It was very scary at moments, but emails like this helped.


I'm really sorry you've had to go through this ordeal. I'm a retina specialist, so it happens that retinal detachment repair in myopes like you  is right up my alley. It's what I dedicate my professional life to, and repairing RD's is something, crazy as it sounds, that I love to do.

I have a good idea of what an ordeal this process must be for you, between the anxiety of worrying about your sight, to the ordeal of the surgical and post surgical experience, the positioning, the discomfort, uncertainty, and ultimately the need for further surgery, and doubt about your ultimate visually outcome. My heart is with you.

Without a full exam it's hard to give you a more accurate idea of what you might expect going forward, but I'll  write thoughtfully about what I can.

Underlying risks:

As a -6.5 nearsighted person, you are at risk for developing a retinal detachment (RD). The fall likely precipitated the RD, but unless there was some severe direct trauma to the affected eye, it may have been a trigger for something that you were otherwise at risk for developing spontaneously. Feel free to fill me in with more details about the impact.

The reason i mention this is because if you are my patient, I'm examining your fellow eye carefully, and making sure you are educated well about the signs and symptoms of retinal tears. These precede detachment in almost all cases, and in your case you'd  be best served by treating retinal tears with laser demarcation before they become detachments. The number one risk factor for retinal detachment in an eye is: " a history of retinal detachment in the fellow eye". So, don't worry, but be vigilant. FYI lifetime risk of fellow eye RD about 15%.

Retinal detachment and surgical repair:

The note your surgeon wrote suggested you had a subtotal retinal detachment. This generally means most of the retina was off. As long as this is repaired within 2 weeks of vision loss (when the vision got really really blurry from that shadow) there is a good chance of recovering reasonable vision after an uncomplicated surgery. You had a vitreous hemorrhage after your initial operation. Vitreous hemorrhage means : blood inside  the globe of the eye. This typically is a result of the drainage step of your scleral buckling, and frequently does not affect final visual results.

I was not sure if the inferior retinal detachment your surgeon noted approximately 10 days after your initial surgery involved the macula or not. If your macula was still attached at the time of your second surgery, your chances of good vision remain >90%. If the macula redetached, the odds may drop to 50%. Without having seen the eye myself, its hard to know from the note. Even examining the eye after surgery can leave unanswered questions. Looking through the gas in a postoperative eye can often be just as challenging as seeing out of the eye is for the patient.

Let's hope it was on and that you continue to do well. The 6/21 vision you registered at your last visit is a positive, especially since you are filled with silicone oil and almost certainly have some cataract, but I'd like to see improvement at your next visit unless the cataract is quite significant.

Usually I leave oil in for a few months (2-6) depending on patient needs. Your surgeon intially mentioned 3-5 months which would put you into late June or early July. If all is going well, don't feel rushed. It's important to monitor the eye periodically to make sure the eye pressure does not rise too high while it is filled with oil. Sometimes the oil emulsifies and causes congestion in the trabecular meshwork (i.e. the bathtub drain gets clogged) and the eye pressure goes way up. This can damage the optic nerve and result in irreversible vision loss, so make sure you stay on top of that while you have oil in. (4-6 weekly pressure checks- optometrists can do them if your surgeon isn't handy). But if the pressure is OK, and you are in no hurry to remove the oil, it can stay safely for 6 months or longer (I generally remove it as I said in 2-6- if the eye looks good I leave it up to the patient.).

If you have a cataract (highly likely) you can remove the cataract and put in an artficial lens at the same time as you remove the oil. A cataract is another word for "cloudy lens". Doing vitrectomies, especially when silicone oil is involved almost always causes the lens to become cloudy over time, so given your vitrectomy with oil, its a near inevitability - if not now within the next 24 months. Count on that.

There are different ways to do cataract surgery/oil out. It sounds like your surgeon is comfortable combining cataract surgery with oil removal. It's the way I do it sometimes too. IN other instances retinal surgeons will invite a cataract surgeon in to remove the lens and place the artificial lens, while the retina surgeon  manages the oil out. Ideally, I like to do it this way because my observation is that cataract surgeons who do nothing but cataract surgery do a better job than I (who mainly do retinal surgery and only occasionally do cataract surgery) do. Sometimes though, for adminsitrative or financial, medical , or even cultural reasons this approach is discouraged. Anyway, worth a mention.

