Friday, January 15, 2016

Watch Out for Your Eyes

Let me give you a bit of advice for the New Year: if anything suddenly changes with your vision, get it checked out by an expert. Make an appointment with an ophthalmologist post-haste and have an exam. Do not waste hours or days googling the symptoms and deciding it’s nothing to worry about. By the time you realize you should have gone to the doctor, it may be too late.

Sounds melodramatic, doesn’t it? Well, here’s a cautionary tale for you.

After having so much fun birding on Christmas Day, my husband and I decided to start the New Year birding, if weather permitted. New Year’s Day dawned with sunny skies and no breeze despite earlier forecasts for wind. It was a beautiful day and we had a great time. Even though we opted for a more relaxed pace than Christmas Day, we saw more birds, thanks to good weather.

Since a week of rain and cold was predicted starting on the 4th, we went out again on the 2nd and 3rd. We got this crazy idea that it would be fun to keep track of bird sightings for the year to see how many different species we could see, but without necessarily chasing down individual rare bird sightings. (Remember, in the last post about birding, I told you we aren’t obsessive-compulsive about this.)

I was feeling pretty good about the year starting out so nicely, especially since last year started out so horribly with my mother-in-law’s heart attack. However, after birding all day on the 2nd, my husband mentioned how frustrating it was that he apparently now had another symptom of aging: more floaters in his eye. They had appeared in his dominant eye and were proving to be quite distracting while birding. I hadn’t even known this was going on but he told me he’d checked his symptoms online. Although most medical sites recommended getting any vision changes checked out by an ophthalmologist, he also saw numerous YouTube clips from ophthalmologists that said floaters were normal with aging and there was no need to worry. So, like many people, he opted not to worry and to just 'wait and see.'

'Wait and see' is an acceptable approach for some medical issues. A cold or a bout with the flu will generally clear up with no medical intervention. A minor cut in the skin, also unlikely to pose a big problem. (Yes, there can be rare cases of flesh-eating bacteria introduced in a minor cut, but for most minor cuts, the normal steps of cleaning and treating the wound at home will suffice.) With the eyes, though, we are now convinced that one should have any sudden change checked out.

Luckily, he did have some niggling worries and made an appointment to see our regular eye doctor on the 4th. As I sat in the reception area during his appointment, I got a bad feeling when the doctor came out and rooted around in the desk for a minute, taking a business card back with him. Sure enough, he had recommended a retinal specialist and had gotten my husband an appointment the very next morning at 8 am. He went home with a tentative diagnosis of “vitreous hemorrhage.”

The inside of the back part of the eyeball is filled with vitreous, which is a gel-like substance. The new floaters in my husband’s eye were evidently blood specks. A more thorough examination, with dilation, was needed to determine the source. I went along again the next morning so that I’d be able to drive since this kind of eye exam requires dilating the eye. That leaves the eye very light-sensitive for several hours and unable to focus well.

We were nervous when we arrived for his appointment. I brought a book that I hoped would keep me distracted while he saw the specialist, figuring it would possibly be a long wait since they’d fit him into a full schedule and might need to do a variety of tests. I was surprised when he came back out only an hour later. As we waited to see what was required with our new insurance, he quietly told me that he’d just had surgery.


The retinal doctor’s exam quickly revealed that my husband had a severe tear in his retina. There is no pain with a retinal tear. There may be no vision loss with a retinal tear, as was the case for my husband. The new floaters were indeed due to blood as the tear happened right over a blood vessel. But, why did the retina tear in the first place? He’d had no impact to his eye, no recent surgery, nor does he have diabetes.

Apparently, as we age, the vitreous in our eyes begins to liquefy. The vitreous is attached to the retina, and as it liquefies, it can peel away and detach from the retina. This in and of itself is not a medical emergency and does not impact vision. However, in rare cases, there can be points at which the vitreous is firmly attached to the retina and the force of it pulling away from the retina can tear it. If a retinal blood vessel is torn or damaged, as in my husband’s case, the blood can leak into the vitreous and cause new floaters to appear.

The eye surgeon told my husband that he was very lucky. It is rare to have a retinal tear happen this way and it will not get better. Had he tripped or even sneezed, the jarring could have torn the retina off completely. A detached retina is serious and will result in vision loss. Retinal detachment is painless but symptoms include a sudden profusion of floaters, flashes of light when your eyes are closed, or obscured visual field in one eye. If the retina is not re-attached within hours, the vision loss my result and be permanent. My husband frequently has violent sneezing attacks so we are amazed that he avoided this fate.

But, wait. The news gets worse. Even if a person with a torn retina is lucky enough to avoid tripping or sneezing, they are not out of the woods. Once there is a tear, fluid begins seeping in under the retina through the tear. In time, simple hydraulic pressure will detach the retina. A ‘wait and see’ approach could easily lead to losing the ability to see out of that eye! Again, if a person gets to ER and can have eye surgery done in a matter of hours, this can be repaired. But, as my husband pointed out, this could have happened at any point, including in the middle of the night while he was sleeping. He could have woken up, blind in one eye, and past the timeframe during which surgery would help.

Retinal detachment from hydraulic pressure, especially in a tear as severe as the one in my husband’s eye, can happen within hours to days. When the doctor counted up how long it had been since the original tear – 5 days – he was shocked that it had not happened. My husband was apparently very, very lucky.

It will take a while for him to fully recover from the surgery but his eye seems to be getting incrementally better every day. Until he gets the doctor’s okay in another 10 days, he’s being cautious about physical activity. No skydiving, horseback riding, and such. Okay, so he wouldn’t have been doing those activities anyway, but he is avoiding projects where he might trip, bump his head, fall off a ladder, or do anything jarring. It may take another month or so for all the blood from the original tear and from the surgery to clear out of the eye so that the floaters disappear. In the meantime, he’s trying to ignore them, although he says the “flocks of blackbirds” he sees everywhere are pretty distracting when we’re out birding.

Please remember: if you have any sudden change in your vision, see an eye doctor right away. As they say, better safe than sorry!

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