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Ongoing flashes after laser retinopexy in 25 year old male myope
I am highly myopic - my rx for my right eye is about -7.75 for right eye and about -9.5 for left eye with bilateral lattice degeneration. So I had 2 laser retinopexies this year. First laser session was on the beginning of may this year to seal a retinal hole on the superior portion of my retina in my left eye (5 o’clock ?) this hole was symptomatic and was suspected that retinal fluid could pass through it and put me at higher risk of retinal detachment. The second laser retinopexy was done 3 weeks ago to seal „new suspicous areas of lattice degeneration placed inferiorly” in my left eye. I have few questions regarding my situation:
1. I still have moderate amount of flashes few weeks after laser retinopexy but 90% of the time they happen during certain situations like when I go from dark to well lit room, when I close my eyes or during eye movement or head turning. Flashes happen rarely outside above mentioned circumstances. The doctor that has done retinopexies told me that there is no set rule when the flashes will go away although he noted that they should fade away with time. I have LESS flashes than before the laser session but it’s hard for me to tell if they are fading away atleast it’s a very slow process. Is this normal?
2. Does young age (25 y/o) at which a symptomatic retinal hole was diagnosed in my left eye put me at increased risk of retinal tear formation in the future compared to someone who had his first (and probably last) retinal tear diagnosed at age of 55 (at much older age than me)? Should I expect to be more prone to tears than before this one occured?
3. I reached second opinion to a reputable vitreoretinal surgeon in my country. After dilated eye exam he stated that retinas in my both eyes look fairly good and he told me he has seen a lot worse cases in his career - he estimated that I’m at low risk of retinal detachment. He said that both areas of retina in my left eye that were lasered are secure and healing good but he also noted it was the right choice to laser superior symptomatic retinal hole but it was arbitrary decision to laser the new inferior lesion/(hole(s) ?) and it could be observed in his opinion. His recommendation was to visit him every 12 months or sooner when I have increased amount of flashes, shower of floaters or dark curtain across my vision. My concern is that my amount of flashes is still fluctuating like I can get 5 flashes on monday then 12 flashes on tuesday and then the next day I again get 7 flashes. The thing is I don’t want to visit my eye MD every times I see a flash in my vision because firstly it would drive me insane and secondly I simply can’t afford it. I set a rule I won’t visit my eye MD earlier if I don’t have other symptoms than just flashes like shower of floaters or black curtain in vision. Is this the right strategy Doctor Hagan I couldn’t come up with better idea? Other than that I will keep sure to visit my eye doctor every 12 months at least.
4. My retina specialist stated that my retinal detachment risk is low but what would be approximate ball park considering I have high myopia and lattice degeneration?
Thanks in advance for answers and I’m sorry for such a long post but this topic is driving me a little bit anxious haha
1. I still have moderate amount of flashes few weeks after laser retinopexy but 90% of the time they happen during certain situations like when I go from dark to well lit room, when I close my eyes or during eye movement or head turning. Flashes happen rarely outside above mentioned circumstances. The doctor that has done retinopexies told me that there is no set rule when the flashes will go away although he noted that they should fade away with time. I have LESS flashes than before the laser session but it’s hard for me to tell if they are fading away atleast it’s a very slow process. Is this normal?
2. Does young age (25 y/o) at which a symptomatic retinal hole was diagnosed in my left eye put me at increased risk of retinal tear formation in the future compared to someone who had his first (and probably last) retinal tear diagnosed at age of 55 (at much older age than me)? Should I expect to be more prone to tears than before this one occured?
3. I reached second opinion to a reputable vitreoretinal surgeon in my country. After dilated eye exam he stated that retinas in my both eyes look fairly good and he told me he has seen a lot worse cases in his career - he estimated that I’m at low risk of retinal detachment. He said that both areas of retina in my left eye that were lasered are secure and healing good but he also noted it was the right choice to laser superior symptomatic retinal hole but it was arbitrary decision to laser the new inferior lesion/(hole(s) ?) and it could be observed in his opinion. His recommendation was to visit him every 12 months or sooner when I have increased amount of flashes, shower of floaters or dark curtain across my vision. My concern is that my amount of flashes is still fluctuating like I can get 5 flashes on monday then 12 flashes on tuesday and then the next day I again get 7 flashes. The thing is I don’t want to visit my eye MD every times I see a flash in my vision because firstly it would drive me insane and secondly I simply can’t afford it. I set a rule I won’t visit my eye MD earlier if I don’t have other symptoms than just flashes like shower of floaters or black curtain in vision. Is this the right strategy Doctor Hagan I couldn’t come up with better idea? Other than that I will keep sure to visit my eye doctor every 12 months at least.
