eye surgery question

[bobbyr]

I went to the Optemetrist who ran a test that landed me at a retinal specialist who said that I would benefit from the following procedure on my left eye:

vitrectomy with membrane peel

90% chance of success, with the level of success a bit of a question mark.

Wondering if anyone has had this surgery?

 

[Katsmeow]

Yes, indeed. Here is my long thread about it:

https://www.early-retirement.org/fo...-cataract-surgery-also-post-lasik-109448.html

There are a lot of factors. The vitrectomy and peel are themselves not difficult. Depending upon the location of the pucker (I assume you have a macular pucker but you might have a hole), you will most likely end up with either no gas in your eye, short acting gas, or long acting gas. I went in with a likelihood of short acting gas but a retinal tear was found which necessitated the long acting gas. The difference is that the short acting gas goes away very quickly while the long acting lasted 10 1/2 weeks for me. During that time I could very little with my left eye due to the peel.

Also depending on what they find and the gas they use, you may have a positioning requirement for some period of time after surgery. In my case I had to be face down during the day for I think a week and then had to sleep on my side for several weeks. I talk about all this in the thread. If there is any possibility of a positioning requirement you should rent equipment that will make that a little easier to bear. I rented it for a week and it helped.

The doctor may have already talked to you about cataract. If you have not had a cataract replaced in that eye, the vitrectomy typically either causes a cataract or make it much worse. Pre-surgery I had a mild cataract. A month after the vitrectomy my visual acuity had greatly improved showing that the peel had helped. A month after that, my vision got much worse which was the cataract getting worse. As a result, I had cataract surgery 3 months after the vitrectomy.

It is how almost year since my macular pucker was discovered. I have good vision in my eye that had the peel. Post cataract surgery they were my left eye vision was about 20/25, almost 20/20. Before I had the peel I think my best vision in that eye was 20/60 or so. So the peel really did help the loss of visual acuity. I also had distorted vision from the pucker. Mostly horizontal lines and vertical lines being wavy. (I check this with an Amsler grid). Also when I look at something with my left eye it looked like it is slanted down to the right.

It is about 9 1/2 since I had the vitrectomy. The distorted vision has not really improved much if at all. The doctor says you can get improvement for up to 2 years after the peel but most improvement in usually in the first 6 months. I think the distorted vision for me is not likely to improve.

But, that is honestly a minor problem. The return of my visiual acuity was far more important (oh -- I now have monovision in my left eye so I don't actually see 20/25 with that eye but that is fine as the monovision helps my vision overall).

I don't actually even notice the distorted vision any more. With both eyes open I really don't "see" it. If I close my right eye, then I can tell the distorted vision is still there. But, of course, I always use both eyes together so it is all fine.

 

[bobbyr]

wonderful info, thank you...I'll digest all of the other thread (three pages!)

 

[target2019]

I went to the Optemetrist who ran a test that landed me at a retinal specialist who said that I would benefit from the following procedure on my left eye:

vitrectomy with membrane peel

90% chance of success, with the level of success a bit of a question mark.

Wondering if anyone has had this surgery?

You need a second opinion IMO.
We only use specialists at local university hospitals.

 

[bobbyr]

You need a second opinion IMO.
We only use specialists at local university hospitals.

Generally agree, although I have seen the pics, had it explained to me and no pressure was put on me to have it done if I didn't want to...

I am almost 64 and my insurance is not great...I may defer until medicare (will first get an insurance quote to find out how much this procedure along with the follow up cataract surgery will cost me).

 

[target2019]

Generally agree, although I have seen the pics, had it explained to me and no pressure was put on me to have it done if I didn't want to...

I am almost 64 and my insurance is not great...I may defer until medicare (will first get an insurance quote to find out how much this procedure along with the follow up cataract surgery will cost me).

I am not in the medical field but have long history with several trusted individuals in Ophthalmology.

Almost ten years ago a specialist at local eye hospital showed me pictures, and I too have a pucker. I still have a pucker. What is cool is that the equipment to capture the images and 2D projections is available in more than just limited locations as in the past. So I now see an opthalmologist at local eye clinic.

The advice I've given you is all that I have. I know that the domestic and foreign specialists who are friends are very cautionary with today's recommendations.

That is not medical advice, though. Hope it works out for you.

 

[Chuckanut]

I have a hole in the top layer of the retina. When I discovered it, the thing was scary, causing distortions near the center of my vision. But, overall, I could still read, safely drive a car, and go about my life. My optometrist at that time advised me to wait. It's been about 5 years. The hole has healed quite a bit but it is still there. However, the distortions are completely gone. Other than taking the pill mentioned below I did nothing other than watch and wait.

