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Thanks For Your Answers To My Earlier Questions In This

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Posted on Fri, 12 Apr 2019
Question: Thanks for your answers to my earlier questions in this thread (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=384643).


I have consulted another doctor and just done another OCT yesterday , and found that the RE retina thickness has increased from 333 (OCT done on 1 Feb ) to 394. The significant rise just after about five weeks sounds alarming. This new doctor said that it is very rare for the epiretinal membrane to grow so much he opined that it might be due to different machines used for the OCT.

Here I have some more questions

1. My RE vision is now more or less the same as previous examination around 20/30. I understand that ERM ususally progress slowly but it seems that my case is rapid progression. Could ERM have such rapid progression? What could be the causes for such rapid progression? Is machine difference accountable for such a significant progression?

2. What is your advice? Immediate surgery? Or could I still wait and observe for a while?

3. Due to work commitment, I could go for surgery late April but not earlier. Do you think I can wait until then? Do you think my conditions will deteriorate much by then and will affect surgery outcome and recovery?

4. Is my condition has progressed to severe level? Any retina thickness reference indicating the need for surgery?

5. The doctor said that vitrectomy will increase the risk of retinal detachment in the longer term by 10%. While my first doctor said that after vitrectomy, retinal detachment risk is less because no more pulling of retina by vitreous gel. Seem the two sayings are conflicting. Which one is true?

6. From OCT, I can see some holes, is it lamellar holes you mentioned or macular pseuoholes? If latter, can it progress to macular holes?

Would appreciate your advice. I am worried about my deteriorating conditions
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Follow up: Dr. N K Mishra (0 minute later)
Thanks for your answers to my earlier questions in this thread (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=384643).


I have consulted another doctor and just done another OCT yesterday , and found that the RE retina thickness has increased from 333 (OCT done on 1 Feb ) to 394. The significant rise just after about five weeks sounds alarming. This new doctor said that it is very rare for the epiretinal membrane to grow so much he opined that it might be due to different machines used for the OCT.

Here I have some more questions

1. My RE vision is now more or less the same as previous examination around 20/30. I understand that ERM ususally progress slowly but it seems that my case is rapid progression. Could ERM have such rapid progression? What could be the causes for such rapid progression? Is machine difference accountable for such a significant progression?

2. What is your advice? Immediate surgery? Or could I still wait and observe for a while?

3. Due to work commitment, I could go for surgery late April but not earlier. Do you think I can wait until then? Do you think my conditions will deteriorate much by then and will affect surgery outcome and recovery?

4. Is my condition has progressed to severe level? Any retina thickness reference indicating the need for surgery?

5. The doctor said that vitrectomy will increase the risk of retinal detachment in the longer term by 10%. While my first doctor said that after vitrectomy, retinal detachment risk is less because no more pulling of retina by vitreous gel. Seem the two sayings are conflicting. Which one is true?

6. From OCT, I can see some holes, is it lamellar holes you mentioned or macular pseuoholes? If latter, can it progress to macular holes?

Would appreciate your advice. I am worried about my deteriorating conditions
doctor
Answered by Dr. N K Mishra (3 days later)
Brief Answer:
OCT

Detailed Answer:
Thank you for your query.

Kindly upload your recent OCT, that will help me to answer your query in a better manner.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. N K Mishra (0 minute later)
Brief Answer:
OCT

Detailed Answer:
Thank you for your query.

Kindly upload your recent OCT, that will help me to answer your query in a better manner.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. N K Mishra (13 hours later)
Dear Dr Misra,

Latest OCT uploaded. For your expert advice

Thanks
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Follow up: Dr. N K Mishra (0 minute later)
Dear Dr Misra,

Latest OCT uploaded. For your expert advice

Thanks
doctor
Answered by Dr. N K Mishra (13 hours later)
Brief Answer:
ERM

Detailed Answer:
Please find my answers below
1. My RE vision is now more or less the same as previous examination around 20/30. I understand that ERM ususally progress slowly but it seems that my case is rapid progression. Could ERM have such rapid progression? What could be the causes for such rapid progression? Is machine difference accountable for such a significant progression?

There is definitely some change in your ERM, but it will be very difficult to ascertain the reason for it. It is always advisable to repeat the scan on the same machine as it has the ability to take the scan from the same location of retina. Doing it on another system will definitely have some changes.

