Peripheral retinal degenerations - laser treatment needed?

[Agnes2001]

Hello, I was recently diagnosed recently with the peripheral retinal degenerations (snail track and paving stones). I do not have any holes or tears. I'm myopic (-4) since 11-12, now I'm 35yo. Doctor told me that I should have an immediate laser treatment, because of this snail track degeneration. She also forbade me to exercise as usual (fitness, climbing) until I have a photocoagulation. The doctor warned me that snail track degeneration increases the risk (30%) of  retinal detachment. I'm confused and do not know what to do. I do not have any problems with my eyes - no flashes, only a few small floaters which I always had. The examination lasted 3 minutes and an ophthalmologist used Goldman triple mirror. I'm afraid of laser treatment at this stage and not sure it is absolutely necessary. I live in Eastern Europe and in here laser treatment is quite popular right now. I am afraid in some cases overused. I'm having another appointments to get more opinions. Could you please advice if this kind of degeneration requires photocoagulation and what kind of ophthalmological examinations would you recommend to get rid of doubts? Thanks a lot in advance!

[JohnHaganMD]

Most cases of snail track do not need treatment and there is not anywhere near the risk you were quoted.  I would get a second opinion from a Eye MD that specializes in retina diseases. If not then at least see another one or two Eye MD ophthalmologists to get additional opinions.  That risk (30%) is wildly overstated and flat out wrong.    

[Agnes2001]

Thank you doctor for your answer and sorry for a delay in my thanks. I really appreciate your help and opinion :)
In the meantime I got a second opinion from retina specialist and the third from the Eye MD who did the ultrasound of my eyes. The second retina doctor confirmed what the first said - I should have a photocoagulation. He said that I have lattice degeneration, micro lids (caps) - not sure how to translate it and tractions. Acorrding to him and ultrasound specialist these micro holes(?) and tractions cause the risk of further detachment and that's why it should be treated by laser. On my printout from USG  I see the comment that in both eyes the borders of the vitreous are invisible. I'm not sure if it means that the vitreous is ok? All of them (3) told me that there are tractions and that's why photocoagulation is needed. I consider the meeting with the third retina specialist, but not sure it will change the diagnosis. I'm a little confused, cause I read that asymptomatic micro holes needen't treatment, but maybe I'm wrong and just afraid too much of the laser intervention;) Thanks in advance for your comment on that. Have a nice day!

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

First of all the diagnosis of "snail tracks" is incorrect. It was not confirmed by the second opinion.  lattice is not anything like snail tracks.  Lattice is common (I have it) and most people don't need treatment.  Lattice can have small holes and if no traction generally no treatment needed.   Lattice with vitreous traction is not "assymptomatic" because of the traction.    Since both have recommended laser its your option whether to do it based on 2 opinions or seek a third.  If you understood right the first doctor was incorrect in calling this "snail tracks" when its lattice with small holes and traction.

[Agnes2001]

Thank you for the quick reply. The first doctor just told me that I need laser, nothing else. After the appointment I asked for documentation and I saw the the doctor wrote snail track and traction. I read in a medical article that some authors believe that snail track is an early stage of lattice degeneration. Anyway, my question is how the retina specialist decide whether the traction exists or not? Is it possible to observe it using Goldman triple mirror? As I understand corectly,in my situation the most important thing is to make sure if this traction is present?

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

Sometimes the Goldman 3 mirror can tell you, other times can see with indirect ophthalmolgocy, sometimes can see with OCT.  Whether to treat or not depends on a lot of other factors: how myopic are you. Lattice in hyperopes,  emmotropes and mild myopia not as much concern as moderate of high myopia, more concern if superior temperol, less concern in lower half of eye, more concern people who have had major trauma or cataract surgery or family history of retinal detachment.    There is no agreement among 'experts' whether snail tracks is early form of lattice and who/if leads to high rate of RD and who needs to be treated. So you will proably need to go with the recommendation of the two Eye MDs you feel most confident int.

[Agnes2001]

I see, thanks a lot for your answers and advice. All the best!

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

And to you also.