Surgery recommended for ERM

[eyesonyou]

I said I would follow up with a post about my problems with the epiretinal membrane in my left eye -- and here I am.

Saw the retina specialist on Friday.  He talked to me about my cataract surgery (already done on Jan. 11) to see how I felt about the results.  I told him I did not feel there was any improvement in the vision in that eye.

He again did an OCT scan on my left eye.  I have severe traction.  He recommended that I have the ERM peel and the vitrectomy.  I agreed with his assessment and tentatively scheduled the surgery for April 1.  The odds of getting some of that lost vision back are certainly in my favor.  I do wish, however, that I knew how long the ERM had been present on my macula.  It would sure help with assessing the situation.  I can only say that this is what I remember:  when first going for visits to my optometrist, she was able to correct the left eye to 20/30, but in a matter of a few years, she could only get it to see 20/40 at best.

My gut instinct tells me that the ERM is more the cause of poor vision than is my residual astigmatism, for which the cataract surgeon did the LRI during surgery. According to the last eyeglasses prescription written for me in Fall 2009, the astigmatism is the same in either eye, yet my right eye sees so much better than my left eye does.

I like my surgeon, he is well thought of, he is very experienced, he does about 3 ERM peels per week, and he has taught the procedure to surgical residents.  He also has good communication skills, and really seems to listen.  I don't know what anyone here thinks about peer rankings, but for the last nine years, he was chosen as a top doctor in my area based on votes from fellow M.D.'s in his discipline.

One other thing -- he felt, since we didn't give much attention to the right eye the first time I saw him months ago, that he'd better do an OCT scan of it as well.  Imagine my dismay when I learned that I've got a very insignificant ERM on that eye, with very little traction -- hardly more than a small blip on a radar screen.  It is not near the problem of the other eye, but now we have to watch it, as well.  :-(

He operates at a large hospital in my area.  I wasn't thrilled with having to go to a hospital to get this done. but oh well.  The post-surgical experience sounds promising.  He says that with the fine new surgical instruments available, healing is a lot faster and patients start experiencing better vision in a fraction of the time compared to the past.

[eyesonyou]

Yes, you've got that right.  My present eyeglasses prescription corrects to best acuity of 20/40 in the left eye.

[caren123]

Just to clarify, it is 20/50, sometimes 20/80 uncorrected and best correction is 20/40 in one estimation, is this what you are saying?  Thanks.

[eyesonyou]

That's very thorough -- consulting 3 surgeons.  Pretty amazing report, I'd say.

My present O.D. seems to give more conservative readings.  And it's true I started out with their practice in an office in another city!  Both of my ophthalmologists rate my uncorrected vision in that eye as 20/50.  My O.D. says, uncorrected, it is 20/80.

Thanks for your help.  It is much appreciated!

[JodieJ]

Before I had my first surgery to peel my ERM, I consulted three surgeons and had 3 eye exams.  My best-corrected vision in my affected eye was measured at 20/30, 20/60, and 20/40 within a few weeks.  I don't really think there was much change in my acuity.  The eye charts and lighting seemed to be what made the difference.  It's been my experience that some charts are easier to read, and others are more difficult.

What's really important is that you have a skilled and experienced surgeon (and you do).  I think that you can look forward to better vision.

[eyesonyou]

Well, Jodie, now I am really confused.

My optometrist office finally called me back and gave me the history.

On 1/23/08, aided visual acuity in left eye was 20/50, near and distance.

On 9/15/09, aided visual acuity in left eye was 20/40, as told to me by the O.D. during the exam (done in satellite office by a different O.D., but they all belong to the same practice).

Well, it sounds like it got better in 1.5 years (??!!!!!)  I can tell you, for sure, that I have had frequent changes to my eyeglasses prescription.

The two prescriptions were:

1/23/08   OD  +1.25   -0.75   163    Add +2.50
              OS  +2.25  -0.50   035    Add +2.50

9/15/09  OD   +0.50   -1.25   165    Add +2.50
             OS   +0.25   -1.25   030   Add +2.50


It's no wonder I'm confused.

[eyesonyou]

Jodie,
I believe that the drop in visual acuity happened sometime in the last year, but I am trying to verify that with my optometrist's office, since they have the eyeglasses prescription for both 2008 and 2009.

My optometrist did not speculate on a cause of the loss of acuity; just that my cataract had grown bigger.  She then referred me to an ophthalmologist, who I went to see very soon after.

If I can find out any other information of interest, I will post it.  Thank you for the reply.

[JodieJ]

Recent evidence suggests that symptoms appear during the month or 2 following ERM development, and in most cases they remain stable after that time.  When did your acuity in your left eye drop to 20/40?  (Did your optometrist look for a reason for this drop?)

Many people have ERMs that are so slight they go unnoticed. Hopefully, the slight ERM in your right eye will never be a problem for you.

Best of luck with your surgery.  I predict that you will never even need a Tylenol during your recovery--this is generally a painless procedure.  Let us know your outcome.

[Ray T Oyakawa, MD]

Good luck.

Dr. O.