Tuesday, August 23, 2016

The Joys of Aging: Part Quatre . . .

Yesterday, as Georgia and I were walking on the beach, I saw something I had seen before, and hoped I would never see again. Fine filaments of black in my vision, swirling around and breaking up into tiny discrete dots in my left eye. A hemorrhage from the retina into the vitreous humor.

I mentioned it to Georgia, who asked if I wanted to stop where we were (at the Calvert Beach ramp) and have her come and get me in the car. I said no, and by the time we reached the car, the streamers of fresh blood had stopped, and the tiny dots were all over the visual field in my left eye, but not so bad that I still couldn't see clearly. This is the same eye that had the tear several years ago, that was apparently lasered up and healed without further complications. Once home, I called the retina guys office, explained what had happened, and arranged for an 11 AM appointment this morning.

Georgia went out on an errand, and while she was gone a neighbor called to ask about something, and while I was on the phone describing the symptoms, the streamers started again, and kept going. In fairly short order, the back of my eye had so much blood in it, it was like looking out through a thin layer of lumpy oatmeal.

I called the retina guy's office again and explained, and they seemed to think that it was OK to take the morning appointment, and agreed to move it up to 8 AM, but said if it was truly a sight or blindness emergency I could go to Wilmer's Eye Institue (part of Johns Hopkins) in Baltimore on an emergency room basis. I was kind of upset at this. Once Georgia got home, we managed to call Wilmer's and talk to a doctor there, who very kindly heard me out (and didn't assume I was an idiot), and explained that, given the symptoms I was describing, in all likelihood I would sit there most of the night waiting to be seen, only to be told to go home and wait a few days to see if the eye would clear enough to see the retina and determine if they could repair the retina with a laser or if more work was necessary. Oh, and don't eat anything after midnight just in case they want to operate. . .

After a restless night, we kept the 8 AM appointment, and after dilation and a vision test, which I totally flunked (the left eye can see an arm move, but not fingers, and the right which has a cataract for which my prescription is a year out of date), the technicians (nurses?) took pictures in both eyes, and did an angiogram (injected dye into my arm, and took pictures the back of both eyes, looking for leaks and abnormalities). They admitted that seeing much in the left eye was impossible. Finally, the retina guy himself came in, poked and prodded and shone bright lights in both eyes, and did a retinal sonagram to look for retinal detachment, which he did not find, thank heavens.

So, the guy at Hopkins was right. The current line of therapy is steroid eye drops to help clear the blood. and to come back in two days to see if it's clearing without further bleeding. The hope is that the eye will clear enough soon to see what's really happening, and maybe laser it shut again. I'm to watch carefully for any signs of retinal detachment (fixed black areas in the vision field), which are the emergency situation. Even assuming the tear can be patched, it possible the so much "gunk" has leaked into the back that my vision may be permanently affected, and may even benefit from a "vitrectomy", the removal of the remaining vitreous humor in the eye, and replacing it with clean fluids, an operation that both doctors, and a friend who had one said is best avoided if possible.

What causes it? In the previous case I had, it was the posterior vitreous detachment (PVD) pulling on the retina that caused it. In this case, they won't know until it clears, or until they go into to clean up, but most likely it's either the older scar pulling on a blood vessel, or a fresh rip caused by the expanding PVD.

No comments:

Post a Comment