Eye Care

[wvarela]

We are looking for a second opinion because our current doctor told us basically there is nothing else they can do to correct my father's vision. I do not really know the procedure we need to follow but based on information on the web it seems like he can be a POSTERIOR VITREOUS DETACHMENT patient.  

I am really interested to see if somebody can give me a recommendation to correct his problem with surgery/laser.  

Below is a summary of his condition as explained by the Vitreoretinal Diseases and Surgery Doctor:

My father is a pleasant 68 male with history of systematic hypertation. He complains of flashes and floaters in his left eye and poor vision in that eye for years. Past ocular history is notable for server trauma resulting in enucleation of the right eye and aphakia of the left eye due to refractive lensectomy 7 years ago.

Examination today (August 27, 2008) shows VA of 20/200 OS. Ocular tonometry is 17mmHg OS. Anterior segment examination is notable for well fitting prosthesis in the right socket. There is aphakia of the left eye.

Dilated fundus examination of the left eye shows Weiss rings indicative of PVD. The optic nerves appear normal. There is extensive peripapillary RPE arthropy and myopic degeneration extending into the macula. The major vascular arcades appear normal. There is superior lattice degeneration but no associated retinal holes or tears.

He told us that he has severe myopic degeneration involving the macula. In addition, he has superior lattice degeneration and has undergone uncomplicated PVD in that eye. His right eye has a well fitting prosthesis as a consequence of severe ocular trauma. He has tolerated his surgical aphakia well due to his severe myopia. I have continued him regarding protective eyeware for his left eye and have asked him to continue to see his ophthalmology for all of his general eye care. I will monitor his retinal disease and will inform his ophthalmology of his condition.

I hope there is something you can do to help us. Thanks.

[John C Hagan III, MD, FACS, FAAO]

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[wvarela]

Thanks a lot. We really appreciate the time all of you spend in this forum to try to help peolple like us.

[John C Hagan III, MD, FACS, FAAO]

From your description it is unlikely that any type of treatment would be recommended to remove the Weiss ring. I think it not likely worth the expense of going to Miami. Perhaps frequesnt (twice/year) exams by a local retina MD would be appropriate.

JCH MD

[wvarela]

Dr. Hagan,

Thanks for your post on the best ophthalmology programs in the USA and the world. The Bascom Palmer Eye Institute of U of Miami was the first we contacted but the person who replies the international e-mail never wanted to forward my request. She wanted us to go there which can mean for us to spend the money we have for this without any warranties. Do you think is worthy to make the trip there or have any contacts over there or any of the other institutions that can help us? We our willing to pay for any consultation fees but pay for travel, etc. without somebody doing a screening check is tough.

Regards,

wvarela

[John C Hagan III, MD, FACS, FAAO]

Please see my posting tonight on the best ophthalmology programs in the USA and the world.

JCH MD

[AnnaE]

Castle Connelly is an organiztion that obtains ratings on doctors fron their fellow MXs. You can find the best-rated docs in the nation, or your state.

I would post the other question on his other conditions as a new question. This will make it easier for the doctor to notice.

Best,

Anna

[wvarela]

Thanks. I apologize for not having experience in these types of dicussions.

I know a lot of doctors are against vitrectomy for floaters and if it can do more harm to my father I am against it too. However, do you have any advice for my father's other eye conditions?

Thanks in advance for your response. This forum has been really helpful for us.

[John C Hagan III, MD, FACS, FAAO]

It means I have read the discussion thread to that point and do not need to comment further its an electronic "period".

JCH MD

[wvarela]

I am really sorry but I do not know what - means. If you can help me on this we will really appreciate it.

[John C Hagan III, MD, FACS, FAAO]

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[wvarela]

Who is Castle Connelly? Has he recommended one that is good to you?

[AnnaE]

To: Berrywoo, wvarela, Dr. Hagan
What about the severe myopic degeneration involving the macula?  extensive peripapillary RPE arthropy?

[John C Hagan III, MD, FACS, FAAO]

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[AnnaE]

www.aao.org lists member doctors. It does not recommend them. Castle Connelly, for a small fee, will recommend one who has been rated highly by his peers.

Also, one should usually get a second or third opinion.

[AnnaE]

What about the severe myopic degeneration involving the macula?  extensive peripapillary RPE arthropy?

[John C Hagan III, MD, FACS, FAAO]

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[berrywoo]

At this point in time there is no treatment for floaters. If a doctor suggests doing any sort of laser for just floaters I would not follow through as this could pose serious risks to your sight.
As time passes your father will learn to adjust to the floaters and they may even settle down to the bottom of the eye and out of sight.
Also, a simple case of PVD does not warrant treatment.
The main reason for your father's vision loss is due to the pathological myopia and if not corrected properly the aphakia. Talk w/ his retinal specialists about available options to help the pathological myopia, especially since it has started to affect the macula.

I know you and he both worry about this since it is his only eye. Best of luck.

[wvarela]

Thanks for your advice.

I found am eye Floater Treatment Center with laser. Based on your experience, do you think this can help my fathers condition?

I really appreciate your help.  

P.S. I went to www.aao.org and the M.D. who treated my father before is one of the recommended M.D. so I guess he really knows what he is doing.

[berrywoo]

here is the website again as it didn't show up properly:

www.guideline.gov/summary/summary.aspx?doc_id=4351

[John C Hagan III, MD, FACS, FAAO]

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[berrywoo]

I should have added that PVD w/ no retinal breaks just require close monitoring.
Also, here is a website that I found w/ guidelins for treatment copy and paste into your browser:

http://www.****.***

[berrywoo]

PVD does not warrant surgery, just careful monitoring. Make sure your father knows the signs of a retinal detachment. Also, there is not much to help pathological myopia, however if extensive damage is occuring to the macula and CNV is present he may benefit from steroid injections.

For a second opinion visit www.aao.org to find a doctor near you.