4. My retina specialist stated that my retinal detachment risk is low but what would be approximate ball park considering I have high myopia and lattice degeneration?
Thanks in advance for answers and I’m sorry for such a long post but this topic is driving me a little bit anxious haha
Response to your questions:
1. There are many postings like yours. It is not possible to predict how long it will take the flashes to stop. In some cases people have complained of flashes years after laser or cryopexy to retinal tears.
2. Yes you are are at higher risk than older patient because you have longer life expectancy and some of your vitreous may still be in contact with the retina and peel off later. Older patients more likely to have all the vitreous 'detached' from retina face.
3. Generally the advice goes like this: If the flashes change, get more intense, more frequent, you have showers of new floaters or loss of peripheral vision see the retina surgeon ASAP. If same old same old symptoms annually or as directed.
4. Only your retina surgeon can give you the odds. These cases are too unique to generalize.
1. There are many postings like yours. It is not possible to predict how long it will take the flashes to stop. In some cases people have complained of flashes years after laser or cryopexy to retinal tears.
2. Yes you are are at higher risk than older patient because you have longer life expectancy and some of your vitreous may still be in contact with the retina and peel off later. Older patients more likely to have all the vitreous 'detached' from retina face.
3. Generally the advice goes like this: If the flashes change, get more intense, more frequent, you have showers of new floaters or loss of peripheral vision see the retina surgeon ASAP. If same old same old symptoms annually or as directed.
4. Only your retina surgeon can give you the odds. These cases are too unique to generalize.
6 Comments
Thank you for your answers doctor. I understand that's every case is unique but would you be concerned if you were me? I'm just scared I might go blind one day and lose my abiliy to function independently.
As much as you would like reassurance I can't tell you how much to worry but your retina Eye MD should be able to and assure you that you are unlikely to go blind.
Hello Doctor this is me again I wanted to say thank you because after reading your advice I decided to book an appointment with my retina surgeon just in case because my flashes got a little bit worse over the course of last few days. Yesterday I went for a checkup 5 weeks after my last laser retinopexy in my left eye because I was worried about the flashes. The retina surgeon found I have an atrophic retinal hole with subretinal fluid at 11 o'clock, the area around the hole was detached albeit it was small and he was looking into my eye for several more minutes before deciding if I should have another retinopexy or do scleral buckling surgery. In the end he decided that he will do a laser retinopexy and he wrote a note in my medical history: "Laser retinopexy was done around atrophic hole with SMALL amount of subretinal fluid". He scheduled my check up appointment in 2 weeks to ensure that this area is stable and if not (God forbid) then scleral buckling will be the next step - he estimated my chances are 50% that the lasered are will hold successfully. I have few more questions:
1. How quickly does a retinal detachment from an atrophic hole develop?
2. Can my case be labeled as retinal hole/tear or retinal detachment? I asked this my doctor and he is comfortable with the note that he left in my medical chart. But I am a bit cautious about this because he said that the area around the hole had small detachment/passage of subretinal fluid and I wasn't even aware of that. I still see 20/20 with correction in that eye.
3. Could physical exertion cause the retinal fluid to pass through the retinal hole and cause this situation? I also had an accident where I got hit in the head playing football but fortunately I was wearing sunglasses, but still the impact was quite significant even if my eyes were partially protected by the sunglasses. This accident was 2 weeks after my laser retinopexy.
4. What could be the cause of the downhill regarding retinal health of my left eye? I have no horseshoe tears or round traction holes, my doctor said the only findings are atrophic holes but still the last atrophic hole was enough to let the retinal fluid to pass through. I had no such problems before all of this started 6 months ago. From there I have new retinal findings that require retinopexy every 1/2 months on average. My doctor says that I am highly nearsighted and that I'm prone to such issues but he is not aware of any other problems that could cause this series of unfortunate retinal findings. He just says I need close monitoring and that all of this will settle down.
