Monday, December 15, 2014

On retinal detachment

Many thanks to colleagues here and elsewhere who got in touch with their good wishes and their own stories about retinal detachment after I posted briefly about mine.   I was lucky, having caught mine early, which I'll describe a bit more, below.  But if you're over 40 and near-sighted (both risk factors), do take a look at the Mayo clinic page so that you know what to watch for by way of symptoms--without prompt treatment, retinal detachment can lead to a complete loss of vision in the affected eye.  By contrast, caught early, the existing treatments are extremely effective.

I knew some of the symptoms precisely because I had read the Mayo clinic page a couple of years ago, when I had some unusual "floaters" in one of my eyes (I forget which one, actually):  they were colored, zig-zag lines, not enough to interfere with my vision, but enough to be noticeable.   Often these kinds of eye floaters are harmless and symptomatic of nothing; this turned out to be the case with mine that time, and they went away after a few days, but I did get them checked out by my opthamologist since sometimes they are the first symptom of a retinal tear. 

The retina is attached to a membrane at the back of the eye by a kind of suction; if the retina develops a tear, fluid gets behind the retina and breaks the "seal" between retina and membrane--that's a detachment.  If the tear is caught early enough, it can be effectively "welded" shut through a laser (it is painless, believe it or not) before any detachment begins.  But if the tear is not sealed soon enough, the retina can begin to detach.  The telltale symptom of detachment is a dark or shadowy spot in one's field of vision, which, in severe cases, can appear like a curtain moving across one's eye.   Here is where I was lucky--I noticed a tiny dark spot in the corner of my right eye (the more near-sighted of my eyes, though I should note I'm not especially myopic) near the bridge of my nose.  At first, I thought it was just a speck of dirt on my glasses--that's how small it was.  But then I realized it was there even when I didn't have my glasses on.  My wife thought there was some kind of little bump in the corner of my eye, and so then I thought that might be what I was seeing.  But the bump disappeared, and the spot did not.  After about a week, I went to my opthamologist, who had to use two different kinds of examining lenses to finally spot the tear and the detachment on the retina.  Fortunately, things had not progressed very far, and that afternoon I was at the retinal surgeon's office not far from Hyde Park. 

I should note I'm very squeamish about my eyes--I don't use contacts, and I hate having my eye pressure checked, so I viewed this affair with some trepidation.  I'm happy to report that the procedures were remarkably easy to undergo.  With some local anesthetic in and around the affected eye, the surgeon injects a gas bubble into the eye--painless, though the eye felt a bit tender aftewards.  The bubble floats up and reattaches the retina to the membrane behind it.  The following day, the surgeon used the laser to seal the tear--86 shots of the laser light were required (some patients require 1,000 or more!).  I was lucky that the tear was high up on the retina (roughly where the small hand is when it's 10:30) and the tear was not very big.  For the first few days, I was not allowed to do any reading that required back-and-forth eye movement--this was to allow the tear to seal and to keep the gas balloon pushing in place against the retina so that it remained attached.  I also couldn't look anyone in the eye--I had to keep my eyes looking downward, at everyone's stomach rather than face.  That was odd, but depending on where the tear is, one might have to keep one eyes looking up the whole time.  I also could only sleep on my left side at night, once again so the gas balloon stayed in place.  Fortunately, the treatment was so effective that after only four days, I was given a reprieve on both reading and looking straight ahead, and two weeks later all limits on reading were removed and I was allowed to roll over at night.  The gas balloon is still there, but gradually shrinking and it will disappear over the next few weeks (the gas balloon is in part of one's field of vision--in my case the bottom since the balloon is at the top of the retina--it's a bit like looking through a glass of water.).  A follow-up visit in a few weeks will determine whether the tear is still sealed and the retina still attached, but my surgeon is optimistic given where we are.

Having a retinal tear or detachment is a risk factor for having another one, alas, so I will have to be vigilant for any symptoms, starting with new eye floaters.  But as these things go, I was lucky; I've heard from many others who had more complicated ordeals, with more dramatic detachments, sometimes multiple surgeries--though all were ultimately successful. 

I hope this information proves helpful to some readers in the future!

ADDENDUM:  I'm opening comments for any other advice or experiences that might be relevant; post your comment only once, it may take awhile to appear.

https://leiterlawschool.typepad.com/leiter/2014/12/on-retinal-detachment.html

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Comments

A valuable, accurate report. Thanks, Brian. I too have suffered it, in both eyes as it happens. It was caught very early in one, not so quickly in the other. The sooner detected, the better the outcome, as you say.

Posted by: Robert McGarvey | Dec 15, 2014 8:29:39 AM

Brian, Thanks very much for this. It is kind of you to share this info.

Dan Frank

Posted by: Dan Frank | Dec 15, 2014 9:32:31 AM

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