2. What is your advice? Immediate surgery? Or could I still wait and observe for a while?

The decision for surgery is based on only two parameters the visions and distortion of images. If you have significant issues with these, then only proceed for surgery. We don't advise surgery just on the basis of OCT scans.

3. Due to work commitment, I could go for surgery late April but not earlier. Do you think I can wait until then? Do you think my conditions will deteriorate much by then and will affect surgery outcome and recovery?

As stated above, you can delay or hasten the surgery depending on two factors.

4. Is my condition has progressed to severe level? Any retina thickness reference indicating the need for surgery?

As such there are no guideline that dictate the decision for surgery based on OCT findings.

5. The doctor said that vitrectomy will increase the risk of retinal detachment in the longer term by 10%. While my first doctor said that after vitrectomy, retinal detachment risk is less because no more pulling of retina by vitreous gel. Seem the two sayings are conflicting. Which one is true?

Both the statements are partially correct. All retinals surgeries may lead to retinal detachment as part of the spectrum of complications. And yes, removing the vitreous gel reduces the traction on the retina.

6. From OCT, I can see some holes, is it lamellar holes you mentioned or macular pseuoholes? If latter, can it progress to macular holes?

No these are not holes, they are space created due to pulling of the retina due to the ERM.

Would appreciate your advice. I am worried about my deteriorating conditions

I hope my answers help.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. N K Mishra (0 minute later)
Brief Answer:
ERM

Detailed Answer:
Please find my answers below
1. My RE vision is now more or less the same as previous examination around 20/30. I understand that ERM ususally progress slowly but it seems that my case is rapid progression. Could ERM have such rapid progression? What could be the causes for such rapid progression? Is machine difference accountable for such a significant progression?

There is definitely some change in your ERM, but it will be very difficult to ascertain the reason for it. It is always advisable to repeat the scan on the same machine as it has the ability to take the scan from the same location of retina. Doing it on another system will definitely have some changes.

2. What is your advice? Immediate surgery? Or could I still wait and observe for a while?

The decision for surgery is based on only two parameters the visions and distortion of images. If you have significant issues with these, then only proceed for surgery. We don't advise surgery just on the basis of OCT scans.

3. Due to work commitment, I could go for surgery late April but not earlier. Do you think I can wait until then? Do you think my conditions will deteriorate much by then and will affect surgery outcome and recovery?

As stated above, you can delay or hasten the surgery depending on two factors.

4. Is my condition has progressed to severe level? Any retina thickness reference indicating the need for surgery?

As such there are no guideline that dictate the decision for surgery based on OCT findings.

5. The doctor said that vitrectomy will increase the risk of retinal detachment in the longer term by 10%. While my first doctor said that after vitrectomy, retinal detachment risk is less because no more pulling of retina by vitreous gel. Seem the two sayings are conflicting. Which one is true?

Both the statements are partially correct. All retinals surgeries may lead to retinal detachment as part of the spectrum of complications. And yes, removing the vitreous gel reduces the traction on the retina.

6. From OCT, I can see some holes, is it lamellar holes you mentioned or macular pseuoholes? If latter, can it progress to macular holes?

No these are not holes, they are space created due to pulling of the retina due to the ERM.

Would appreciate your advice. I am worried about my deteriorating conditions

I hope my answers help.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. N K Mishra (46 hours later)
Thanks Dr Misra for your reply.
 
My doctor said that as I have symptoms (distortion and blurry vision), he suggested surgery and said that the longer I wait, the greater the difficulties/complications of surgery/complications because the membrane will only grow thicker and thicker, more and more pulling on the retina, and the neurons/cells will die as time passes if surgery is delayed.  Also the longer the membrane covering the retina, the more difficult to peel off the membrane because it will stick to retina more and more tightly.  As such, the recovery will be slower and the results (ie.. vision acuity and reduction of distortion) will be more and more away from pre-disease good conditions along with the delay time of surgery.
 
My questions –
 
1.         Is there any so-called “golden time” for ERM surgery?
 
2.         Given that I have symptoms already as a result of the wrinkling of retina, is the risk of dying neuron/retina cells increase with time? Is my doctors’ saying true?
 
3.         My thinking is that if more and more neurons/retina cells will die as time passes and the poorer the surgery outcome will be the longer the delay, then for the sake of recovery to as close as possible to my pre-ERM good vision without any distortion, it seems wise to go for earlier surgery even if my vision is currently not bad and distortion is tolerable.  Any views/advice?
 
