High myopia, vitrectomy inbound and anticipated cataract surgery afterwards, any advice appreciated
Posted , 13 users are following.
Been reading on here for a little while, anticipating cataract surgery later this year so looking for recommendations and information.
A little background in case anyone is interested:
At 40, I had what I feared was a retinal detachment, I was walking outside and had a big black shape come down from above. I'm a high myope, so I've always read I was at risk for that and the next morning was being seen. I was told it was a large floater, right in the middle of my vision and shown a picture. They said I had no retinal detachment, and that it would either go away on it's own or I would adapt to it and learn to ignore it.
3 years went by, and it was still sitting dead in the middle of my vision, moving only slightly left and right. I began to notice when I looked in the mirror, that my right eye was turning inward where my left eye was straight; it was as if I was trying to always look around the floater, it looked like I was crosss-eyed just in the right. I heard about the laser vitrectomy (essentially using the laser to break up the floater), and there was a doctor within driving distance of here. I made an appointment, was told it wouldn't be a problem, and had to go twice because he couldn't do it in one go, it was too dense. A piece of the floater he couldn't get an angle to hit, but my central vision was clear and I could ignore the remaining small ones. I was happy for about 5 months, then I started to get more floaters of all types. What was different now is that rather than the one large floater (and smaller ones that were easy to ignore, I always had lots of small ones), it's more like looking through a cloud of floaters.
This has been going on for 7 more years, I'm now 50. This last year I've somewhat hit a wall; the cloud has become denser, I'd describe it more like looking through soup. Everything in that eye is several shades darker than the other, similar to a cataract. Unlike a cataract, I think I can't adapt to just using the other eye because of all the constant movement of the floaters and the soup. If I move my eye rapidly, I can sometimes get it to clear in the center and I can see that my vision is quite good (other than the myopia of course).
I've seen two top retinal surgeons, both say my retina is healthy, and that I suffered a PVD in that eye, probably at 40 when the large floater first appeared. Interesting comments they made included that a doctor there had a vitrectomy for floaters and they had "less than you have" and that they understand why I'm having issues because I have "more than my fair share" of them. Obviously I don't want to risk my sight on eye surgery (the vitrectomy and the cataract surgery that will follow typically 6 months later).
While my vision is better some days then others, I started getting double vision on occasion due to the difference between my eyes looking through the soup. It seems to have become a little thicker. I try to avoid driving at night whenever possible, as I otherwise have to close my right eye. I need to drive 2 hours every day to from work and taking the kids to school, so... the vitrectomy is in 3 weeks. I don't want to do this, but if it hasn't become better after a decade, it's probably not going to. Quite terrified, actually, even though I know it will probably be fine. I tell myself on the brightside, that with the cataract surgery and lens replacement, I can know what it's like to not need contacts (or hopefully need a lower power). I mentioned I've always been highly myopic since I was a child, -15 in the right and -13.5 in the left. I've been told I will see really well with any replacement lens, better than I ever have in my life due to my myopia, can anyone say if that is truly the case?
After reading here, I was really convinced the Symfony was the way to go; then I read about the Panoptix. While I'm used to visual oddities, I think I've come full circle back around and think if I have to make a choice that the mini-monovision is the safest way to go with some myopia, I don't mind if I still need glasses, but it would be nice to not need them for everything. Anyone a high myope or has experience with a vitrectomy and this process, and any advice, particularly with recovery or selecting a lens? It seems there is praise and criticism for every lens, no real consensus or a safe choice. Thanks for taking the time to read this and if you respond.
0 likes, 47 replies
scott10751
Edited
I changed the target to the -1.1 option. Four weeks from today will be the day after, Hoping for a good result.
