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Blurred vision, dot on retina. Advised retinal surgery. Is surgery the only option? - Online Doctor Chats

Date : 19-Mar-2013
User rating for this question
Very Good Posted in: Vision and Eye Disorders
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
User:Good afternoon Dr
Doctor:welcome to XXXXXXX
User:I had a problem with my right eye for sometime.blurred vision
Doctor:ok, please proceed with your query.
Doctor:May i know your age ?
User:contacted the Ophthalmologists near my residence and even the Retina Specialist
User:I am 54
User:They observed and said there is a dot on the retina and this could be the beginning of Cataract
User:But even after a year,the condition remained the same and then I thought of switching over to another Dr.who detected this as a Hole in the retina
Doctor:were any refraction errors detected on refraction testing ?
User:No refraction testing done.
User:They suggested retinal surgery as the only option
User:My doctor then also advised me to take opinions on this as she is not a retina specialist
Doctor:so the condition, has stayed the same , and has not progressed ? is this right ?
User:yes the same
User:With trhis eye,I have a periferal vision.Not from the centre
Doctor:do u have anything floating within your eyes , any form of pain or redness ?
User:The retinal specilaist who took some poictures at the hospital said that once you have a surgery,there could be complications in that eye.Just seeking your views on this
User:No pain ,redness
Doctor:did they mention , what the diagnosis was ?
User:But I can see a web like formation which they said is some problem sighted in the vitreous gel
Doctor:do u have diabetes or hypertension ?
User:Maculkar Hole
User:No diabetes
User:But hypertension is there but controlled
User:I had laser surgery doen in the eye almost 20 years back for venal occlusion
User:Then there waas no problenm
User:till now
User:is surgery the only option?
User:the vision with that eye is the everything gets dented at the centre
User:Itr is Macular hole.wrongly spelt
Doctor:I understand
Doctor:the macula controls and helps in central vision
User:any medication that would help
Doctor:any disease or disorder that affects the macula results, in loss of central vision
Doctor:this is a form of anatomical defect, and medications are usually not effective
User:i have never had any disease with the eye
Doctor:Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision.
User:how do they seal themselves?
Doctor:In this surgical procedure--called a vitrectomy--the vitreous gel is removed to prevent it from pulling on the retina and replaced with a bubble containing a mixture of air and gas.
User:yes Vitrectomy is the name I read in the report
Doctor:sealing is by natural healing, just like normal skin heals
Doctor:The bubble acts as an XXXXXXX temporary bandage that holds the edge of the macular hole in place as it heals.
User:is there anything that can be done to hasten the normal healing process?
Doctor:due to the presence of fluid in the eye cavity, the edges of the macular hole , are floating, and not in contact with the edges
Doctor:so healing may be difficult in large holes
User:u mean surgery is the only option?
Doctor:but , it is definitely possible in small cuts, which are in apposition with each other
User:i am meeting Dr Natarajan also next week for his opinion.He is apparently the best Dr in Mumbai for retina
Doctor:Surgery is performed under local anesthesia and often on an out-patient basis, so you need not worry about it
User:I was told it is a major surgery
Doctor:yes, it is the best option in such anatomical defects of the eye
User:will there be any complications later in that eye?
Doctor:The most common risk following macular hole surgery is an increase in the rate of cataract development.
User:i was told that such invasions in the eye triggers many problems like vcataract ,glaucoma
Doctor:In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal.
Doctor:less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated.
User:can the visoion be restored back post surgery to the normal levels?
Doctor:Vision improvement varies from patient to patient.
Doctor:People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period.
User:I do not know when this actually started
Doctor:do u know the size of the hole ?
User:I am meeting one Retina surgeon today for his opinion on this case
Doctor:have they mentioned the stage of the condition ?
User:Not mentioned
Doctor:The size of the hole and its location on the retina determine how much it will affect a person's vision.
Doctor:When a Stage III macular hole develops, most central and detailed vision can be lost.
User:what the Dr said was normally this happens to age over 70.In my case,sinec this has happened at 54,i could go in for the surgery,the success rate he mentionbed could be 70%
User:But I have a periferal vison can see people almost clearly in normal diustance
Doctor:yes, that is right , macualr holes, are related to age
User:since this has happened to the right eye,can this affect even the left?
Doctor:yes, that is possible
User:can this be prevented?
Doctor:If a macular hole exists in one eye, there is a 10-15 percent chance that a macular hole will develop in your other eye over your lifetime.
Doctor:Aside from avoiding trauma, there is nothing that can be done to avoid a macular hole.
Doctor:Diet and exercise do not contribute to the formation of a hole.
Doctor:self evaluation, is the best way to detect it earlier
Doctor:Occasionally covering each eye - to test the other eye alone -- is the best way of detecting a change in central vision.
Doctor:In addition, having a regular, annual eye exam is the best way to catch a hole in its early stages.
Doctor:please remember - It is important to note you should not fly in an airplane while there is a gas bubble in your eye.
Doctor:The gas will expand at higher altitudes which can cause pain, high eye pressure, and permanent visual loss.
Doctor:Depending on the type of gas instilled, the bubble usually lasts from two to eight weeks.
User:you mean after the operation?
User:fonly for this period?
User:can I resume duties after a month?
User:is it advisable to do the surgery immediately?Can this be delayed?Would this delay increase complications?
Doctor:yes delays will cause the hole to increase in size
Doctor:it is better done much early as possible
Doctor:after surgery, time needed for recovery, may be upto 4 weeks
Doctor:this is because - Maintaining a face-down position is crucial to the success of the surgery
Doctor:This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole.
Doctor:As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids, and the healing is complete
User:The bubble instilled,will automatically seal the hole?
Doctor:yes, the bubble will put pressure, on the cut edges, which will get into apposition
Doctor:when this happens, healing starts and finally the hole seals off
Doctor:hope u followed my suggestions
Doctor:do u have any other questions ?
User:yes doctor.Many thanks for your valuable suggestions
Doctor:You are welcome
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