On Sunday, November 2, the day of my last post, I called the UCSD Eye Center and drove down and was examined by the on-call ophthalmologist. My symptoms were consistent with a detached retina, a condition classified as a medical emergency because it can quickly lead to blindness if not treated. The peripheral vision in my left eye appeared to be reduced, as compared to my right eye, and there was a dark half-circle beginning to intrude into my field of vision.
The ophthalmologist saw what he thought was a detached retina, and advised that it would likely be treated that afternoon with a laser. He was not certain, however, because he could not see any retinal tears, so he called in another senior resident who was specializing in the retina.
She arrived soon and, without asking about my symptoms, did what appeared to be a thorough exam of my retina. Then she said I was fine, to go home and call the next day (Monday) to make a regular appointment for sometime during the next week, whenever they had an opening.
I was shocked, because I had researched the subject after earlier being warned about "dark curtain" symptoms by another doctor who had looked at my retinas a few days earlier, after I reported seeing flashes. Flashes and floaters are symptoms of the eye's vitreous gel pulling away from the retina, a common occurrence that happens to almost everyone over 60, and also often precipitated by cataract surgery. It's called posterior vitreous detachment (PVD). When the vitreous gel that fills the eyeball starts to separate from the retina, it tugs on it, causing flashes. Bits of the gel break off and are seen as "floaters," spots and shadowy forms moving across your field of view. If the bond between the retina and vitreous is strong, the gel can pull the retina off the underlying tissue. When this happens the vitreous liquid can seep behind the retina and peel it off like old wall paper.
I dutifully went home and continued my internet research into my symptoms and possible causes, and the next (Monday) morning called and made an appointment (for Thursday morning). But during the day the small black half-circle continued to grow, and eventually threatened the center of my vision. By this time, I knew that if a detached retina reached the eye's macula (the center area of the retina where light receptors are most highly concentrated), the chances are that treatment would likely not be able to restore vision to what it had been. The longer the wait before treatment, the worse the prognosis.
So Tuesday morning I got up before dawn and made the rush-hour drive to downtown San Diego, arriving at the eye center before it opened. I waited until they could fit me in; two hours later a triage ophthalmologist confirmed a retinal detachment. She then ran off to find the eye surgeon. She returned and said he would treat me, but he was also swamped with appointments and the wait would be two or three hours.
After another two hour wait, they put me in an exam room and dilated my eyes. After another 30 minutes, the doctor arrived and did a thorough exam, mapping out all the small holes in my detached retina. He said he would have to seal all of them; if he didn't, the vitreous fluid could get back in behind the retina and it would not reattach. He then discussed the various procedures that were available. I had researched all of them, so we quickly agreed on pneumatic, cryo-probe. If treated the first time I presented myself (Sunday), a simple laser tacking of the retina would have worked well. But now, with a large detachment and all the holes to repair, the cryo-probe was needed to freeze the holes, which would make the tissue "sticky" and seal the holes.
Furthermore, some gas would be injected into my eyeball. The many bubbles would coalesce into a single big bubble over a few days. The bubble of course would float to the top of my eyeball; I would be tasked with positioning my head so that the part of the retina that was detached would be above the bubble. The bubble would hold the retina against the inside of the eye, forcing out the fluid and allowing the retina to reattach itself. This procedure would likely work well, since my detachment was near the top of my eye. I merely needed to hold my head upright and leaning to the left a little—for days and nights.
The doctor promised the surgery would start soon, and assistants began bringing equipment into the exam room. There was another delay while the surgeon tried to catch up with his regular appointments, and then the procedure started (with local anesthetic, as I needed to assist by moving my eyeball to different positions). But then the cryo-probe would not get cold enough to freeze the tissue (applied to the outside of the eyeball, the freezing had to go all the way through to the retina). Another delay while technicians replaced an empty gas cylinder, and the surgeon attended to his other patients.
The procedure took about fifteen minutes. At first I could not see anything (my eyeball was full of tiny bubbles), but then cleared somewhat and I could see in the large portion of my field of view that had been black. I drove home with my left eye closed, and ate dinner (first food all day), then propped up cushions on my sofa so I could sleep with my head upright (front to back), and tilted to the left about 20 to 30˚.
The next afternoon I returned to see the surgeon (who, by the way, was excellent). He noted at one point that the resident had mis-diagnosed the retinal detachment (thinking it was just a vitreous detachment). Everything was looking as it should. He said to continue maintaining my position (night and day), and to return in two days (on Friday), when everything was still good (but "not yet out of the woods"). I no longer had to tilt my head to the left.
Then back five days later (Wednesday, the 12th). He then said I could start sleeping on my back again. I replied that I would prefer to continue sleeping with my head more of less upright, explaining that since the bubble was still there (it would take six to eight weeks to be absorbed), I thought we should keep it working holding my retina in place. (This whole ordeal has been very stressful to me as I contemplated the prospect of losing vision in one eye.) He then explained that he wanted to "test" the repair; if the retina pulled away again, he would tack the weakness with a laser. That didn't appeal to me at all, given that the weekend was approaching. The idea of again putting my eyesight into the hands of the on-call residents scared me. The surgeon then negotiated for me to start sleeping in a normal position starting Sunday night (the 16th). We'll see how that goes.
But back to the remodeling work. It ground to a halt, and has since resumed at a relaxed pace. I've completed the living room drywall work (joint compound, etc.), and painted the walls and ceiling. I've started finishing off the drywall seams in the home theater, and laundry room, and put up another couple of sheets of drywall in the new laundry room. I want to be able to seal that room off, either with permanent walls of plastic sheeting, so when I pull down the ceiling (opening up the room to the attic temperature extremes), the whole house will not be affected (so much). I also need to take care of miscellaneous lighting/electrical/telephone circuits that have been languishing.
Most of this work is going slower because my left eye vision is still impaired. It's okay when I'm looking straight ahead, but because the big bubble is still inside my eyeball, looking either up or down is a problem. When I look down, the bubble moves up against the back of my eye, center of my retina. I'm essentially looking through the image of the bubble (with its dark border). When I look up, the bubble floats up against the lens (behind pupil), and makes everything a blur. When there is a bright light, the bubble causes internal flare and reflections. I don't really mind it, because the bubble gave me my vision back, but it's there.
I'm still seeing some flashes, and still anxious, but hoping the fix holds and I won't need another procedure. Too much work to do. Stay tuned.
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