On the double vision front I mentioned, I had read their were exercises, but searching had actually only turned up vague examples of targeting items at different ranges. I finally came across something, a "Brock string", just a string with beads you slide back and forth and target different distances. Finally something that looked repeatable and measurable. Surprisingly, this simple thing works, at least for me using it only once today. I used it for five minutes and I could see a converged image only for a short distance 18 inches maximum, but learned something interesting; even though I don't have double vision at close range, I must not be using both eyes. After the exercise, I didn't need the +1 reading glasses I use to see the computer and phone. Both were exceptionally clear. It faded after about 20 minutes and I had to put the +1 glasses back on. A few minutes ago I put on something with subtitles on TV, and was startled no double vision. It also faded after about 20 minutes. This certainly looks promising, I'll continue this daily and God willing we'll see if the results last longer.
annemarie47990 scott10751
Posted
your post on the Brock String has me thinking this might help me? Also extremely myopic (-11) and had a Symfony multifocal in one eye and a monovision in the other. Vision was great, but now close up and midrange are blurry. Doc cant figure it out (I have a much longer post, posted today with more details if interested)
Maybe my eyes arent working together???
scott10751 annemarie47990
Posted
Hello Anne, I actually saw your other post before your post here and replied.
Regarding the Brock string, I think I taught myself not to use/trust my right eye over the course of many years, until the double vision kicked in several years ago, now I have to train myself to use it again. I've read since that the Brock string is also used by athletes to train regarding seeing a ball better who don't have any issues with vision. I don't know if it will help, but I wouldn't think it could hurt. There are quite a few youtube videos you can see to decide if you want to try it.
scott10751
Posted
Everything went well yesterday, I was surprised how quickly it went. I arrived at 1pm, was in the waiting area until about 1:35, and walked out the door at 2:45.
Had 1 day postop, and it appears I landed at -1.2. I haven't had really clear vision at any particular distance since the procedure, but just over the last 3 hours it's changing quite a bit. I went online this morning and had ghosting/double vision directly below any text, that was still the case (though reduced) 3 hours ago. Now, that's completely gone as I type this. I'm noticing other items that were illegible this morning (label on the hand soap, etc) I can read now. This may still shift up to .75 diopter over the next 3-4 weeks, I'll post again once things have stabilized and I know the final results.
Lunabug scott10751
Posted
Did your retinal surgeon give you an OCT scan when you went for the exam? i ask because the retina could be the cause for the anisekonia. I'm not a doctor but would want to ensure my retina is okay before doing the other eye.
I am also myopic (-11 in contacy lenses) and had a severe PVD in my left eye which left with with huge thick white floater in my central vision. i had a vitrectomy which was uneventful but was left with disabling dizziness and distortions in my vision ever since. My retinal surgeon has been doing everything to try and figure out the cause - and everything looks like it is pointing to the lens. Possibly the surgery caused a defect in the lens. There is no evidence of cataract yet but a Pentacam scan showed an abnormality at the lens capsule surface. I may need to exchange the lens in my future and I am scared, especially after reading your story. My other eye also has a PVD and i would have had another vitrectomy for it if this had not happened.
scott10751 Lunabug
Posted
Hello,
I believe I posted this before, but I'm quite certain I didn't have anisekonia after the vitrectomy. I was constantly comparing images between the two eyes, and noticed no difference in size. After the IOL it is always present and really obvious. I may have been two conservative in saying it's between 5 and 10%. I'd say it's at least 10%. I've come to dislike it, as comparing the two eyes it's like you are zoomed in, so you are losing some of your peripheral vision. As there isn't anything you can do about it, I just have to live with it. The tough decision is to do my other eye to zoom that one in as well and get rid of the anisekonia. I'm going to hold off on that for a little while.
In the small amount of research I've done, I read a document, would have to see if I bookmarked it, how every cataract patient suffers from this when they have one eye done but not the other, but the difference between images sizes is less than 3% so their brain can compensate without noticing and most have the second eye done within two months anyways. My guess is that, as most people are having a larger power lens implanted than someone like us, that the size difference remains small. (IOL is inverse to glasses/contacts prescription, so most folks have a high prescription have a small correction). I was choosing between 0, 1 and 2 power, so it seems logical that the smaller the power, the greater the magnification/size difference. You could ask for them to take a measurement just to see roughly where they think your IOL power would be. Just because you were -11 doesn't mean you will require a lens power as low as mine, as there are other factors such as steepness of cornea. Maybe if you find out you are a higher number for IOL prescription you won't feel as worried. I went with 2, so I'd guess (and it is a guess, I'm not a doctor) that any number higher than that will have less of this magnification affect, the higher the better.
Your experience sounds quite a bit like mine, I had the PVD with the large floater first, with the laser vitrectomy making it a soupy mess, then a real vitrectomy. I have a PVD in the other eye, but the floaters aren't that bad so I'm not thinking about a vitrectomy for that eye. You had the dizziness and distortions ever since the vitrectomy? What are the distortions like?