4.         I learnt that ERM usually progress slowly and some patients can remain stable for years before surgery. For such cases, is surgery after several years will yield poorer results compared with early surgery even if conditions remain stable for years ? I wonder whether time factor alone (even if no disease progression) will affect surgery  outcome
 
5.         Is my current ERM condition mild, moderate or severe?  Is the measurement of 394 mcrons and the OCT findings indicative of the severity of conditions?

6. Are there other ways other than surgery that can improve or stabilise my ERM conditions? eg, supplements. What should i pay attention to or be alert in my daily life in view if my ERM conditions?
 
Thanks and look forward to your advice
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Follow up: Dr. N K Mishra (0 minute later)
Thanks Dr Misra for your reply.
 
My doctor said that as I have symptoms (distortion and blurry vision), he suggested surgery and said that the longer I wait, the greater the difficulties/complications of surgery/complications because the membrane will only grow thicker and thicker, more and more pulling on the retina, and the neurons/cells will die as time passes if surgery is delayed.  Also the longer the membrane covering the retina, the more difficult to peel off the membrane because it will stick to retina more and more tightly.  As such, the recovery will be slower and the results (ie.. vision acuity and reduction of distortion) will be more and more away from pre-disease good conditions along with the delay time of surgery.
 
My questions –
 
1.         Is there any so-called “golden time” for ERM surgery?
 
2.         Given that I have symptoms already as a result of the wrinkling of retina, is the risk of dying neuron/retina cells increase with time? Is my doctors’ saying true?
 
3.         My thinking is that if more and more neurons/retina cells will die as time passes and the poorer the surgery outcome will be the longer the delay, then for the sake of recovery to as close as possible to my pre-ERM good vision without any distortion, it seems wise to go for earlier surgery even if my vision is currently not bad and distortion is tolerable.  Any views/advice?
 
4.         I learnt that ERM usually progress slowly and some patients can remain stable for years before surgery. For such cases, is surgery after several years will yield poorer results compared with early surgery even if conditions remain stable for years ? I wonder whether time factor alone (even if no disease progression) will affect surgery  outcome
 
5.         Is my current ERM condition mild, moderate or severe?  Is the measurement of 394 mcrons and the OCT findings indicative of the severity of conditions?

6. Are there other ways other than surgery that can improve or stabilise my ERM conditions? eg, supplements. What should i pay attention to or be alert in my daily life in view if my ERM conditions?
 
Thanks and look forward to your advice
doctor
Answered by Dr. N K Mishra (4 hours later)
Brief Answer:
Episode Retinal membrane.

Detailed Answer:
My dear,
Good of you to get back to me.
The indication of going ahead with surgery is when you are having symptoms ,as the doctor has rightly pointed out.Indications of not having a surgery is when there is hardly any symptoms and the progress of disease is very slow.
Both these do not feature in your case.There is haziness and the progress is rapid.
Since there is no other treatment which will help you,we want surgery quickly.As you already know,thicker membrane has a list of complications which can occur,early surgery is recommended.
Question 4 doesn't apply to you as you problem is not stable.
More signifcant than catagory is the progression of thickness,so early surgery avoid most of complications.
So plan surgery at the earliest.
There is no need to delay thereby leading to complications like bleeding and detachment.
So you focus on surgery and do not wait to complicate the matter.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. N K Mishra (0 minute later)
Brief Answer:
Episode Retinal membrane.

Detailed Answer:
My dear,
Good of you to get back to me.
The indication of going ahead with surgery is when you are having symptoms ,as the doctor has rightly pointed out.Indications of not having a surgery is when there is hardly any symptoms and the progress of disease is very slow.
Both these do not feature in your case.There is haziness and the progress is rapid.
Since there is no other treatment which will help you,we want surgery quickly.As you already know,thicker membrane has a list of complications which can occur,early surgery is recommended.
Question 4 doesn't apply to you as you problem is not stable.
More signifcant than catagory is the progression of thickness,so early surgery avoid most of complications.
So plan surgery at the earliest.
There is no need to delay thereby leading to complications like bleeding and detachment.
So you focus on surgery and do not wait to complicate the matter.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. N K Mishra (3 days later)

Thanks for your advice. I will see my doctor again soon and arrange surgery

1. Would like to know the prognosis of the surgery, Currently my VA is not bad, 20/30. But vision feel wavy and like having a piece of cellophane in front , also vision of both eyes not balanced and feel uneasy. I want to know for such wavy images. cellophane vision, and vision imbalance, will they disappear after surgery? Or substantially improve? Any predictive factors in my case?