FWIW, I take a daily AREDS2 pill. It's a combination of nutrients specifically designed to help the retina. Apparently, it helps some people who have macular degeneration. There is no evidence that it helps other retina problems such as mine. I take 1/2 the dose recommended by the study. I figure it can't hurt to take the nutrients.

 

[bobbyr]

I love this forum. My wife said 'post on the forum and you'll probably get a lot of feedback'

she was right, thanks folks...I am moving very slowly on this and every bit of feedback is helpful

 

[TrvlBug]

I have issues resulting from recent surgery for a severely detached retina. The scans they can easily do now are amazing. I see the monthly progression of healing at the cellular level, however, it does not correlate with functional improvement. The retina specialist says they are seeing improvement after years so there's hope for me yet. In the meantime, he has also suggested the AREDS2. It can't hurt and may help.

 

[MRG]

I have issues resulting from recent surgery for a severely detached retina. The scans they can easily do now are amazing. I see the monthly progression of healing at the cellular level, however, it does not correlate with functional improvement. The retina specialist says they are seeing improvement after years so there's hope for me yet. In the meantime, he has also suggested the AREDS2. It can't hurt and may help.

Mine took a year or more to get better. I had severe, at least for me, distortion that has eventually gone away. Good luck.

 

[Aerides]

I went to the Optemetrist who ran a test that landed me at a retinal specialist who said that I would benefit from the following procedure on my left eye:
...

Perhaps it's the phrasing, but "would benefit from" is not a very good reason for surgery.

Would solve a problem
Would save my eyesight
Would dramatically improve my eyesight

- that's when I'd consider surgery- only when necessary and/or it solves an issue of which you are acutely aware.

It very much sounds like you are being shopped a procedure you don't actually need. Even if it's the softest selling attempt, as you've written things it doesn't sound like something I'd consider.

 

[TrvlBug]

Mine took a year or more to get better. I had severe, at least for me, distortion that has eventually gone away. Good luck.

Unfortunately, my vision will never get back to my previous normal nor get any better than it currently is. This has been confirmed by very highly qualified second opinion. I'm on his list for any trials that may open for which I qualify and am interested in, of course. The healing at the cellular level should continue though and that's the best I can hope for. Sometimes life gives you the short straw. What frightens me most is the unknown cause of this freak occurrence.

 

[TrvlBug]

Perhaps it's the phrasing, but "would benefit from" is not a very good reason for surgery.

Would solve a problem
Would save my eyesight
Would dramatically improve my eyesight

- that's when I'd consider surgery- only when necessary and/or it solves an issue of which you are acutely aware.

It very much sounds like you are being shopped a procedure you don't actually need. Even if it's the softest selling attempt, as you've written things it doesn't sound like something I'd consider.

While I have never had unnecessary surgery, based on my experience during the last one, I would NEVER consider any type of invasive medical action that was not absolutely medically necessary. You never know what could happen.

 

[Katsmeow]

Generally agree, although I have seen the pics, had it explained to me and no pressure was put on me to have it done if I didn't want to...

I am almost 64 and my insurance is not great...I may defer until medicare (will first get an insurance quote to find out how much this procedure along with the follow up cataract surgery will cost me).

On the issue of whether to have the vitrectomy, what visual problems are you having due to the pucker (again, assuming you have a pucker -- if not, clarify).

In my case, the pucker occurred after a retinal tear and it greatly affected my visual acuity in that eye, reducing my vision in that eye to 20/60 to 20/70. Also, it caused distorted vision (which I described in my earlier post). In my case, the only way to improve my vision was through the peel. The surgeon was clear that there was a small percentage of people that would see no change in vision after the peel. There was a very small percentage where vision could get worse. For him, personally, over 90% of his patients have gotten improvement in vision from doing the peel. I know that he does sometimes advise people to wait and monitor depending on the situation. One of the other members here had the same surgeon I had and in his case we waited I think a few years before having surgery. In my case, though, my vision was already bad and getting worse and only surgery would help.

Your doctor should be able to clearly explain to you how your vision is being impacted by the pucker (if it is) and what improvement is likely. He should be able to explain to you the risks. He should be able to explain the overall results the he usually gets from this surgery.

One thing to specifically ask is whether there is any risk in waiting to have surgery. In my case, the pucker was getting worse and it was better to get it peeled sooner rather than later. But different people have different situations. Unless you are really comfortable with this doctor I would get a second opinion. (In my case, the retina specialist was already DH's doctor for several years so I knew a lot about him).