Lunabug scott10751
Posted
Hi Scott,
I wore my glasses for three weeks after the vitrectomy while doing the eye drops. I never wear glasses, ever, because of the high rx. A few days after the surgery I noticed the Amsler grid was ghosted; double lines all over and also the tiniest little blip on horizontal lines. The blip is a tiny few peaks or crinkles to the right of central vision, it is more noticeable in distance vision and its mostly on high contrast horizontal lines; house siding lines, computer screen graphics, TV etc. i have had five OCT scans to date and the macula is normal. The surgeon says its not coming from the retina. Fine, but where it is coming from then, and is that what is making me dizzy?
The day i returned to my contact lenses i was hit with the most incredible dizziness and disorientation i have ever experienced. I thought it was because I had been out of them for so long and being really near sighted, figured i just needed time to adjust. But it felt much worse in the operated eye; a sense of pulling and strange feelings and the vision out the lens looked different than my other eyes; it was clear but very glassy. And it felt weird. Like the lens wasnt mine. Lighting affects my ability to walk; a gray overcast day and im a pirate on a swaying ship. A bright sunny day and im almost normal.
I was bed ridden for months until the retinal surgeon put me on Pilocarpine which is a glaucoma drug used off label to constrict the pupil therapeutically, bascially to a pinhole sized pupil. It has reduced my dizziness to where i can Get out of bed and do light chores or take drives with my husband, but it is not curative. It has dampened things down. The side effects are really tough too; dim vision in dark rooms due to the small pupil, the vision is much clearer in the eye for intermediate and near due to the pinhole effect which is weird, headaches, nausea etc. What makes me so sad is the night before the surgery I asked my husband if i should cancel and try and live with it. But i was miserable with a huge white floater in my central vision 24/7. it was like having a white t shirt stretched across my vision on top of the hubdreds of eyelash like floaters in my periphery. Plus the other eye had kicked off though not as bad. But nobody told me this could be a risk of the surgery and i would take my floaters back in a minute. Its frightening and disheartening to be told that the dizziness is unusual and confounding. My retinal surgeon said this is a once in his career event. Why? Why am i so special? The eye only has so many components, so it has to be one of them. My gut tells me its my lens, given the light sensitivity, distortions and ghosting (a hard contact lens improved the blips but left behind ghosting on the Amsler grid, which the optometrist explained is residual lenticular astigmatism. But i never had it before the surgery.
I see clearly in my central vision, so i suspect it's the periphery of the lens. and i can "feel" it too. just like i could feel my huge floater in the back of my eye despite being told it wasnt possible. But i just dont know why dizziness and disorientation are the symptoms.
i read another post here about a woman post cataract surgery experiencing dizziness. my story is very similar to hers except my dizziness is more constant and i dont have an IOL. But it seems to share a common problem that its something lenticular and its upsetting the brain. i was not dizzy until i wore my soft contact lenses, it keeps me up at night trying to figure out why. wearing my glasses is not practical with my high rx and i now get the same dizziness when I do wear them but at a lower intensity. i also tried prism glasses because i have double vision on lateral gaze. My retinal surgeon was ecstatic thinking he'd found the answer and was gutted when i had to report back no change.
im sorry for the long post and any typos. this platform is terrible and i dont have a spell correct option.
Does the anisekonia cause you dizziness? I'm sorry youre in this predicament now having to decide on whether to do the other eye. My worries are similar, like a chess board where no play seems sure.
scott10751
Posted
I wasn't planning on posting here until after the next Dr visit at the 4 week mark, but I'm experiencing something that hadn't come up in my research: Aniseikonia. Items in my right eye with the IOL are noticeably larger than my left, tough to gauge but I'd guess somewhere between 5 and 10%. I can find conflicting documentation online, and could provide search terms to documents that say vastly different causes and percentages. It may simply be due to my high prescription that it's caused by the difference in distance between the IOL vs the contact lens, and doing the 2nd eye will resolve the issue. This can be caused by any retinal procedure including a vitrectomy, but I'm fairly certain with all the comparisons between my eyes I was performing that this is new after the cataract surgery. Just another FYI for anyone reading later, If I learn more after consulting with my Dr in 3 weeks I will post it.
