vision loss: should i do something more?

[carolee]

Female, age 62, normal weight, very myopic.  Evening of Aug. 25 I was driving home, heat index 100, airco not working.  During 45 mile trip I noted black area at very edge of vision field, right eye, upper quadrant nasal side. Location from about 11:50 to 11:55.  Aug 26, Aug 27, area was gray and had spread a little.  Aug. 27, had spread a little more.  Aug. 28 had spread a a little more (approx 1/3 of quadrant) went to see optometrist A,  IOC right eye 25; left eye 23. he dilated eyes and diagnosed early state macular degeneration. Aug. 29. had spread into lower nasal quadrant. called optometrist B . by appointment Aug. 30 gray had spread into upper and lower temporal quadrants.  Central vision by this time was slightly affected. IOC right eye 25.7; left eye 28.  Thorough examination. no defects in the eye itself, (no tears or rips whatsoever, fundus normal, everything normal) said he wished his macula was as good as mine.  told me problem had to be behind eye - vascular, vision pathway or inflammation of optic nerve.  prescribed acular ls 4x a day.  little, if any, change since Thursday's visit.   went back this morning 9/1 for more detailed vision field test.  he was not there, assistant did the test.  printout results for right eye. upper nasal quadrant mainly black encircled with gray with some white innerspersed and a larger section of white near intersection of four quadrants.  lower nasal and upper temporal mainly gray with black innerspersed and a few patches of white.  lower temporal more white than gray with black innerspersions.  left eye unremarkable. he's not going to see the results until Tuesday.  I am alarmed.  Concerned about this gradual loss of almost all my right eye vision in  course of 8 days.  Terrified this is going to happen to my right eye.  Should I go to an emergency room or just wait until Tuesday? No precipitating event.  no injury, no medications except two aspirin a day.  

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

Hello carolee. Thanks for the follow up. I'm most gratified that you are now seeing a neuro-ophthalmologist. I hope others learn from your experience. For medical problems go to a medical physician that does eye disease and surgery (Ophthalmologist). Also when you call the ophthalmologist if its a drastic thing tell them you consider it an emergency. If you can't get it call another, and another.

Most practices like the one I belong to keep empty spaces to see same day emergencies.

Hope all turns out well Carolee. (please read the prescribing information carefully about Diamox (numbness and tingling in toes and fingers, carbonated beverages will taste flat; and especially about oral steroids).

JCH III MD

[carolee]

First, I want to thank you so much for responding to me.  Watching the inexorable encroaching darkness is a very scary time.

I followed your advice and contacted a well know ophthamologist at 3 a.m.  Amazingly he picked up his phone.  He asked me several questions because I was 70 miles from him.  He theorized that I probably had a hemorrhage of some sort behind my retina.  He asked that I call him the following morning to arrange to meet him at his office on Sunday.  When I called he spoke with me for more than 1/2 hour and opined that the situation would not suffer by wating  until Tuesday morning.  I went to his office at 8 a.m. today. He gave me a thorough exam and referred me to a brilliant neuro ophtamologist.  Diagnosis:  perineuritis of optic nerve.  the inflammation exerted enough force against the back of my eye to cause a hemorrhage behind my retina.  I am now on diamox to reduce swelling of optic nerve and will commence prednisone on Thursday.  Apparently my optic nerves are smaller in diameter than normal and my right optic nerve is aberrently small. Both are inflamed but only right one is affecting vision at this point.  We are awaiting blood tests to hopefully ascertain systemic disease or condition causing swelling and then she will prescribe appropriately.  If condition is not responding by Tuesday, surgery necessary.  Already some of my central vision is returning.  Words are inadequate to describe how grateful I am for your immediate response to my situation.  For what it's worth, I attempted to get an appointment with both of the two ophthamalogists in my rural area.  Neither would give me an appointment without a referal from my primary physician or optometrist.  My GP doc retired two years ago.  I fully intend to visit with each of the optometrists and ask but one question:  "Why didn't you immediately refer me to an opthamalogist?"  I take full responsiblitly for not being more assertive but at the time, I believed they certainly knew more than I.  However, their failure to recognize the efficacy of referring me remains inexplicable.

Again, thank you so much for devoting your time to this forum and responding to my situation.  I will let you know of my, hopefully, successful outcome.  Because of your advice I was able to quit obsessing about my deteriorating vision and take some productice action.  

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

Carolee, it seems you should have been referred to an eye physician (ophthalmologist) after your first visit to an optometrist (a non-physician, limited care eye provider) . I would make every effort starting immediately to see an ophthalmologist as an emergency and NOT wait till Tuesday, especially if you are seeing  an optometrist again.

You can start calling ophthalmology practices and tell them what's happened and that things are getting worse and you still haven't been referred to an ophthalmologist. You can also call your personal physician (or the physician taking call for him/her over the holiday weekend) and ask if they would help you see an ophthamologist hopefully Sunday AM.

If all else fails I would go to an emergency room as they will have an ophthalmologist on call that must attend to eye problems that present. I would be sure that you tell the ER physician that you want them to call an ophthalmologist in.

I repeatedly have emphasized to readers the difference in training and skill of a   MD EYE PHYSICIAN (OPHTHALMOLOGIST) and a non-physician, limited eye care provider (OPTOMETRIST). Your problems clearly illustrates the wisdom of seeing a full service MD physician.

Please move on this quickly and if a diagnosis is made please re-post so that we may learn the diagnosis.

JCH III MD Eye Physician and Surgeon