vitreous detachment question

[heatherw22]

I am pregnant 36 weeks and woke up one morning to a dark spot in my vision of my right eye.  never had eye issues in my life.  i had pre eclampsia with my last pregnancy, but not sure if this is related to pre e this time.  i went to an eye doctor and she didn't dialate my eye (due to pregnancy)  she was very evasive with my questions. but what she did say is that i have a posterior vitreous detachment.  i looked this up and it happens usually to people 60 years plus.  i am 26.  i have had no trauma to my eye ever.  could this be related to my pregnancy?  should i get a second opinion?  

[AudreyRose]

Boy can I ever relate to the anxiety of eye surgery going bad and the doctor walking away. I am so frightened of all eye doctors now that I do not think I will ever beleive another one.  They are like little boys that hide behind their mama's apron and cannot handle problems. Women a so much stronger mentally thanthese type doctors. Yesterday, my husband received a note from a Specialized DDS on a sports matter and he ended this letter by saying, "tell your wife to come by and see us.  We miss her  smile and her wittiness.  She makes us laugh.  We will order lunch".  Anna, what a difference in doctors!  This DDS stood by me when I wa shaving a problem with a nerve area.  He did not turn his back on me or send me a Dear John Letter. This is the making of a true doctor...taking the good with the bad.  
I want a letter of apology from that eye surgeon.   A great injustice was done to me and I am maddd now. He will not do this to another person.  He will take the good and the not so good. Shame on him!
I finally got on to post to the doctors here and when I clicked send...it would not send. All it did was the above.  Is there a limit of words that is not listed for Dr. Mike and Sandy here.  I would like to learn more on my lens and to see if it can be removed. Thank You Anna and "Dr" Jodie.  Yes, Jodie is very knowledgeable. I wish she lived next door to me.  
Audrey

[AudreyRose]

I have tried to post my tale of woe since Catarasct surgery.  The daily limit is always full. I will keep trying.
I went to supposedly one of the best cornea/cataract doctor's in the country.  He was not the best.  He did not recognize my post op Large PVD that drove me crazy.  He would not acknowledge that he may of placed the wrong lens in my eye.  (now cannot see anything up close as it is all a blurr....cannot see anything in a distance either)  I wish I had never had surgery. Will not have the other cataract removed as I freak out thinking about what I have been through.  I was fired by the eye doctor and told me to find someone else.  He states he has a perfect record and I am expecting too much to be able to drive at night and sew for the children and read lables at the grocery store.
MY PVD was finally diagnosed by other MD's and I was instructed to watch for other things that could be a retina tear or a retina detachement.  I see a Vitreous MD today.  The original surgeon also left a sore in the upper inner lid that is painful when touched or face being washed. This came when he pulled the cataract out. I was told it will be with me forever.
I pray that no one else has to go through what I have been through with the eye surgeon the past 5 months.   He wanted a perfect record and he was not going to let me spoil that for him.  He would not refer me to a retina/vitreous doctor. He kicked me out the door.   I pray that someting like this happens to him and he gets the cold shoulder, too.

[AnnaE]

That is like what I was told. That helps.

Could the Weiss ring be the black spot that Heather saw?

Thanks

[dukey]

From my understanding, the sign of a weiss ring indicates advanced/complete PVD. I could be wrong though.

[AnnaE]

I am confused--not by you, just about PVD. The cerclage to my eye was supposed to be Ok because I had had PVD. The cerclage took place 19 months ago. I still have sysneresis, and a Weiss ring, meaning that I have not completed PVD, right?


My doctor told me that PVD took about 3 weeks to complete. The doctor wo did the cerclage sais that I had PVD 19 months ago. I have a Weiss ring, which means that PVD isnot complete, right. Could the Weiss ring be the black spot that Heather saw?

[dukey]

Your doctor is wrong. To quote just one source:

"With age, there is a depolymerisation of hyaluronic acid, causing these molecules to release their water and form lacunae i.e. pockets of liquefied vitreous. The collagen 'filaments' aggregate to form larger 'fibrils', causing further collapse of the vitreous gel structure. This process is known as vitreous degeneration and 'syneresis'." I'm guessing other factors can cause this, i.e. myopia, genetics etc.

"Eventually, with the accumulation of enough lacunae (liquified vitreous pockets), the vitreous framework collapses and the vitreous completely separates from the retina. This process is called posterior vitreous detachment (PVD)."  

Of course, there will be syneresis at the end as it probably needs to happen to develop a PVD in the first place!!! I could be wrong but I have read around and it seems correct to me.

