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Surgery

Blurry Vision Following Vitrectomy

blurry vision following vitrectomyHere are some causes of blurry vision following vitrectomy eye surgery.  These are temporary causes and should resolve in a short time.

There are other reasons that may blur your vision, but those reasons may be related to the particular eye disease for which we are operating.

An Eye Patch Causes Blurry Vision

After every vitrectomy, an eye patch is placed to keep the eyelids closed against the eye.  There really no medicinal use of a patch other than comfort.

The pressure required to keep the eyelid closed is also enough to temporarily change the shape of your cornea.  In a sense, we are artificially creating astigmatism.

Any alteration to the smoothness of the cornea or its shape can cause significant changes in your vision.

Blurriness from the patch usually resolves the same day.

Dilating Drops Cause Blurry Vision

Dilating drops are a very common cause of blurry vision.  The drops dilate the pupil allowing me to see inside your eye and perform the operation.

The same drops also paralyze the muscles used to help you focus.

We usually use dilating drops which are slightly stronger than those used routinely in the office, hence, the dilation lasts longer.

Blurry vision is caused for two reasons.  First, more light is allowed into the eye.  Most of the this extra light needs to be focused.

Second, your eye can not focus normally because the focusing muscles (ciliary muscles) are paralyzed.

Blurry vision from the drops can take a few days to reverse.

Scleral Stitches

Sometimes I elect to close the small entry wounds, called sclerotomies, with absorbable stitches (aka sutures).  The wounds are adjacent to the cornea, but close enough to cause some warping or bending of the cornea if pulled too tightly.

This should all reverse when the sutures fall out by themselves.

Most vitrectomies these days are sutureless, so this has become less of an issue.

Any questions or comments?  Please feel free to add them below!

 

Categories
Macular Degeneration Testing

Eye Examination for ARMD: Macular Degeneration

When You Need Eye Exam for Macular Degeneration.  Randall Wong, M.D., Retina specialist, Fairfax, Virginia.Routine eye examinations for macular degeneration in patients without symptoms are probably not necessary.

Unlike conditions such as diabetic retinopathy, where the disease is likely to occur  yet still be asymptomatic, macular degeneration is not “silent” and does have associated symptoms.

Once diagnosed with macular degeneration; however,  routine examinations are important.

Family History Does Not Matter

While it is true that patients of northern European descent have a greater chance of developing the eye degeneration, brothers and sisters and children of patients with the disease are not necessarily at any higher risk.

For example, if I contract the disease, my twin brother is not necessarily going to get the disease.

Vision Must “Degenerate”

The most common symptoms of macular degeneration are decreased vision (e.g. blurry vision) and/or the development of distortion.  Both signify a change in vision.

Without a change in vision, that is, if your vision remains 20/20 it is unlikely you have ARMD.

Signs vs. Symptoms of ARMD

Signs of a disease are those things we, as doctors, see or find during an examination. If you have no  signs of macular degeneration, you do not have it.

For instance, drusen and pigment changes in the retina are common signs, or findings, of dry macular degeneration.  Fluid, edema and blood are common findings of wet ARMD.

Pigment changes, fluid and blood may cause blurry and distorted vision….symptoms (subjective, what the patient experiences) of macular degeneration.

Often, patients are diagnosed with drusen.  Drusen alone, especially without loss of vision, do not make the diagnosis of macular degeneration.

Advancing Age and Macular Degeneration

The National Eye Institute has a nice review of macular degeneration.  The incidence of developing macular degeneration does increase with age.  This means the chance of getting the disease does increase with age, but not without signs and symptoms.

What Does This Mean?

In short, unlike diabetic retinopathy, a disease that may develop without symptoms,  you can safely monitor yourself for any symptoms of the ARMD, regardless of ethnicity, age or family history.

If you develop symptoms of decreased vision or if you develop decreased vision you should get an eye exam.  Often, patients are directed to test themselves with an Amsler Grid.  This is a simple way to monitor changes in your vision.

If you have signs of the disease, for example, drusen and changes in the retina, you might ask your doctor about getting examinations on a routine basis.  This will be more important in the future if/when we discover changes in our diet or behavior (i.e. quitting smoking) alter the course of developing the disease.