Lunabug scott10751
Posted
Hi, any updates on your situation since your last post?
scott10751 Lunabug
Posted
Hello, I wanted to wait for more time to pass as I had quite a few changes, but I think things have settled down now.
If I hadn't mentioned it earlier in the thread, I obtained a trial contact that was -1 from my current prescription for the non-operated eye, and ordered a pair of -1 glasses off of Amazon, guessing that the prescription would come near the target. I had been wearing that combination since the surgery without issue the first week.
At the one week mark, I had an incident where I had to drive my son to the Dr. While in the waiting area, I had flickering in the IOL eye and when I returned to the car, I noticed I couldn't read the street signs in the IOL eye with the -1 glasses that had been fine up to that point. Concerned something was wrong that there was such a drastic change, I called and they told me to come in. They dialated and said the lens looked good and everything was as you would expect after one week, but I went from the -1.2 to -1.75, apparently in one go. So a half a diopter shift. I wasn't happy with what I could see or read at that point.
At the 3 week mark, If I were to gauge my results, I would say I had about 30% of the improvement I had hoped for. Colors weren't as off as they were, but the vision in that eye was still noticeably darker than the other, and it just goes to show that despite all the best planning, you aren't necessarily going to get the results you think you are. All the data said I can expect a hyperopic result with my extreme myopia, with the best calculator. Had a prior vitrectomy? Throw an additional half diopter on there as the lens ALMOST always sits lower. In my case, it went more myopic.
Interestingly enough, during the 3rd to the 4th week, I'm not sure when, something happened. I mentioned that eye was still darker than the other, even during the day, although the colors had improved. That went away. It is only darker now in an extremely dark room with only a night light, so I really don't care in that scenario. Even a single lamp at night it's fairly comparable. So note that if you are unhappy at even the 3 week mark, you can still see a drastic change, at least I did. With that I'd change my outcome from 30% of what I was hoping for to 70-80%. I still have glare, that decreased slightly but didn't go away. I also don't have the level of detail in that eye that I do in the other. I remember when I had the PVD and floater 11 years ago that started this, the Dr saying "Yes, that's a huge floater with a piece of the optic nerve attached to it". So maybe that's why I'm lacking detail in that eye.
Regarding my 4 week appointment, when I went in at one week when I had the large myopic shift, they had me read the chart and I could make out a couple letters on the 20/30 line, so my hope was if I could read 20/30, that would be great with 3 more weeks of healing and the improvement in brightness. The way the, not sure of her job title, assistant performed the exam, it was just wrong. Asking me what I could and couldn't see, it was difficult to read the projection because the lights were fully on in the room. When we were almost done, that's when she said "Oh, those should be off" (but she didn't start over), and they couldn't get me to any better than 20/40. He said I did have PCO, 1+ on the 1 to 4 scale, and I could get that taken care of in 90 days in August. I knew the prescription was off, as they had me at -1.25 in the IOL eye, and I had purchased several cheap pairs of glasses online with -1.25, -1.50, -1.75; I knew I saw better with a different prescription.
I made an appointment back where I had my retinal surgery, where literally everyone there is exceptional and arguably some of the best you can see for any eye issue. I had to wait 3 weeks for that, and sure enough, they had me at -1.50 and reading the 20/25 line.
So where I am now is better than I was when this started with the vitrectomy at the start of 2020. I feel somewhat relieved as now, other than getting the PCO treated, I've done everything I can for that eye, the floaters and the headaches from the constant motion are gone, and the darkness is gone also. Before the vitrectomy, I had double vision issues because of the floaters. Now I have double vision because of the aniseikonia. The last Dr I saw confirmed it's because I have the IOL in my right eye and the contact in my left, and that the double vision will not be resolved until I get the left eye done (the brain can't compensate and combine the images when the size difference is so vast). But the left eye has alot of accommodation, and it's become apparent how much I rely on it, so I'm afraid to do the IOL there and lose the accommodation and of course the risk with my better eye.
I can say I'm thankful for my near sightedness as a child and how awesome it was to see that way. I'm also thankful that I still see as well as I do. God gave me these eyes and this vision, so I suppose he will take them away when he wants, I'm hopeful he will allow them to last as long as the rest of me does. I think if you can drive, work, shop, and function normally other than glasses, you are doing well, my .02.