[AnnaE]

Did the doctor ask you if anyone in your family ever had retina problems? You should tell him, if anyone has. Also, I am sure that you are not highly nearsighted, and have never been diagnosed with a retina condition called lattice degeneration. These factors would give you additional rsk, but you did not mention them, so it is probably not a worry. Just remember the symptoms Dukey has told you to watch out for, and enjoy your baby.

Also watch for obstructions in your vision that look like a piece of shaded broken glass. Also be aware of any changes in your vision. My vision was also blurred. and there was pressure, like something was in my eye,

My daughter had a double detachment at 18, with no symptons. Luckily. it was caught during a routime exam. I am not trying to overwhelm you, but to supply you with information that may help you relax because you are informed.

[AnnaE]

Yes, the county medical board, at the very least.

So glad you got help from Jodi. There is a limit to the messages here. Try posting at midnight, forum time, It turns aroung then.

[JodieJ]

I'm more than a little surprised to see your Rx numbers.  You were not very nearsighted pre-surgery, and you have almost the same Rx now.  It's hard to believe that your surgeon never discussed your surgical target beforehand.  (I'm in the dark as to what vision he was aiming for, or how close he came to this target.  Most people want good uncorrected distance vision, but you are very far from that.  Maybe the target was good uncorrected reading vision.)  In any case, your surgeon deserves an F in communication.

In my opinion, it's quite realistic to expect good corrected vision at all distances post cataract surgery.  Yes, get another exam from a good optometrist.  I've gotten strange results from an exam by a tech.  

[AudreyRose]

Thank You for your kind words.  I never have met a doctor in all my years like this one.  I have been nothing but nice to his verbal abuse.  Before I got this letter a week or so ago, he said the same thing to me on my last visit with him.(3 weeks before I received the letter)  I was being treated for inflammation/ infection in that eye.  I found it strange that with this infection that I was not to return for 2 months.(October) But, I said nothing.  I bit my tongue also that day when he said I was expecting unrealistic results of his cataract surgery. I told him I did not think being able to drive a car at night was unrealistic.  I also told him that being able to sew for the grandchildren and read to them was not unrealisitc. He was very cool to me but I knew I had to stay in the system and get a retina doctor that used that hospital.
I am in the process of contacting higher ups about this.  I do not think they will do a thing but I will follow up with a letter to our insurance company, our State board of medical examiners and our County medical board.  
One of the posters mentioned that her cataract doctor (she is also nearsighted) placed a lens for distance in the right eye and will place a lens for near in the other eye.  Jodi, the eye surgeon I used, never indicated this.  I just assumed he understood me and knew what I expected and would accomplish this.  I was not asking to see the Taj Mahal from my home.  I was not being unrealistic.  I was a simple case, he said, pre-op.

Yes, I had a new eye exam.  17 months ago exam was R. -2.50 + .50 axis 145 add 2.50
                                                                                 L -2.50 + Sph.  add 2.50

Recent exam R.  -2.75  +.50   Axis  150   Add 2.75   Lft. -2.50 sph    add 2.75

Post op cataract eye exam is almost identical to the exam of 17 months earlier.
I have not had the RX filled yet as I am dealing with this rather large PVD in the operative eye.  The new exam was done by the surgeon's tech.  Would it be better to see a good Optometrist rather than a Tech in his office?
I want my life back.  I want to sew again and read to the grandbabies. I want to drive at night.  I want to be able to clean the house and see the dust.  I do not think this is "Unrealisitc Expectations".
God Bless You, Jodie.  You need to be every eye patient's advocate.
Audrey

[JodieJ]

Thank you for your kind words.  I'll give you my (non-professional) perspective about your situation.

Your cataract surgeon's inappropriate attitude/behavior and his refusal to address your post-surgery problems have caused you a great deal of anxiety.  It seems that he was more concerned about maintaining his "scorecard" of surgical outcomes (which undoubtedly isn't nearly as good as what he imagines) than in providing good (or even adequate) patient care.  He construed your legitimate post-surgery concerns as an attack on his skills and responded by having a childish temper tantrum.  (Obviously, the man has some serious personality problems.)  You might consider writing a letter detailing your complaints about your treatment to the chairman of the ophthalmology department.  Of course, you'd want to attach a copy of the "Dear John" letter you received.

Your retinal specialist's report contains some very good news.  You don't have to worry about developing a macular hole, and it's very unlikely that you'll experience a retinal detachment.  (Great news!)  The large floater may eventually fall to the bottom of your eye (out of sight), and/or your brain can learn to ignore it.  Your AcrySof IOL seems to be correctly positioned, and you don't need cataract surgery on your other eye at this time.

Making IOL power predictions is not an exact science, and the available formulas don't work as well for people who are very nearsighted/farsighted.  (I was very nearsighted before cataract surgery, and I didn't end up exactly where I wanted to be either.)  But power errors can be fully corrected with glasses, which should improve your vision at all distances.  You'll need to get a new prescription, if you haven't already.  I definitely don't think you should consider removing/replacing your IOL.  (It's much too risky with little benefit.)

