Retina - distorted vision

[volusia]

Hello, first post here,  About 3 1/2 years ago I had a vitreous detachment in my right eye and about a year later I noticed that my vision in that eye was becoming distorted. Straight lines were now curved and my vision was no longer sharp. In December of 2020 I had a vitrectomy to remove an epiretinal membrane to supposedly correct the problem. For about six weeks after surgery I was on predforte and combigan. At this point the surgeon said everything has healed and stop taking the drops. A month later I noticed that my vision in my right eye had deteriorated and I went to see a different eye Dr. My corrected vision had changed from 20/30 to 20/200 and the pressure in my eye was at 28 and I now have glaucoma. Since February 2021 I have been on glaucoma drops and have had cataract surgery. My vision is back to 20/30 with a new prescription but my vision is still very distorted, everything is curved. So can I assume the vitrectomy was a failure? and that there is nothing that can be done? I love to play pickleball but my game is limited with poor vision.  Thank you

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

First of all a vitrectomy almost always causes a cataract. It was probably in the conscent form you signed. Second ERM surgery is very unique and individual so it is not possible to generalize. If your vision right now is better than the day you had your ERM surgery then it has improved your vision.  More often than not ERM surgery improves vision but does not make vision return to normal or eliminate the distortion. The glaucoma drops are problomatic. Pred Forte is a steriod and about 8% of people are steroid responders. So the PF steroid might have caused the intra ocula pressure (IOP) in your eye to go up. usually after the steroid the IOP goes back to normal. In rare cases it can remain elevated.  When you have a retinal detachment, retinal tear, retinal hole or ERM in one ey your are at high risk for the same in other eye.  If you get glaucoma in one eye you are at high risk for  glaucoma in the other eye. My suggestion would be to get a second opinion from a different retina surger.  Ask:  1. is there anything else that can be done to help my macula.  2. Do you see any sigh of holes/tears/retinal detachments in either eye? Does my other macula have any problems? Does my other eye have any cataract.  What kind of activities can I do.       If you have 20/30 vision in 'bad eye' but 20/20 in the good eye you should be seeing quite well and not have 'poor vision' if it is poor what is wrong with the unoperated eye?

[volusia]

Thank you Doc, my left eye is corrected to 20/20 and my iop was at 19 so the DR put me on Rocklatan in both eyes and cosopt in just my right eye. My vision is very good for driving but not very good for swinging at a moving ball. I was much better at that before all of this started. My eyes have trouble judging depth perception which I assumed was due to the distortion in my right eye. I sometimes trip going up or down from a curb. The DR has cleared me for all normal activities and I have been told of the risks to my left eye as well. Thank you

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

Either live with it and continue to see your present EYE MDs (a retina eye physician and a retina eye MD) or for your piece of mind see a different retinal Eye MD specialist and get a second opinion.

[volusia]

The Drs are now telling me that the optic nerve in my left eye is thinning out despite my eye pressure being in the low teens with the Rocklatan. Not sure why this is happening. In addition I have terrible pulsating tinnitus. I had a MRA scan of the head which turned out as normal. I'm starting to question whether my glaucoma is caused by high eye pressure or some vascular problem near my eyes.

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

It is not at all likely that the tinnitus is effecting your eyes. That needs a full work up.  Your IOP at one time was 28. It is likely that you have Chronic Open Angle Glaucoma. To determine if glaucoma is progressing a nerve fiber layer OCT with high quality image 9 or 10/10, a visual field, and a careful look at your optic nerve is needed to determine if glaucoma is progressing. My suggestion would be to gather all your records and see a Eye MD glaucoma specialist for a second opinion about your glaucoma.  As a physician I am never angry or hurt if a patient asks for a second opinion, it doesn't happen often because i am quick to get second opinions if difficult or complicated cases.