Vision Prognosis:

The first 6 months after retinal detachment repair is the most important. Its when the risk of recurrent retinal detachment is highest. After six months the risk begins to drop and after a few years your 2 eyes become at similar risk (some would say that your fellow eye is more likely to detach after an RD repair that has been stable for 2 years. I've only seen a few late recurrent RD's in successfully repaired eyes that have remain attached after 2 years in 15 years of doing only retina work.


I'm sure for you the most important question is "what will my vision be like?"

The answer is, it really is hard to predict in your case. Your macula was off, and your required a second surgery. Both of these are real concerns. At this point though, you seem to be measuring pretty decently, especially considering you are still relatively early in the post surgical period, you have oil in the eye, and you are problably also looking through a cloudy lens. So I'm hopeful that you could do ok.

One important thing to remember: Most improvement occurs in the first 6 months, but improvement defintiely continues for the first 2 years after an RD repair. So there is for sure a lot of room for improvement for you.


Some Questions Answered

Me:
I slipped on some tile and fell strait back .. All 6.5 feet of me .. And hit the back of my head on hard marble .. Split my scalp and got stitched up.  But no direct eye impact . An hr after I got stitched up we decided to go see the sunset on the beach .. I brought my camera to shoot a friend .  While shooting .. Hundreds of dark black dots appeared and scattered the sky .. Was beautiful and scary!

Your fall account has me convinced- you tore your retina with a rapid deceleration! Holy smokes that was quite a fall. That happens to bungy jumpers too- when the line snaps taut and they suddenly decelerate.

Those were some major league floaters you experienced. they represented tiny droplets of blood within your eyeball which were released as your retina tore.  


Me:
My other eye has a -3.5  .. But only because I did an experimental PKR laser back in the 90s , it made my numbs lower .. But not better vision with correction . My vision is still around 20/40 with correction - both eyes.   

One thing to consider after PRK laser with imperfect vision..i.e 20/40 (6/12) with correction is the possibility of uncorrected irregular astigmatism. When the retina surgeries are all behind you, if your -3.5 eye has greater visual potential than your detached eye, you may find a hard contact lens provides better vision for you. Next time you have a refraction, ask if there is any residual astigmatism in either eye. If so a trial of hard lenses in your PRK eye might surprise you.

 

Me:
Surgery was 10 days after tear.  I could only see out of 50% of my eye right b4 I went in surgery .. The other half was black . The shadow .. Quickly became darkness with in 2 days .. After I finally got a good diagnosis on Bali I left for Singapore.

This is promising!

 

Me:
The macula was still in tact :).


Good!


Me:
This oil is crazy sometimes ..  Well I think it's the oil. My vision is all over the place ..  When I look down my feet are blurry .. When I look strait it's good , but distorted .    My side view seems a bit blurry / dark .   When I put on my -6.5 my strait view is blurry , my feet are not ..  Lol

oil is crazy! So is having a retinal detachment.

 

Me:
What bothers me the most is the darkness on the side .. Gives me flash backs to the week I had the shadow .. And at night time my vision is at its worst --

Both of these are normal observations early after RD repair. Hopefully with time this dramatically improves, though most people, when questioned carefully, still have some residual darkness in the area where the RD was longest lasting, and dark adaptation may be slower for you.

 

Me:
What seams to be effected most at at this time is vision about a foot away from my eye .. Distance seems ok , close up is crisp ish but twisted , maybe from oil ?

The oil is like a plus lens, so seeing near will be hard. The twisting/contortion is called "metamorphopsia" .  This may be because the retina did not settle in excactly the same configuration that it had predetachment. If so your brain may take a while to reconfigure the trillions of data sets it aligns with every moment of binocular sight.

If there is a fold in the retina, you would be told, this is another cause of twisting but doesn't sound like your case. Lastly, small "epiretinal membranes" are common after RD and can lead to varying degrees of vision warping. You are a bit early for that. So let's chalk it up to scenario one for now.

The twistiness you see may represent the retina having laid down slightly differently than it was configured before the detachment. As long as there is no fold in it, and no tissue membranes growing on its surface which can wrinkle it- usually the brain adjusts and things orient. The dark area you are noting hopefully corresponds to the shadow you saw early on prior to your diagnosis. The tissue that was off the longest takes a while to recover and appears dark for some time. You may have some permanent part of the vision slightly darker in that eye- but lets see 6-24 months from now. The refraction is all jacked up now because of the oil. It's a bit like looking through a slightly yellow magnifying glass. Spend as little as possible on interim glasses.