Loss of Vision in an Old Friend

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Loss of Vision in an Old Friend

Finding the right doctor for diabetic retinopathy involves trust and friendship.I had an old friend visit me this week.  AB and I met when I was a young doctor in Baltimore.  He was referred to me for treatment of his diabetic retinopathy. Eventually, I operated to remove a vitreous hemorrhage resulting from his proliferative diabetic retinopathy.

For several years, we saw each other twice a year.  He retired about 8-10 years ago and moved to Florida.  There are lots of eye doctors there!

I don’t think we have seen each other for 8-10 years.  As you know, I now practice in Virginia.  He found me on the Internet.

70+ YO Male With Progressive Loss of Vision

When I get to the office, I glance over the patient schedule for the day.  I recognized AB’s name instantly and was excited to see him.

He hadn’t changed much.  I recognized him from across the waiting room, talking with some of the other patients.  He is now in his early 70’s and has had diabetes for 40-45 years.

He told me I’ve gained weight.  He looked as I remembered him, that is, I couldn’t return the  “compliment.”

He said he has had slow progressive loss of vision over the past 6 months.  Reading road signs and watching TV had become increasingly difficult.  He also griped about the last retina doc he saw in FL…didn’t like him at all.

Possible Causes

Diabetic retinopathy can not be cured, but we are often successful maintaining status quo…provided regular checkups occur.

AB not liking his docs could have a couple of meanings;  he doesn’t go back as often as he should, and/or perhaps he didn’t like the news he received from the docs.

The top possible causes?  Diabetic retinopathy (specifically diabetic macular edema), poor sugar control, needs new glasses or cataracts.  While there are many more causes of loss of vision, I thought these were the most likely.

After complete dilated exam, I was happy to report to him that he needed cataract surgery and, most importantly, there were no signs of diabetic macular edema nor active proliferative disease.

What Does This Mean?

Find a doctor who you trust.  That’s the definition of the “best doctor.”  It becomes crucial for patients suffering from long-term, or chronic, diseases such as diabetes or diabetic retinopathy.  All diabetic patients need regular eye exams for diabetic retinopathy.

If you don’t like your doctor, you aren’t likely to believe what she has to say and you won’t go as often as you should.  Simple human nature.

I expect AB to return to 20/20 vision after successful cataract surgery despite his age, length of being diabetic and the history of proliferative disease.

I noted his weight was stable, hinting AB is very disciplined and, unlike me, has been able to control his weight over the years.  I am not sure if there is any causal relationship between good vision and stable weight/diabetic control.

My point is that the disease is not certain to cause blindness or even severe loss of vision and I wanted to share a good story of seeing well despite chronic disease…and a trusting friendship.

 

 

26 Comments

  1. Josh says:

    The title scared me at first, but I read on, and felt better by the end. Being that I have had Type 1 for 34 years and just turned 38 this year weighs heavy, but happy to say my NPDR has recently stabilized and the leakage in my maculas is gone in both eyes for the first time.

    I agree whole heartedly you need to like your Dr. It is tough to go every 5 months and prepare for bad news if you can’t feel comfortable who you are talking to. But the most important thing is to always go to your appointments and do EVERYTHING in your power to reduce your risks by keeping good stable control of the blood sugars.

  2. Miguel Silva says:

    Dr. Randall, i haven’t even met you and i already trust you. You seem to have such a good nature within you that is somehow very reassuring to sufferers whom get in touch with your work.

    Yes, trust is the biggest asset in a doctor/patient relationship. I would never commit to any effort towards such an important endeavor as eye health and treatment approaches if i did not trust the doctor.

    Hope all is well with yourself/family as well as AB. Good luck to him.