If you have neither symptoms nor findings, you most likely require exams periodically as directed by your doc.

 

Categories
Macular Degeneration

Never Enough of a Dry Eye

Intermittent blurry vision from dry eye is common, and although ultimately a corneal problem, is a condition often faced by a retina specialist.   Many times, patients with retinal disease, such as diabetic retinopathy or macular degeneration,  are referred to me with unexplained, fluctuating,  decreased vision.  It is always up to me to figure out if the change in vision is due to the dry eye, or the retinal disease.

The cornea is the transparent tissue in the front of the eye.  It is the tissue covered by a contact lens.  The cornea is responsible for about 2/3 of the focusing power of the eye.  Not even our natural lens, which rests inside the eye, has this much focusing power.

Tear Film – When we blink, the eyelids spread tears across the surface of the eye.  The tears keep the cornea hydrated.   A well-hydrated cornea has a very uniform and smooth surface.  The air-water interface, where the air hits the watery tears on the cornea, gives the cornea so much focusing power.

(Actually, it is the radius of curvature of the cornea and the index of refraction of the  air-water interface that yields the final focusing power of the eye.  This is also why laser vision correction works; it changes the radius of curvature, or roundness, of the cornea.)

In dry eye conditions, the surface of the cornea becomes, uh…dry.  On a microscopic level, it is no longer smooth.  A “dry” cornea is irregular and rough.  It does not focus light accurately or consistently as the tear film is some what patchy.  The result is a very blurry image that reaches the retina.  We complain of blurry vision.

Treatment for dry eye usually consists of artificial tears and lubricants.  Other treatments are available, but are beyond my scope of practice.  It is important to remember, yet hard to implement, that the use of artificial tears should be regular and not used only when symptoms develop.  The idea is to prevent dry eye from developing.

Symptoms of dry eye include blurry vision, burning, sensitivity to light and tearing.  The blurry vision may only be at certain times of the day, during certain activities, such as reading, or may be more prevalent at certain seasons (winter is generally drier along the East coast).  The cornea is a highly sensitive tissue, the dryness causes the burning and sensitivity (try not blinking for 30 seconds).  The tearing develops in response to the burning (as if to wash something away).

What Does This Mean? Due to the enormous focusing power of the cornea, any small perturbation of the corneal surface can translate into rather dramatic change in vision.  To a patient with retinal disease,  these changes in vision are worrisome, scary and can be depressing.  A key difference, however, between loss of vision from dry eye versus progressing retinal disease is that the symptoms from retinal disease should not fluctuate, especially on a daily basis.

I am always happy to “blame” the dry cornea for changes in vision and we all breathe a sigh of relief when I find the retinal  disease is stable and unchanged.

It really should be called “dry cornea.”

“Randy”

Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax Virginia

Categories
Macular Degeneration

How To Tell if You Have Macular Degeneration

What are the symptoms of macular degeneration?  Most patients have blurry vision and distortion.  Macular degeneration is usually a bilateral disease (both eyes are involved) and is progressive, thus, symptoms are usually in both eyes and progress over time.  The symptoms of blurry vision usually are persistent (they don’t come and go) and occur gradually.

Symptoms of patients with the “wet” or exudative form are slightly different and develop faster.   Patients with wet macular degeneration may develop distortion and blurry vision in terms of weeks rather than losing visiong over months or years.  In no case do patients go blind overnight. Unlike the dry form, patients with wet macular degeneration may complain of a dark, central grey spot.

What is the Amsler grid used for? An Amsler grid is used to self monitor.  It can be placed in a common area in the home such as a refrigerator door or vanity mirror in the bathroom.  Testing/ monitoring should be done frequently, perhaps daily.  It is ideal in patients that already have some mild distortion.  New, persistent distortion should be reported to your doctor.

When to call the doctor? If you notice a change in vision, including distortion, that is persistent, I recommend calling your eye doctor and scheduling an appointment.  Symptoms that are transient (come and go during the day) are less likely to be related to the retina, but if concerned, you should call your doctor.

“Randy”

Randall V. Wong, M.D.
Ophthalmologist, Retinal Specialist
www.TotalRetina.com

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