery, that the clouded lens would be surgically removed and replaced with an artificial lens (intraocular lens implant or IOL). He said the surgery would take place in an operating room and that it would only be 10 to 15 minutes long if there were no complications. He also told me that the new lens would give me better vision and that he would try to get the left eye close to the vision in my right eye because of the 8 diopter difference between the two (if that makes sense). 

I asked the doctor how fast do cataracts progress and he said it's according to the situation. I read about cataract progression and found that for age related cataracts it usually takes a number of years for vision to become completely impaired but for me the cataract seemed to progress rapidly over a number of months.

As the cataract progressed my vision became more blurry though most of my vision came from my right eye. I explained in an earlier blog that since the vision in my left eye was distorted that most of my vision comes from my right eye due to my brain ignoring the distortion. For a while the same was true with the cataract until my eye became so foggy that I could no longer ignore it. 

Things like reading became difficult as I tried my best not to strain my eyes through the haze. There was a lot of burning, itching and tears as well. By the end of the year (November 2018) my retinal ophthalmologist suggested that I go back to the cornea specialist because the cataract was really seemed to be affecting my vision.

I saw the cornea specialist again and he agreed that my vision was getting worse. He said that he would schedule my surgery when I was ready. The idea of another surgery worried me because I feared re-detachment which I read could happen during cataract surgery and even though I knew I would eventually have to have surgery I just wasn't ready.

In about a month after seeing the cornea specialist the vision in my left eye went from blurry to white. I could barely see anything even when using both eyes so I called the clinic and scheduled my appointment for the surgery and prayed that everything would go well.
 

I did my usual research of what I would experience during the surgery and felt a little better about it because it didn't seem too bad, but it was still surgery. I even watched a cataract surgery video on YouTube and saw that the surgery didn't look as scary as other eye surgeries.

After Surgery Update

In April of 2019 I had cataract surgery. Everything went very well and my vision is actually much clearer than it was before, though I have the distortion due to the scar on my retina from detachment two years ago.