2. I will soon have teeth cleaning. Can I go for it, given my medical conditions? Will tooth cleaning affect my ERM and eye conditions?

3. my left eye has vitreous haemorrhage in Dec 2018, and then a small retinal tear treated by laser. My doctor said i will have a greater chance of ERM on my left eye because of these conditions. I would like to know the % increase of such risk as compared to normal people without these prior conditions?

Thanks.

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Follow up: Dr. N K Mishra (0 minute later)

Thanks for your advice. I will see my doctor again soon and arrange surgery

1. Would like to know the prognosis of the surgery, Currently my VA is not bad, 20/30. But vision feel wavy and like having a piece of cellophane in front , also vision of both eyes not balanced and feel uneasy. I want to know for such wavy images. cellophane vision, and vision imbalance, will they disappear after surgery? Or substantially improve? Any predictive factors in my case?

2. I will soon have teeth cleaning. Can I go for it, given my medical conditions? Will tooth cleaning affect my ERM and eye conditions?

3. my left eye has vitreous haemorrhage in Dec 2018, and then a small retinal tear treated by laser. My doctor said i will have a greater chance of ERM on my left eye because of these conditions. I would like to know the % increase of such risk as compared to normal people without these prior conditions?

Thanks.

doctor
Answered by Dr. N K Mishra (5 hours later)
Brief Answer:
Epiretinal membrane

Detailed Answer:
My dear,
Thanks for getting back to me.
It is good that you are planning for surgery.Though your symptoms may not disappear completely,it may take a while for improvement to occur.If you plan not to have surgery,diminision of vision will keep on progressing.One predictive factor has been the delay in surgery.More is the time gap for surgery,less is the improvement.
Your dental cleaning has no bearing on ERM.
Chances of getting ERM in the other eye are more,but conclusive guidelines about % of occurrence is lacking.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. N K Mishra (0 minute later)
Brief Answer:
Epiretinal membrane

Detailed Answer:
My dear,
Thanks for getting back to me.
It is good that you are planning for surgery.Though your symptoms may not disappear completely,it may take a while for improvement to occur.If you plan not to have surgery,diminision of vision will keep on progressing.One predictive factor has been the delay in surgery.More is the time gap for surgery,less is the improvement.
Your dental cleaning has no bearing on ERM.
Chances of getting ERM in the other eye are more,but conclusive guidelines about % of occurrence is lacking.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. N K Mishra

Ophthalmologist

Practicing since :1977

Answered : 1297 Questions

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Thanks For Your Answers To My Earlier Questions In This

Thanks for your answers to my earlier questions in this thread (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=384643). I have consulted another doctor and just done another OCT yesterday , and found that the RE retina thickness has increased from 333 (OCT done on 1 Feb ) to 394. The significant rise just after about five weeks sounds alarming. This new doctor said that it is very rare for the epiretinal membrane to grow so much he opined that it might be due to different machines used for the OCT. Here I have some more questions 1. My RE vision is now more or less the same as previous examination around 20/30. I understand that ERM ususally progress slowly but it seems that my case is rapid progression. Could ERM have such rapid progression? What could be the causes for such rapid progression? Is machine difference accountable for such a significant progression? 2. What is your advice? Immediate surgery? Or could I still wait and observe for a while? 3. Due to work commitment, I could go for surgery late April but not earlier. Do you think I can wait until then? Do you think my conditions will deteriorate much by then and will affect surgery outcome and recovery? 4. Is my condition has progressed to severe level? Any retina thickness reference indicating the need for surgery? 5. The doctor said that vitrectomy will increase the risk of retinal detachment in the longer term by 10%. While my first doctor said that after vitrectomy, retinal detachment risk is less because no more pulling of retina by vitreous gel. Seem the two sayings are conflicting. Which one is true? 6. From OCT, I can see some holes, is it lamellar holes you mentioned or macular pseuoholes? If latter, can it progress to macular holes? Would appreciate your advice. I am worried about my deteriorating conditions