In this month's edition of, ‘what’s going on with my eyes’ - and thankfully, this time, it's not a bad change - I bring you, partial but significant vitreous detachment.
It all began a few weeks ago when I noticed small spots in the peripheral of my bad eye and two big splodges in the upper right area of my good eye that would flash when I blinked. The best way to describe this is by likening it to the after-image you get after looking at the sun, or when a camera flashes. Except, this flash doesn't fade like a normal after-image does.
I left it a few weeks to see if it persisted (and also secretly to check to see if it was just in my head and whether I was simply being a drama queen), but, after a fortnight, it was still there. One of the spots in the peripheral of my bad eye was the most noticeable when I'd check when using my laptop; if I closed my good eye, it looked like the cursor was on the right hand side of the page, but then when I would check to see where the cursor was, it would be somewhere completely different on the page. There were also a couple of other spots dotted around the right hand side. In my right eye - the 'good' eye, as I call it, there was a bigger area that flashed. It appeared as two big splodges in the top right area of the eye, but unlike my left eye, I could only really see these splodges if I was looking down, rather than at all times (so much so, to begin with I thought it was my eyelashes just all bunched together) .
It's all incredibly difficult to explain, so I've done my best to show what I was/am seeing in terms of these new changes with the below illustrations. Believe it or not, I hold a media degree, and these are my computer-generated images. From these, even if you still can't quite understand the changes I'd seen, what is clear is that the skills I learnt from my degree were not at all practical (I promise I'm better at theoretical and came away after four years at Uni with so sort of skill). So whilst the below will make the Photoshop queens die of embarrassment, it's my best effort, and made on none other than the very professional, PowerPoint 😂
I've edited the Amsler grid to show *roughly* where I started noticing flashing spots in the peripheral of my left eye. The spots off the grid are the changes I'm referring to, and the two black spots on the grid are complete blind spots and areas of distortion left behind from my first and second PIC episodes.
The image underneath shows the changes to my right eye. The Amsler grid for my right eye is thankfully still normal (no blind spots or distortions), but there are two black splodges off the grid in the upper right hand corner of my vision. They are bigger than those in the left eye, and are less 'perfect' and uniform in shape.
Left eye:
Right eye:
I felt concerned by these changes largely because this after image - like flashing was how my PIC had first begun last year. With my vision also still being blurry (a symptom from my last flare), and an extra influx of floaters having appeared, the panic really got going.
Just to add to the worry, I felt concerned that if it didn't show on scans then the changes I was seeing might not be very believable and/or might just seem like anxiety. These feelings haven't stemmed from how my current hospital has made me feel, but more a mixture of previous bad experiences (I won't bore you by banging on again about how many people I saw before I was diagnosed), and simply the sheer fear of potentially losing vision all over again. Just to add some extra feelings into the mix, my mind likes to torment me further by holding some heavy guilt against me; if it doesn't show on scans, I feel like I have wasted NHS resources or potentially taken an appointment from someone else who really needed it. As you can tell, it's really fun living in my head.
But despite it not being ideal that there are changes, I felt incredibly relieved when after an OCT, OCTA, and an Optosom photo, the doctors told me that they could also see changes which may reflect the differences I am seeing. To my surprise, it wasn't my PIC misbehaving, but the OCT did show a lovely snowy white line quite a good way across my eye where my vitreous was coming away from the retina (posterior vitreous detachment - PVD). My doctor then suggested we do an an ultrasound (or a B-scan) just to see how severe it the vitreous detachment was, as it looked quite significant on the OCT.
I don't know why given the wonders of modern medicine I found it so weird (but amazing) that it's possible to do an ultrasound on eyes. Literally, like you would expect, they put gel on my eye lids and just below my brows, and then rolled a probe over it to gather information which was then relayed on the computer screen next to me.
My ophthalmologist said that the B-scan suggested that the detachment was more severe than she had thought from the OCT, but that it is still 'partial'; so essentially, some bits are still hanging on in there. I was even given a print out of the scan to have myself (because the machine was being slow and my doctor accidentally pressed print twice 😂 but still...). Again, it was weird but very cool to be able to see the back of my eye and to have a lovely little keepsake photo of it. So here's a copy for you to enjoy the weirdness and coolness too...
Despite what you may think, the circle graffiti on the images to the left aren't another poor 'how I see' computer manipulation effort, but are there to help explain the images better. The yellow circles highlight white specs within my eye which are areas of detachment and condensation.
In the bottom picture, the top yellow circle shows the line where the vitreous is pulling away from the retina but is still partly attached.
From the appointment I learnt that vitreous detachment really isn't the end of the world - it's more annoying than anything else because of the symptoms. The eye will replace the jelly itself, and I should eventually learn to ignore the floaters and flashing spots.
After a quick physical examination too, my ophthalmologist also said I had something else (there's too many fancy medical words to remember what she called it), but after a bit of conversation, it turned out that I have very, very early stage cataracts in both eyes from long-term steroid use. My doctor said this wasn't a worry though, because when it eventually gets bad, they can simply replace the lens with a working one. From what I can understand, this is not a bad thing in terms of myopia either, as I think they would replace the clouded lens with one that has the correct, or at least better, prescription than how I see now. So, from what I can gather, if I were to have cataract surgery, (after recovery), there's a good chance that I'd actually be able to wake up see without any help from specs or contacts?!
As neither changes are particularly bad, I’m feeling positive. I'm glad that the changes showed on the scans and that they could also be explained, so I can now stop worrying that my PIC is trying to flare up. And just to make the visit better still, my ophthalmologist said that based on my last couple of scans, my PIC is looking stable. So let's hope it stays that way!
She also agreed that after four months I can come off my Timolol pressure drops! It was queried whether my pressure (which was recorded at 14 mm Hg at this particular visit - a huge improvement from the 27 mm Hg recording after my Ozurdex implant) was only this stable due to taking Timolol on a daily basis, but, I am going to try and stay off them to see whether this recording can be maintained. If I get any symptoms of high pressure again and the horrendous-nearly-touching-your-eye pressure-reading machine agrees, then I'll have to go back on them.
But for now, it's all good news! It's felt a long time coming, and I hope it stays this way 🤞🏻
If you've had any experiences yourself with PVD and/or cataracts following steroid use, I'd be grateful to hear them!
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