5. When (if I hope so) the things will settle down I plan to visit my retina specialist more frequently than 6 months increments. Vision is very important to me and the last atrophic hole needed a mere month to develop small amount of retinal fluid and this was probably the most sinister finding in my whole life so far when it comes to eye health. So my plan is to visit him every 3 months (or earlier if I get concerning symptoms) so that I can can catch possible tears or detachments in the beginning stages.
6. Sir I am a dentistry student and I enjoy the classes and do well in my degree but these events bring me worrying thoughts that I may not be able to continue my future career path because my vision may fail me in the future? I'm about to start 4th year of dental school but maybe I should change my future plans?
1. How quickly does a retinal detachment from an atrophic hole develop?
2. Can my case be labeled as retinal hole/tear or retinal detachment? I asked this my doctor and he is comfortable with the note that he left in my medical chart. But I am a bit cautious about this because he said that the area around the hole had small detachment/passage of subretinal fluid and I wasn't even aware of that. I still see 20/20 with correction in that eye.
3. Could physical exertion cause the retinal fluid to pass through the retinal hole and cause this situation? I also had an accident where I got hit in the head playing football but fortunately I was wearing sunglasses, but still the impact was quite significant even if my eyes were partially protected by the sunglasses. This accident was 2 weeks after my laser retinopexy.
4. What could be the cause of the downhill regarding retinal health of my left eye? I have no horseshoe tears or round traction holes, my doctor said the only findings are atrophic holes but still the last atrophic hole was enough to let the retinal fluid to pass through. I had no such problems before all of this started 6 months ago. From there I have new retinal findings that require retinopexy every 1/2 months on average. My doctor says that I am highly nearsighted and that I'm prone to such issues but he is not aware of any other problems that could cause this series of unfortunate retinal findings. He just says I need close monitoring and that all of this will settle down.
5. When (if I hope so) the things will settle down I plan to visit my retina specialist more frequently than 6 months increments. Vision is very important to me and the last atrophic hole needed a mere month to develop small amount of retinal fluid and this was probably the most sinister finding in my whole life so far when it comes to eye health. So my plan is to visit him every 3 months (or earlier if I get concerning symptoms) so that I can can catch possible tears or detachments in the beginning stages.
6. Sir I am a dentistry student and I enjoy the classes and do well in my degree but these events bring me worrying thoughts that I may not be able to continue my future career path because my vision may fail me in the future? I'm about to start 4th year of dental school but maybe I should change my future plans?
1. atrophic holes are very common and rarely lead to retinal detachments, most do not require treatment especially if on the lower half of the retina. Most RDs develop from horseshoe tears or large areas of lattice with confluent lattice and numerous atrophic holes.
2. No most ophthalmologists would NOT call your last hole/laser for a detached retina
3. No not due to exertion. If a small hole develops there is almost always tiny amount of fluid around edge
4. You are highly myopic, this happens, not rare, I'm not nearly as myopic as you but I have lattice, and retinoschesis.
5. I think every 3 months the rest of your life is over-kill. You appear to really have a problem dealing with anxiety and you might want to work with a psychologist or psychiatrist on healthier ways to deal with stress
6. That is almost absurd. The chances of you having vision good enough to practice dentistry your entire career are likely much higher than 99.5%. I live near a dentist that has had a RD and he continues to practice and do great dental surgery. Again learn to deal with your anxiety, you are obsessing.
2. No most ophthalmologists would NOT call your last hole/laser for a detached retina
3. No not due to exertion. If a small hole develops there is almost always tiny amount of fluid around edge
4. You are highly myopic, this happens, not rare, I'm not nearly as myopic as you but I have lattice, and retinoschesis.
5. I think every 3 months the rest of your life is over-kill. You appear to really have a problem dealing with anxiety and you might want to work with a psychologist or psychiatrist on healthier ways to deal with stress
6. That is almost absurd. The chances of you having vision good enough to practice dentistry your entire career are likely much higher than 99.5%. I live near a dentist that has had a RD and he continues to practice and do great dental surgery. Again learn to deal with your anxiety, you are obsessing.
Thank you Doctor Hagan your words really helped me to put matters into perspective. I'm sure going to chase my goals of becoming a dentist.
Best wishes for a fabulous career.
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