I agree with you that there's more to being a good doctor than just having board-certification.

Best wishes.



  

  

[AudreyRose]

Also have to add that I went with my son to visit an Endodontist.  I was waiting in the outer office for him and lo and behold the Endodontist came into the waiting room and gave me a hug.

I know it is not me. I am an easy going, good person that was unfortumate to have picked a bad eye doctor.  Being Board Certified in Opthamology means nothing to me,anymore.  Bad eye doctors make it hard on the good ones.  
God will get us through this.  

[AnnaE]

I am so glad that some of this will settle down. There are two patients on this forum who have a great deal of knowledge, in addition to the doctors. Jodie J knows about lenses and Dukey knows about detachments.

Hospitals, for me, are worse than reality, so I went on xanax from the start. My first rd confused me so badly that I went to a psych for meds. She helped. I also have a therapist. I see a new rd on Friday. I had a nightmate last night that I had to go back to my first one. It frightened me so badly I could not sleep. I have seen four rds. The mentality in my town does not foster the immigration of excellent doctors. But the low limit on medical liability brings a lot of the other kind here. We have few retinologists of any kind.

Your doctor means that your retina will not likely require surgery.That is really valuable information that it could affect the other eye. Watch out for a shower of black dots, an obstruction to your vision that lokks like tinted chunk of hroken glass (AKA a "curtain"), and flashing lights. Every four days or so, look at a blank computer screen or the sky and cup your hand over each eye, alternately. Look up, down, right, and left and watch for obstructions in your vision.

My retinologist "sent me flying" with anxiety when he more or less denied that what I saw in my good eye was a result of a procedure, so I thought my good eye was gonna be a goner, too, for about two months. Because of inconsistent vocabularyo n the part of one doctor, and flakiness on the part of another, I could not find out what I was seeing , until the tech explained that it was a resultof the procedure. Three doctors in the same practice could not/would not explain what was going on. Retinologists can clear millions a year, so many of them will not risk their income to explain a post op problem they caused. It is also true that good doctors should not waste time in court. But I think they mostly do not give caring help/will not talk because of corruption.

I hope the doctors/forum members will also give you clarification about your experience and your lens. You can also submit questions on the eye care community forum. Dr. Hagan monitors that. Yes,  2 forums, and questions on the other are not limited.

Take care of yourself, do not exert yourself for a while, and be vigilant. Sounds like you have an ally in your doctor. That is a blessing.

Live and learn, and question what you have learned. You can sometimes learn more.

Anna

[AudreyRose]

I saw a vitreous/retina doctor yesterday.  He had a female tech in the room taking notes while he was speaking out to her while examinging both eyes.  I recognized his words to her and knew the right eye was OK,  He did note a SMALL cataract in that eye.  He went over to the left (problem) eye.  He stated Large PVD and other things going on.  I started to cry.  The girl brought me tissues.
He finished and told me that yes this can occur with cataract surgery.  (he conferred with the other two eye doctors I had seen 4 months ago which I did not return to as they were too far in drive time for me)  He went on to say that with his findings he did not think I would ever get a hole in that eye.  (whatever that means) He feels also that this rather large PVD floating all around may not cause a retinal detachment...He advised me NOT to let anyone do surgery on that eye, now.  he said this all may settle in time and one can get use to this and it is unfortunate that this happened.  He made no comment about the cataract surgeon and I did not want him to but was aware that I was given a Dear John Letter.  He went on to say that the new Lens is in good but sometimes measurements are off and this well may be what is happening to me with the Alcon AcrySof lens thus 2 problems in the eye.

He stated I am to be watchful of this and was concerend the right eye may do the same thing even without having surgery. I am to call him ASAP.   He advised me to LEAVE the cataract in the right eye alone, as it is very small....Hmmm. I was told this must come out or I will go blind. Live and Learn.

The stress over all of this put in me in the hospital from anxiety.  My PCP has me on Xanax.  

If only doctors would acknowledge post op problems, patients would be so much better off, mentally.  Mental anquish is a killer.

Thanks for all your well wishes.

[AnnaE]

He is trying to intimidate you with his perfect record. He is afraid you will sue him. I hope that some of the damage can be undone. I lost most vision in one eye due to my former eye doctors who would not believe me when I saw them, and would not return my calls when my retina detached. I did not know what was happening to me, and they would not respond. Nothing an bring back my sight or ease my trauma.

I really hope that you can recover some from this. I will write you a private message about what YOU can make happen to the nasty, and unfortunately for you, uncaring and careless doctor. He would not admit any wrong, because there is too much money at stake for him. Whenever anyone hurts you and demeans you, it is because (usually) that person har harmed you and is trying to hide it.

