Please help - can't identify cause of sudden visual decline

[flossy93]

Thank you for a valuable forum and resource for those of us with high-myopia-induced eye concerns.

I'm 50 a lifetime history of high myopia (-14.0 both eyes).  I've used soft lenses since I was a teen.  My degree of myopia has been stable for the past 10 yrs.  I've had a bit of astigmatism in the left eye for years, but it's been tolerable without toric lenses.  I use drugstore readers for fine work (about +1.5), but don't need them all the time.  I have had early onset cataracts developing in both eyes although they've been described as 'mild'; the left eye had very mild blurring from this but no material impact on my daily life.

Two weeks ago I noticed a sudden vision impairment in my left eye.  It started after I stood up suddenly; for a minute it seemed my eyes couldn't focus on the same object at the same time, then when I tested each eye separately I noticed a distortion and greater blurring in my left eye.  The LE also now has vertical distortion of straight lines, and a decrease in contrast on an Amsler grid test (the lines look grey rather than sharp and black, and the vertical lines have a wave/curve - the lines are parallel, they just have a bend or curve).  Central vision in the LE sees square objects as if they are being 'stretched' to the left & up a bit.

I immediately went to my OD, a cataract surgeon and a retina specialist I've seen before.  All tests have been normal to date, although the retina doc (when pressed about the distortion) said he thought he saw 'a bit of foveal thinning' on the retina photo of the affected eye.  He did an OCT which he said appeared normal, although he did not do a FFA or other angiography.  The cataract doc said he could do surgery any time; the retina guy said wait as long as possible.  

So far no specialist has identified the problem's source.  It sure doesn't feel like cataract+astigmatism only.  I'm afraid there's a hidden subretinal or vascular problem.  I'm terrified - what should I do?  

[Doreen Fazio, M.D.]

I am happy you saw Dr. Ward.  If you are still uneasy, you might consider a consultation with a retina specialist at one of the major university teaching hospitals in your area.  The answer might be the same, but at least you will be reassured that you are being recommended the correct procedure.

[flossy93]

Well, the results are in and they aren't good.  Dr Ward diagnosed me with degenerative myopia and an axial length of greater than 30mm in both eyes.  He said the symptoms I have experienced are probably a 'proto-CSR' and that I also have a Fuch's spot in the symptomatic eye.

I have a followup with Dr Ward next week during which I will probably be discussing potential posterior pole buckle surgery with him (depending on where my staphyloma is located and whether it could be addressed with surgery).  Unfortunately the first appointment was rather brief in terms of time with the doctor, so I did not get to ask any questions after the 'bomb' of 'You have degenerative myopia.'

Given that I have seen retina and optometric doctors regularly, I can't believe I got to 50+ before hearing about this condition.  Maybe no one wanted to tell me that I was facing probably loss of vision with no potential intervention options.  It sounds as though the intervention options now are still quite sparse - perhaps treatment of symptoms as they arise (if treatable),

I'm also confused about whether my eye is still lengthening since my refractive prescription hasn't changed for 10 years.  If not, I don't know if buckling surgery is worth the risk (i.e. if the eye is just held by the buckle at the 30mm length, would that really provide any future risk reduction to what is already likely to happen?

I am confused and scared.  Just wanted to report in, and to emphasize that if something doesn't seem right, be sure you get a second opinion.  

[flossy93]

Thank you very much for the feedback, Dr. Fazio.  

I made an appointment with a different retina specialist (Dr. Brian Ward in Northern California) in a couple of weeks.  Based on what I have read it does sound like there must be some problem near the center of my left macula, since the distorting 'wave' is in the center of my vision in that eye.  

I've also made an optometry appointment to get an update on measurements of myopia and astigmatism in both eyes, to determine if these have changed markedly since my last exam for contacts/glasses 9 months ago.  My OD squeezed me in to peek at the retina a few weeks ago, but did not conduct a full exam.

Hopefully Dr Ward can identify what's causing my left eye symptoms.  Something is definitely not right - notwithstanding that the first retina specialist looked at the OCT results and said 'come back in 2 years unless something else changes.'  That was quite frustrating.

Thank you (and all the MedHelp doctors) for taking time to help the community.  We really appreciate it.

[Doreen Fazio, M.D.]

The distortion is most likely coming from the macula, or the center of the retina.  High myopes can develop neovascular membranes with leakage below the macula.  I would obtain a second opinion from another retina specialist.