Solar Retinopathy?

[cbfpga71]

Hello Doctor!

I had an accidental momentary (1-2 second) gaze at the sun during the eclipse in August. I experienced pain, blurred vision, sensitivity to light, an increase in floaters, and dim vision/reduced night vision. I am concerned about solar retinopathy. I have seen three different opthamologists and a retinal specialist - all have said my eyes are perfectly healthy and show no signs of solar or diabetic retinopathy. OCT has been done 4 times along with fundus photography and there are no visible signs of any damage.

The pain, blurred vision, sensitivity to light and dim vision have not improved. Is it possible to have solar retinopathy and have all these tests come back "normal"? This has become a source of great anxiety and I am extremely concerned about my vision.  If it is not solar retinopathy, what else could it be?  Perhaps optic neuritis?

Thank you for your time and consideration!  

[JohnHaganMD]

Damage to the eye from the total eclipse of 2017 were far fewer than predicted. I saw one.  Most occurred with staring at sun for several minutes. One case was described in medical journals with just a glance of a few seconds. The macular OCT was abnormal in that patient and in the very few our practice saw in Kansas City. With  4 ophthalmologists and 4 normal OCTs and nomal photography it is highly unlikely you have solar maculopathy. IF YOU DID there is no treatment for it expect passage of time.  Read about Amsler grid testing, print out an amsler grid an monitor your eyes weekly. If the spot gets bigger or new symptoms appear you might see consider this testing: visual fields, office amsler grid, macular OCT angiography and fluoroscene angiography.

[cbfpga71]

Thank you Dr. Hagan!  I have read many of your responses here and really appreciate all that you do.  I have had two visual field tests which have both come back normal.  The last one was on December 16.  I have used an Amsler grid at home and in one doctor's office without any distortion/blind spots (lines a little blurry, but I am also a type 1 diabetic).  FAF was performed by retinal specialist 2 weeks after incident with no abnormal findings.
The last doctor I saw was actually an optometrist (an alternative medicine/acupuncturist recommended).  She diagnosed me with a mild astigmatism/farsightedness.  I found it odd that none of the opthamologists found that I may need glasses.

My follow up questions are.....1.  Would solar retinopathy still be causing pain/discomfort in eyes over four months later?  2. If not solar retinopathy, what could be causing all these symptoms?

Again, thank you very much for all the help and advice you provide!!!

[JohnHaganMD]

The primary symptom of solar maculopathy is a blurred or distorted vision near the center of sight (fixation)  This patients we saw had this symptom and the case reported in the ophthalmology journals with only a few seconds of exposure had a tiny blurred area they could map out just off fixation.  Floaters would not be caused by solar maculopathy nor is the condition painful even in severe cases. So I would have to say I think it highly unlikely you have that problem.  If a patient comes to our practice for a "complete eye exam" we always do a glasses test as part of the exam (refraction). If they come in for just a medical problem we often do not do a refraction. (we use the pinhole test to see if it improves vision).  Moreover most retina ophthalmologists do not do refractions at all as it antagonizes comprehensive ophthalmologists and optometrists that refer them cases.  Some insurance such as medicare do not pay for glasses test and it comes directly out of the patient's pocket so they often get upset if we do the test on a medical.  Finally optometrists prescribe glasses about 10-15% more often than comprehensive ophthalmologists. You can debate whether eye MDs under prescribe or ODs over prescribe to enhance revenue.

[cbfpga71]

Thanks again Dr. Hagan!  Other than potentially needing glasses, what other conditions could cause the symptoms I detailed in original post?  Thank you!

[JohnHaganMD]

Well given your normal eye exams by 4 Eye MDs not much remains.  Without an exam cornea pathology, cataracts, uveitis, macular edema come to mind but these are usually easy to diagnose.  Glasses problems are not usually sudden onset and usually not painful. What was your visual acuity without glasses when you say the eye MDs? What was it when you saw the optom and what is the glasses Rx given you?

[cbfpga71]

Visual acuity ranged from 20/20 to 20/25 in both eyes at every eye MD - never worse than 20/25 and almost always 20/20.  The blur is not as bothersome as the pain/discomfort and the dim vision/decrease in night vision.  The dim/night vision issue has me concerned that photoreceptors (rods) have been damaged.  But as we have discussed, there is no physical evidence of such damage.  

The glasses rx is as follows:
Right eye:  sphere +0.75, cylinder -1.00, axis 90, add +1.00
Left eye: sphere +0.50, cylinder -1.50, axis 90, add +1.00

[JohnHaganMD]

Hard to tell how those glasses will help or hinder. Did the optom let you look through the RX at the office and compare it with what things looked like without them?  You would need to do that to see if its worth the expense of buying the glasses.  Some people would wear that RX all the time and find it very helpful, some people would wear it for certain things like driving at night or prolonged reading, others would not like the glasses and find them uncomfortable to wear.  Another potential night vision problem is the use of nicotine or cannabis.  You don't use those products do you?

[cbfpga71]

I do not use those products.  I did look through the RX at the optom and things looked a little better but not much difference.  Would I find them uncomfortable because of the progressive lens needed for that script?  I really appreciate your help in trying to get to the bottom of this with me.  Every eye MD has brushed off my fear of solar retinopathy even though these symptoms began the same evening as my 1-2 second exposure.  I have read almost everything there is online about the subject and I understand there is no treatment.  I just find it hard to believe that these symptoms have nothing to do with sun exposure.  Believe me, I hope they have nothing to do with that but I cant keep going to eye doctors just to be told that my eyes are perfectly healthy and there is nothing wrong.  Any other suggestions/ideas/theories would be greatly appreciated.

