Diagnosed with Myopic Macular Degeneration

[jj0992]

Retina specialist visit yesterday found fluid at the back of my right eye after looking at it and running some tests.  He said at this point there is nothing to be done but monitor what progress going forward if any.  He felt any surgery at this point would be premature and do more damage then good.  Looking to get some feed back on if I should be doing anything else at this time.  I have a history of being very nearsighted, had cataract surgery with lens implants 8 yrs ago,  2 yrs ago this month I detached my retina in my left eye, was a long surgery, cause I went 5 days before seeing a DR and another 3 before surgery.  I have a buckle which complicated my eye movement and had strabismus surgery in May to straighten out my eye and help with depth perception and double vision. My medical team consists of two retina specialists, one being the surgeon on the detach, a strabismus specialist, and my regular eye DR.  Just want to  make sure I don't miss doing something proactive at this time. Also looking for some information on how this might progress.

[Rosiecont]

In the middle and low degree of myopia, the fundus macula is generally normal, and macular degeneration will occur only in some patients with high myopia. Because the visual function is mainly in the macula, once macular degeneration occurs, vision will be greatly affected.

[jj0992]

The response I received from the Dr is this - "The retina is myopic macular degeneration".  Not sure that gives me any more information then I already had.

[JohnHaganMD]

Ask him if the fluid represents "wet (exudative) myopic macular degeneration"  If yes  "do I need to start treatment with anti-VEGF injections (avastin, lucentis, eyelea"

[jj0992]

I sent the email off this morning, will wait to see what the response is.

[JohnHaganMD]

Let us know

[jj0992]

I can finally give an update based on my appt this morning with my 2nd retina specialist.  While I am still trying to absorb it all, this is what he said.  Because I am so near sighted the shape of my eye is changing and the gel in my eye is pulling away from the retina.  I believe he said macular skesis or something that sounds like that.  He said it is like a mini detached retina and there are two courses of actions. First is to monitor for 2 months to see what the rate of change is, looking at the amsler grid every day.  I already do that.  Second would be to have surgery at some point to remove the gel, fill the eye with gas, be face down during waking hours for one week and hope everything reattaches the way it should.  He said he would not put another buckle on, so the procedure should be less painful than the last one.  He said there is also a chance it will stabilize where it is and not get worse.  I was very appreciative of him taking the time to explain it all.  I think  I need to mentally start preparing myself for surgery, which will be OK, since I know the DR. and how he works, there are a lot less unknowns.

[JohnHaganMD]

Thanks for the posting and best of luck

[jj0992]

I forgot to mention my next appt. is in 8 weeks.  I was wondering how long after surgery it will take the gas bubble to dissipate?  My last surgery took 10 weeks for the bubble to be completely gone.  Also I do travel for work and forgot to ask if there are any concerns with air travel until this gets sorted out?

[JohnHaganMD]

Air travel could be a concern and you should ask your surgeon.  Absorption varies depending on wither air or SF6 and amount put in eye. Can't generalize.  

[jj0992]

Sorry but I want to make sure I am absolutely clear.  Can there be an issue with air travel while i am waiting to see if it stabilizes, like in the next few months or beyond that if I do not have surgery?

[JohnHaganMD]

To be absolutely clear you need to ask your surgeon.

[jj0992]

Thank you for that response.  Over the years I have noticed after landing from a flight that my eye sight would seem different, I could tell something didn't seem right but then it would be OK.  Most of my flights were not long hauls but multiple 2-3 hr flights.  I guess it could just be a coincidence that my eyes have been stable due to the lack of travel since my detach and have started back up since I took a few flights over the summer.

[JohnHaganMD]

That is a common problem for many people and usually is due to the very dry air in the plane plus people tend to run the air flow onto the eye. The cornea drys out, the vision blurs, the eyes often water, they are sensitive to light and red.  We tell people with dry eyes:  1. don't run the air in your face.  2. put in artificial tears every 45-60 minutes on the plane.

[jj0992]

So I have two updates from one of my specialist.  On the question of what it represents, his response was "It represents myopic macular degeneration but not exudation"  On the question of air travel his response was that I was OK for air travel.  I am now waiting on a new pair of prism lenses, which after working with my specialist, we were able to dial something in that has me real close to 100% clear with no double vision.

[JohnHaganMD]

All good news.

[jj0992]

Here is an update from visit with Retina specialist after 2 months.  Little to no change in the Macula Schisis in the right eye.  Seems to be stable at this point.  Said surgery is not an option as vision loss could be greater than what it is currently.  Wants to see me back in 3 months.  He said try not to lift anything heavy and keep my head above my heart as much as possible.  The new prism lenses from the Strabismus Dr. helped out a lot and they were also going to check with their network of Dr.'s to see if there may be any surgical options since they work with many specialists across the country for specific surgeries.  On my own I have been taking 2 supplements, Vision Max 20/20 for about 1 year and AREDS2 for two months.

[JohnHaganMD]

Thanks. Sometimes holding your own is good news.

[JohnHaganMD]

unfortunately I can't offer insights as there are several places "fluid' might be developing. If it's around a retina hole or under the peripheral retina observation might be appropriate; if the fluid is in the macular that is more concerning and needs to be watched much closer. Your "team" will need to provide the information on location and type of fluid

[jj0992]

Thank you for the response.  What I have noticed from the vision in that eye alone is that objects that I look at are elongated, when compared to looking at them with just the other eye.  I also believe this is the reason why at distance objects distort and start to double up.  I have sent an email through the medical portal for a more detailed description of what is happening, and hope to have that in a few days.  All of this happened rather rapidly as I saw him in August for my annual retina inspection with him and he did not see anything at that time.

[JohnHaganMD]

Most likely that means the fluid is in your macula.  It is important to determine if the fluid is something like "cystoid macular edema" which can be watched or subretinal fluid due to myopic exudative 'wet' macular degeneration which generally need prompt injection of anti-VEGF medications (Avastine, Lucentis, Eyelea).

[jj0992]

Since my retina specialist is the Chair for the department, I would hope his experience would be able to tell the difference between the two and that he also wants to see me back in 4 months would lead me to believe that it would be the macular edema. I am still waiting for the email confirmation with the details.  I would also like to determine if there is anything proactive I should be doing or taking.

[MrPresley]

I have residual cystoid macular edema in my LE following a vitrectomy/ERM peel performed in 2015 and a subsequent cataract removal in 2017. It has never been particularly symptomatic and my retina specialist, who I see every six months, has indicated that it is improving on its own without intervention.  

[JohnHaganMD]

=

[jj0992]

MrPresley,  Thanks for your response.  While I wait for a response from my specialist, I can only speculate on what's happening and the noticeable change in vision in my RE, which up until this point was my good eye.  :-)

[JohnHaganMD]

Waiting is always difficult