    Peace,

    Miguel Matias

  3. Ann says:

    Hi Doctor my question is on another topic. I have written you in the past and you always responded promptly and was very informative. I have been suffering with symptoms of posterior vitreous detachment for the past five years. It started in the right eye but now I have it in both. I’m a very nervous person so I tend to feel everything. My symptoms cone and go. I was fine for the past couple of months and thought maybe it was finally cleared up but two days ago I got up and turned my head and fit the familiar flash of light when I turned my head back and forth. This has been going on at times for the last two days. This has happened before. It seems as if when I’m stressed out about something it gets worse. The doctor told me this has nothing to do with it, however I feel it does. My question is why does the symptoms stop for months and then return and will it ever go away? Also since I have had this so long dies that minimize my chances if it progressing to a retinal detachment? The last time I had bad symptoms was in April when I was in vacation and curiously in about to go on vacation again and I’m afraid to go because last time symptoms got very bad and I came home early because I wanted to see my doctor!

  4. Josh says:

    Ann, as someone who also “sees” all the symptoms, almost too much. ( I check my eyes every day) I would suggest perhaps, if your symptoms come and go it is not a retinal detachment. If it coincides with stress, I would consider it might be ocular migraine or stress on the eyes from stress. It is amazing what the brain does to us visually from stress. Also once our brain has focussed on a symptom, we see it much more clearly… sometimes a small spark can become worse from hyper attention to it. Perhaps see another Dr, instead of being afraid to go back to the same one. It is never a good idea to ignore something causing this much long term anguish. It always helps to ease the mind to get two opinions, and to be quite honest a symptom you speak of would be quite easy for a trained specialist to see right away. Hang in there.

  5. Ann says:

    Thanks Josh. I appreciate your responding to my post. I hope you are feeling better and have no further problems. As I’m sure you know eye problems are very frightening and very hard to ignore. It’s nice to talk to someone who understands take care

  6. Lynn says:

    Hi Dr Wong,

    I appreciated one of your last posts… “Loss of Vision in an Old Friend”. It did hit home. Although I have always had faith in my retina doctor it has come to the point where he can’t help me. I have no more hope that my vision will get better. In the past 14 months I have had 5 surgeries for multiple complex detachments and PVR. I was 55 with no real risk factors (except my age) when this all started. I did everything I was told. I feel like I must have set a record for facedown or side positioning. My vision in this eye is no better than 20/200 but the worst part is that I have terrible double vision and constant moderate discomfort (My eye always feels inflamed, burning, strained). I also have a permanently dilated pupil from scar tissue pulling my iris. All along I was told the double vision was probably the result of the scleral buckle. We tried prisms but they could not correct for the degree of my double vision. My doctor finally agreed to take the buckle out but first wanted me to see a strabismus expert who ultimately felt that the double vision would not be remedied by taking out the scleral buckle. He stated the cause of my double vision is retinal damage and could only recommend a blackout contact lens. My retina doctor feels the discomfort is not a good enough reason to take the buckle off right now but he does not rule it out entirely. He even feels I would have a lower risk of redetachment (than the 30% figures) based on all the procedures I have had….there’s nothing more tugging on my retina. He also states my brain could possibly still correct for the double vision but it could take years (which is a reason not to wear the black out lens). I continue to be on prednisolone for recurring macular edema and have just been put on Latanoprost for increasing eye pressure. I won’t be seeing my eye doctor again until February, but right now I don’t even feel like going back. I’m so tired of hearing bad news. I can’t help thinking that my eye would be much more comfortable without the scleral buckle. Does an eye with a scleral buckle ever feel normal? I would really appreciate your thoughts on this.
    Thank you,
    Lynn

    • Dear Lynn,

      Thanks for posting this as a comment in addition to an email. This is a great forum. If you can make a comment for countless others to witness…it’s much more valuable!

      Thanks for your comment about my recent post regarding “Loss of Vision in an Old Friend.”

      1. We don’t really know who gets PVR. I applaud you for enduring 5 surgeries.
      2. PVR is out of your control. Doesn’t matter what you did or didn’t do.
      3. You are lucky to have 20/200 vision.
      4. Double vision: I’d defer to the strabismus expert.
      5. Pain from buckle? Highly possible. In my practice, might be worth removing. A buckle only needs to be in place for 2-3 months.
      6. In my experience, most eyes with buckles feel normal within a few weeks.