Thank you!

[JohnHaganMD]

This is the reference to the paper in the medical journal OPHTHALMOLOGY of woman with damage to macula starring for 6 seconds.  https://www.theverge.com/2017/12/7/16746040/eclipse-2017-solar-retinopathy-sun-damage-eyes

I think you may misinterpret what the Eye MDs are saying.  Not that your symptoms are imagined or not real; not that your eyes are perfectly healthy, if they were you would not have symptoms. They are saying none of these test suggest solar maculopathy or show any other serious disease. Whatever you have is likely not serious or it would have shown up.    I tell people this all the time. I don't know what you have causing your unusal symptoms but I don't think its likely serious and I do know what its not and we have excluded at this time the major serious disease that might cause this symptoms.  I often say "Better we don't know exactly what you have but know its not serious than know exactly what you have and its very serious. Sometimes a little uncertainty is preferred.  You can also ask the optom if the glasses don't help you if you can have a refund or return them. A place like lenscrafters or eyemasters will often do that.

[cbfpga71]

Dr. Hagan,

Thank you again for your help and advice!  It is greatly appreciated.

I agree that it is good to know it is nothing serious.  I hope that this clears with the passage of time.

I had actually read that article as it happened here in NY.  I have considered contacting that doctor but it seems like it would most likely be a waste of time just to hear another eye MD say there is nothing wrong.

Thank you!

[JohnHaganMD]

Welcome

[cbfpga71]

Dr. Hagan,

Hi!  Me again.

Do you think optic neuritis is a possibility in this case?

Thank you!

[cbfpga71]

Hi Dr. Hagan,

Me again!  Do you think optic neuritis is possible in this case?

Thank you!

[JohnHaganMD]

No. Solar exposure does not cause optic neuritis.  If you had optic neuritis incidental to the eclipse (not cause but occured about this time)  The symptoms would be different and it should have shown up in the tests 4 ophthalmologists did in their office.

[cbfpga71]

Thanks again Dr. Hagan!  I am really concerned and I know we have ruled some things out. I am having a really difficult time dealing with these symptoms with no answers (besides a slight astigmatism - which I think we both agree would not be causing all these symptoms).

I don’t know where to turn next. Neurology?  Get the glasses and see what happens?  Seek yet another opinion?

Thank you!

[JohnHaganMD]

Consider: 1 getting glasses to see if they help. Asking the optician if not help or Rx has to be changed soon can they be returned for full or almost all costs. Any regrinds done in first year done at no charge?  2. If glasses not help and available see neuro-ophthalmologist.

[Ang0485]

Hi Dr- I have a questions regarding the cones and rods in the retina? Are they viewable? Meaning would an eye doctor be able to see them through dialation or on any screening like the OTC? Thanks!

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

No the rods and cones are too small to be seen only shows up on pathology slides or electron microscope images

[Ang0485]

Hi Dr.

I have a question regarding the retinas and “burning” them. I was standing in my kitchen talking to my brother in law and my kitchen light was pretty bright. After a couple seconds, I moved so it wouldn’t be in my vision. However, about a half hour later, my eyes started to hurt. After that, I have had photophobia and light sensitivity. I’m so nervous I damaged my retinas.
I went to my optometrist and she dialated my eyes and said she doesn’t see anything too alarming. I then went to a the retina specialist in that practice and he took images, OTC scan, and dialation. He said everything look good. I mentioned rods and cones and he said he doesn’t have the ERG machine and referred me to a practice that has that because of my peace of mind. He said he doesn’t think anything wrong but I insisted since I would like answers and he was very willing since he could see I’m worried.
I go next week to the new practice.
My question is can a light injury damage cones and rods or am I thinking too much into it? I’m so nervous I damaged the rods. If everything else looks good on the OTC and dialation, does that means the rods and cones are affected? Thank you doctor!

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

There is virtually no likelihood that  you have damaged your eye.  I think your biggest problem is anxiety, some of the money you are sinking into a lot of unnessary eye tests might better be spent working with a psychologist or psychiatrist.   Even with damaging light exposure such as stareing at the sun or looking at an idustrial laser rods are almost never damaged just the cones in the macula

[Ang0485]

Thank you Dr. So the cones can be damaged? Would that cause severe light sensitivity? Cone damage?

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

I'm not walking down 'Anxiety Lane' with you.

[Ang0485]

Hi

Did your symptoms ever resolve or did you ever figure out a diagnosis? I have the same symptoms as you and your post came up during a search. You can reply back to me on here or email me at ***@****. Hoping your eyes are better now.

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

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[cbfpga71]

Hi Ang!  Sorry to hear your symptoms are similar.  Mine have not resolved or subsided.  It has been a year now and i have had very little relief.  My eye pain/discomfort is much worse when I am outside in hot/humid conditions.  I work as a golf professional, so i am outside most of the day and this summer was brutal here in the northeast.  I have seen many eye MD's and none have seen anything wrong with my eyes.  I do wear glasses sometimes now and that USUALLY helps my vision but does nothing to alleviate the pain/discomfort I continue to feel.  I hope you find relief soon!  Best of luck!!

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

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[Ang0485]

Hi-
Are you able to drive at night? I haven't been able to drive at night especially with these LED headlights. How are you in stores with the overhead lighting? I have to wear a cap when going to stores. My biggest symptom is photophobja. And can I ask where is your eye pain? Mine is in the upper parts of my eyeballs. I'm in New Jersey so we're in the middle of a heat wave.
I also have chronic dry eye (MGD). Did anyone say your eyes could be dry or have meibomian glands disorder?

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

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