I am really sorry.

Anna

[AnnaE]

Thanks. I have recently gotten some big ones. Not huge, but not tiny or skinny like the rest.

I am always glad to learn more.

[dukey]

Well I know that people who have acute PVD usually suffer from one or two much larger floaters so that could be what heather is experiencing.  

[AnnaE]

I was having PVD when my other eye detached. The problem is that I am high risk and my doctors did not even tell me I had PVD. They minimized my flashing lightsand connected them to nothing. They minimized my lattice and gave the odds you quoted. They said in the records that I said nothing about floaters. I told them I have had floaters all my life--many many floateres. It would have been very difficult for me to spot an increase.

They did not tell me to watch out for the pepper kind. This would have saved me, I think. I called them when I had the pepper spray anyway--who would not think that this was an overwhelming signal--I called them three times and they never returned my call. I went to 2 emergency rooms and they ignored me, too.

Later, another of their doctors misled me when he said there his no emergency room who would have helped. I did not go to the county hospital, and they are the ones who could have called a retinologist--and the doctor did not even know this.

Heather does not mention any high risk factors, so it is not about her. It is just scary to hear someone say, "relax, something happening is so rare." These words really misinformed me and I believed that they did at that moment when they were spoken--I could find no one to back me up, however, until it was all over--the detachment. This is about me, not Heather.

[AnnaE]

Incidentally, one of my doctors told me that my syneresis is the end stage of PVD. I am in trouble if it is not. I am going to read some more about this.

[AnnaE]

You can always call you doctor with questions. Ii do not think you will need another doc. You should be vigilant but do relax right now. Like Dukey says, there are definite symptoms, and he has described them. If you have a vulnerable eye, the Valsalva breathing technique can lead to retinal detachment during natural delivery. Nevertheless, give your ob doc all the infor about your eyes.

I would also ask him why you are having PVD so young--might be good to know. Let him fill you in on all this. I would want more complete information, for future reference. Sounds like he told you little about what's gong on, and nothing about what it means. That is far too common.

[dukey]

He has given you a good answer, there is no need to seek additional advice. Essentially, you are in the early stages of PVD, the pre-PVD stage if you will. The vitreous begins to degenerate and liquefy but is still attached. At this point the floaters tend to be stringy-like and there may be many of them, some large, others barely noticable but you will probably become more aware of the "gel" in your eye. I have this in both of my eyes and I now also have a PVD. When the vitreous does eventually detach, which seems almost inevitable in most cases, it can be associated with an increase in floaters and flashes or you may not notice it at all. If a tear occurs as a result of the PVD (very rare if you look at the numbers), you will notice a sudden increase in floaters or a shower of floaters and a rise in bright, repetitive flashes. For me, the transition from syneresis to PVD was asymptomatic. Try not to get to caught up on the risk of detachment. It is very rare over all. Even in high myopes, the risk is 5%, which is very low. Message boards like this tend to be populated by people who have had serious problems and it may lead you to believe that many of the unfortunate events that have happened to the likes of AnnaE are common. They really are not. Try to relax. You have a good diagnosis so move on. Just be vigilent and try and inform yourself a bit more so next time you can ask a few more questions.    

[heatherw22]

Well i had a retinal specialist look at my eyes today.  He told me that i didn't have pvd but i may have vitreous syneresis.  after looking it up at home i found out that vitreous syneresis is what leads to pvd.  so now im rather confused.  i wonder how many doctors im going to have to see to get someone to give me straight forward answers.  if it leads to pvd it is serious to me, i am at the end here i don't know what to do now.

[AnnaE]

PVD refers to a normal process that occurs in the laters years. My PVD turned into a retinal detachment. My doctor did not even tell me I had PVD. PVD can lead to retinal detachment in certain cases.

Eye doctors quit commonly evade questions, be our own advocate, as I have become. Please see an eye doctor immediately, for a complete exam. I would say that you should try to get a more caring doctor who will tell you what is going on. You need to know.

I lost my of the vision in my left eye, because my doctors ignored my PVD and my pleas that something serious was going on. I cannot tell you how damaging this loss is, and I do not want you to learn.

As the doctor has urged you, get a second opinion, and a dilated exam asap, like tomorrow, to protect your vision. Find an eye MD at www.aao org. Castle Connelly wil give you the best rated doctors for a small fee. Also check ratemds com for free patient-wrtten ratings and informative forums.
Anna

[Sandy Feldman, MD, MS]

Dear heatherw22,

I would definitely recommend that you see an eyeMD and undergo a dilated examination immediately.  Vision changes and your history of pre-eclampsia are important.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California