Patient Perspective: Retinal Detachment
J. Myers is a realtor in the Washington, D.C., area. He had a vitrectomy for retinal detachment performed by Adrienne Scott, M.D., in November 2021.
In this Q&A, Myers speaks about his experience, while Scott provides her perspective and explains why certain things occur during the process.
What symptoms were you experiencing prior to seeing a doctor? How did you know there was an issue?
Myers: I was driving to South Carolina and I noticed that my vision was kind of blurry in my left eye. I got down to South Carolina and I noticed that in my left eye, there was kind of a shade over it. If I closed my right eye and saw with my left eye, I could not see clearly below a certain level. That shade was giving me a feeling that there was something really going wrong in my left eye. There was no pain.
Scott: Sometimes people are surprised that they don’t feel pain with it, but the detached retina can definitely present with just a spontaneous loss of peripheral vision or a darkening in a certain portion of vision. Oftentimes, people may not be aware of an issue when they’re looking with both eyes as we normally do, but they may become aware that there’s a problem when they go to cover one eye, because both eyes together may kind of mask the visual field defect.
Retinal detachment may occur as we get older. Our eyes are filled with a clear, gel-like substance called vitreous. As we age, vitreous gel liquefies, condenses and separates from the surface of the retina, a process called posterior vitreous detachment, or PVD. This may be asymptomatic, but sometimes a patient can notice the sudden onset of floaters or even flashes of light as the vitreous gel tugs on the retina. A PVD occurs most often without damage to the retina, and many floaters become less visually bothersome with time. However, in some cases, as the vitreous gel shifts, it can result in a retinal tear or retinal detachment if vitreous causes traction on the retina. So the condition can present with flashing floaters or, as in your case, J, just the spontaneous loss of side vision. If a person experiences sudden onset of floaters, or a change in their typical pattern of floaters, sees flashing lights, or experiences a shadow over the vision, we recommend a dilated retinal exam to rule out a retinal tear or retinal detachment.
What advice do you have for others preparing for this type of procedure?
Myers: I had three days to get ready and prepare for the procedure. I did a lot of reading about vitrectomies. My son came from South Carolina to be with me, to take me to the surgery and to bring me back for follow-up appointments.
I bought a few things ahead of time to prepare for the recovery. I bought shower caps because when you shower, you can’t get water in your eyes. With the cap, there is less likelihood water would drip into the eye. I also bought plastic to cover my eye on the days I washed my hair. I bought lots of straws because I was told I was going to have to keep my head down for 50 minutes of every hour for seven days, and you don’t want to put your head back when you drink.
Probably the most critical thing I bought was new wireless earbuds because I knew that I wasn’t going to be watching TV or reading. I bought a 25-hour audiobook and said, “OK, this may carry me through,” and it actually did.
Scott: It’s important to note that some patients with detached retinas must go to surgery that same day or within 24 hours.
What happens during the surgery?
Scott: While for many eye surgeries we use local anesthesia, there are some situations, depending on the patient, where we do the general anesthetic with the patient all the way out to sleep. That is a decision we usually discuss with the patient ahead of time. The surgery takes about two hours to complete.
There are different ways to repair a detached retina. They can include a scleral buckling, which is attaching a band of support around the eye that helps support the retina from the outside wall and decreases the risk of tension on the retinal tears, which may keep a retinal tear from sealing completely.
There’s also vitrectomy, which is what J had. During a vitrectomy, the surgeon removes from the eye the gel that may have pulled on the retina and caused the tear. In surgery, there are techniques that we use under high magnification and high illumination that allow us to tell where the retinal tears are and to seal around them.
What was the rehabilitation process like? What did you have to do, and are there any restrictions you had to adhere to?
Myers: During the first week, I had a series of drops that I was taking four times a day.
Since you’re going to have to keep your head down 50 minutes out of every hour, for seven days, this includes not putting your head back when you’re drinking things. That’s why I bought all those straws. The critical thing is not getting anything in your eye.
I was told I couldn’t fly in an airplane, and I wasn’t allowed to do any heavy lifting or strenuous activity for two weeks.
Scott: We try to discourage any heavy lifting over 10–15 pounds or any repetitive bending or straining for about two weeks after retinal detachment repair because it takes about that long for the retina to heal.
We often replace the vitreous gel with a gas bubble to reattach the retina. The bubble of gas is the reason for the positioning restrictions and why the patient is restricted from traveling over high altitudes — and definitely from air travel — until the bubble dissipates. If a patient travels to higher altitudes, there’s a risk of the bubble expanding and elevating the eye pressure to a dangerous extent.
The typical patient follow-up schedule is to come in the first day after surgery, again about a week after and then again about a month after. This can vary depending on the healing and the patient.
Now that the surgery is complete, how has your vision and/or quality of life changed?
Myers: I see things out of my left eye a little bit blurry, but I see about 80% of what I was seeing before. The quality of life, for me, is back to where it was before. If I get glasses, then it’ll help me a little bit with things I do like throwing a baseball with some neighborhood kids and playing golf. I’m very pleased.
Scott: J is doing wonderfully, and his eye is healing according to plan. I recommend waiting at least one to three months after retinal detachment repair to make sure the eye has stabilized before patients update their glasses. Sometimes a cataract can develop or progress, and that may shift the vision to make it blurrier than it normally would be. The patient sometimes may not get their very best vision back until they have their glasses updated or their cataract removed.