 

[Telly]

On the issue of whether to have the vitrectomy, what visual problems are you having due to the pucker (again, assuming you have a pucker -- if not, clarify).
------------------

Your doctor should be able to clearly explain to you how your vision is being impacted by the pucker (if it is) and what improvement is likely. He should be able to explain to you the risks. He should be able to explain the overall results the he usually gets from this surgery.

That is a very good question, Kat. Does the patient see an issue themselves?

For me, I knew something was up when I was noticing some curvature in one eye. PCO had made it less noticeable, but I knew something was there. After YAG laser work, where everything was clear again, it was more noticeable. My Ophthalmologist said if we could get my vision via lenses to be acceptable, then I was ok for now. Luckily, my distortion is above the "reading spot", the fovea. If I'm reading this forum, for example, I have no problem with a line of text. I am "aware" that some lines higher up have a bit of a hump-up in them, but of course if I look up at the curved lines, everything straightens out immediately, since it is above the reading spot.
Floor tiles laid in checkerboard pattern show it up, once again I am aware of some distortion above where I am looking. IIRC, I think the field of view using the fovea equates to an area of one or two of your thumb-widths at full arm extension. My distortion is out of that area, great! No guaranty that it won't get worse, but so far so good.

In my case, I think I know what caused it... the back of my head slamming down on a concrete floor. It was quite an impact. It was a bit after that that I started to sense something was not as it was before. Took a bit of time for the scar tissue to grow enough to pull on the retina. A scan at the doc's (was it an OCT? don't remember what the scan scheme was) showed it well. A colored contour plot, and a elevation versus location line plot showed it well.

 

[Katsmeow]

That is a very good question, Kat. Does the patient see an issue themselves?

For me, I knew something was up when I was noticing some curvature in one eye. PCO had made it less noticeable, but I knew something was there. .

In my case, I noticed the visual acuity in my left eye diminishing. I had had LASIK many years ago so was used to very good distance vision. I knew I had a mild cataract and thought it was due to that. DH and I went for a drive one evening because I wanted to see how my night vision was. I was opening and closing my "good" eye when I noticed that a street light bar looked slanted.

Came back home and really looked with just the left eye and it was immediately clear how blurry it was and I looked at am Amsler grid and found the distortion. I called the retina doctor the next day (I was actually worried about macular degeneration as DH has the dry form of it).

In my case they found a retinal tear which apparently occurred when I had PVD in that eye. The doctor repaired the tear that day but the scan found the pucker.

Over the next 2 months, until I could have the vitrectomy, my vision in that eye kept getting more and more blurry. So in my case it was very noticeable once I started looking at things with just the left eye. The combined vision made it hard to find it.

 

[bobbyr]

Perhaps it's the phrasing, but "would benefit from" is not a very good reason for surgery.

Would solve a problem
Would save my eyesight
Would dramatically improve my eyesight

- that's when I'd consider surgery- only when necessary and/or it solves an issue of which you are acutely aware.

It very much sounds like you are being shopped a procedure you don't actually need. Even if it's the softest selling attempt, as you've written things it doesn't sound like something I'd consider.

They couldn't give me the level of improvement, but they said I would at least be able to read more than the top line at the eye exam. Currently my left eye, left on it's own, distorts everything, letters move around...not very functional.

I appreciate your point and am not jumping into this without more consideration. The doctor at the retinal clinic said that due to not knowing how long the scar tissue has existed, it was tougher for them to evaluate how much improvement i would have. *I think it's been for a pretty long time, as my left eye has been bad for many years

The doctor also said I had lattice degeneration, that made the possibility of having a detached retina higher. (Small detail I forgot to mention lol)

 

[target2019]

Here is an authoritative description of lattice degeneration:
https://www.aao.org/eye-health/diseases/what-is-lattice-degeneration

Vitrectomy and membrane peel description:
https://www.aarp.org/health/conditions-treatments/info-2021/eye-membranes-vitrectomy.html

 

[bobbyr]

Here is an authoritative description of lattice degeneration:
https://www.aao.org/eye-health/diseases/what-is-lattice-degeneration

Vitrectomy and membrane peel description:
https://www.aarp.org/health/conditions-treatments/info-2021/eye-membranes-vitrectomy.html

very helpful

 

[eytonxav]

That procedure did wonders for my right eye, but if did take quite awhile post surgery for the full benefits to be realized as it can cause a lot of inflammation. No surgeries are foolproof, even if you are getting cataract surgery, but if your surgeon is good, the outcomes nowadays should make your vision better.