      Let me know if I can help further.

      All the best.

      r

  7. Ann says:

    Dear dr. Wong
    So sorry to keep bothering you with my posts but I’m very concerned and don’t know what to do. I read your posts and I trust you I wish I lived in Virginia I would make an appointment. I have been having pvd symptoms for a long time (4 years now) it comes and goes. I had my eyes checked twice this month and thank G of everything was ok. The problem is this time I got more flashes al oat every time I turn my head and a large floater which my doctor said was from the back vitreous detaching (sides still Attached) this was three days ago and the flashes are still happening and I still an getting floaters. The doctor said not to worry it will e entuky go away to go on vacation and forget about it. Easier said than done. My question is every time it seems a little worse I can’t run to the doctor and I don’t know what I can attribute to the nirmal process and what’s something serious since my symptoms fluctuate do much. Is it normal for these flashes abd floaters to continue and an I still at risk for a serious problem if the backs in both eyes have already detached. Thank you so much for your time. And Lynn I hope you feel better soon.

    • Dear Ann,

      Not sure how to ease your mind. Sounds like your doc is giving you good advice and I don’t want to put words in his/her mouth.

      In my experience, an increase in the number of floaters is more specific.

      Randy

  8. Ann says:

    Thank you doctor but I’m confused. Do you mean that this new floater is something to be concerned about?

    • Ann,

      Usually not, but I have to advise you based upon your complaints. As you have been doing, you have been seeking medical help with new floaters. That’s the recommendation…and you are complying. I can’t really tell from my seat (meaning I can’t examine you) what you, specifically, should be doing.

      r

  9. Ann says:

    So sorry but what did you mean by increase in floaters being specific? I have one new one which comes and goes its black and shaped like a worm and sometimes it curls up abd then goes away I’m sorry I’m such a pest thanks what I really want to know is it safe to fly to Florida next week?

    • Ann,

      My point was that an increase in floaters is more specific to a problem, in general, compared to the shape of the floaters, etc.

      Flying has no impact on floaters, PVD or retinal detachment.

      Flying only is dangerous if you’ve recently had an operation and have intraocular gas in your eye.

      r

  10. Ann says:

    Thank you so much Dr. And again I apologize for being such a nuisance. You are very kind.

  11. bell says:

    dear doctor,
    what will you do if you want to like the doctor but the condition of your eyes say otherwise?
    i’m 33, wear -8.00 diopters one day lens in both eyes.
    after my retinal tear laser for 2 weeks, all hell breaks loose.
    these 3 symptoms come at the same time:

    1/4 from bottom of my both eyes look like the water ripples all the time.
    now almost half, if i look straight. i can’t even count my fingers with that vision.
    my doctor doesn’t know the cause, he refer me to another doctor for a comment,
    she doesn’t know the cause too, she said she was his students. so i ask the director,
    he said the vitreous contracts.

    i see patches or cirlce shape of deep blue color with yellow edges half of my bottom vision in both eyes.
    now they appear and fade in my lateral canthus area too. they appear like 50-60 times a day and
    when they appear, that area is blind for 1-2 seconds and that’s how i got my 1st car accident.
    he doesn’t know the cause.

    the floaters, 1st appear as cluster of dots, not single dot, now the same cluster is longer and longer
    cover my vision from top to bottom. everytime i work on the computer, i got new ones.
    now there’re numerous single dots that i lose count because there’re too many of them.
    the doctor said he has it too and he can live with it. he has no idea when they’re numerous
    when they become bigger and longer in size can destroy one’s life.
    i don’t know pain until i know these floaters, they sometimes make me vomit.

    now i can’t drive, can’t work on computer because i see new floaters everytime i strain my eyes
    and they never stop being formed.
    i had my eyes check up before schedules every time and he said everything is fine
    but i want to end my life. do you think the retinal tear laser worth all this?

    • Dear Bell,

      I hope you are feeling better.

      The floaters can be removed safely, but first, you must determine the cause. If you have a retinal tear, then laser treatment is absolutely the right thing to do to prevent a retinal detachment.

      Afterwards, you can deal with the floaters. You don’t have to live with them.

      Randy

  12. Christina says:

    Hi Dr. Wong,
    Thank you so much for this forum. I found your forum while looking up scleral buckling problems and prisms.
    I “see” that you are a very good and compassionate person from your words, and I thank you for the time and effort you dedicated to your education that brought you to this place in your life where you are able to help so many of us!
    I also wanted to respond to “Lynn” whom I share so much in common with. I am a 56 year old female and in the past 9 months have had 4 surgeries for retinal detachments and a macular hole. I too am left with double vision, central distortion, and very limited peripheral vision. I am currently waiting on a pair of prism glasses which will probably not help because retinal scarring is believed to be my issue too. Anyway, I wanted her to know she is not alone, because finding out I am not alone just helped me!
    I feel like I have entered a “grieving state”, after investing so much time and effort to be compliant and hopeful but now be faced with reality. Dealing with double vision and distortion also feels somewhat like an invisble disability because no one can really understand just how off balance and “unnormal” it feels. I am trying very hard to exit the grieving state, and find acceptance. I believe any coping stategies my brain can figure out (like closing my bad eye while I type this) will happen more so when I reach there, and I will find myself once more. Take care Lynn, and thank you Dr. Wong!

    • Dear Christina,

      Thank you so much for sharing and contributing.

      Your remarks are dead on: losing vision is traumatic. There are the same four stages of grief.

      Time will heal as you realize how to adapt and that you could be worse.

      Unfortunately, yours and “Lynn’s” cases are examples where the disease sometimes wins.

      Thanks again for your participation.

      Happy New Year.

      Randy

  13. bell says:

    my dear doctor,
    1st question: how do u remove floaters safely?
    mine is not just the floaters but the water ripple vision
    that distort everything i see half of my bottom vision in both eyes.
    the retinal specialist diagnosed that the vitreous contracts as assumption,
    actually i saw 3 doctors, they can’t find it with their eyes and equipments.
    and the floaters are not from vitreous but the remnants of the torn retina.

    2nd question: do you think the retinal hole at 12:00 topmost will develop
    into retinal detachment? the retinal specialist drew the picture,
    it seems he didn’t laser to surrond the holes but he laser half circle area with the holes in.

    • Dear bell,

      1. Vitrectomy is an elective eye surgery to remove the floaters. Complications are comparable to cataract surgery…both are quite safe. It is often fruitless for your doctor to try and visualize your particular floaters. I don’t know why so many doctors insist on this.

      2. If you have a retinal hole at 12 o’clock, please kindly ask your doctor as to why or why not the hole was treated with laser. I obviously can’t tell without examining.

      All the best.

      Randy

  14. bell says:

    my doctor mention that 1 of the complications from vitrectomy includes lost of focus for near objects.
    those objects will look blurry, is it the same lost of focus when you’re 40 years old up?
    will all patients after vitrectomy develop cataracts after a year or two?

    i asked the doctor about the 12:00 holes that cause all these. he said they should be treated because
    they’re at upper part. gravity? the thing is, how do doctors determine if the holes will likely progress to
    retinal detachment? or they just weld any holes as standard procedure?
    if the vitreous is still gel like, not liquify, can this vitreous enter and pool behind the holes?

    • Bell,

      All people, vitrectomy or not, will eventually develop cataracts. Sometimes vitrectomy may accelerate the development of cataracts.

      There are many variables, too many for this forum, that lead to the decision of treating or not treating retinal holes; location, pigmentation, symptoms,…and aspects seen during examination.

      The water portion of the vitreous can pool behind the holes.

      r

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