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My 85-Year-Old Eye: Dr. Val Goes To The Ophthalmologist

Fortunately for me, my recent brush with the healthcare system was not as frightening as Dr. Dappen’s (he blogs here every Wednesday and recently had a mild heart attack). However, it was provided me with some amusing blog fodder.

Last week I was minding my own business, planning to purchase a new batch of contact lenses from a local optometrist, when I was required (under threat of withholding my lenses) to undergo a vision exam. Much to my disappointment, my right eye was not behaving itself, and refused to correct to 20/20 despite a good deal of lens fiddling on the part of the doctor. A slit lamp retinal evaluation followed, and the optometrist concluded that my right eye’s macula “looked like an 85-year-old’s.”

Well, that was not the most welcome of observations. I asked for the differential diagnosis (being that I’m quite a few years away from 85) and wondered how I’d developed macular degernation. He suggested that it could also be a “central serous” which is (apparently) a stress-related swelling of the macula that requires no treatment and usually resolves on its own.

“So basically you’re saying that my eye could be ‘bugging out’ because of stress.” I said. “And you’d like me to see an ophthalmologist just in case it’s something worse and equally untreatable?”

“Right.”

So I made an appointment with a local ophthalmologist – one of the few working on Christmas Eve – and was sorry to have him confirm that there was indeed something wrong with my retina.  He even ordered an eye angiogram (I didn’t know those existed, but it makes perfect sense) and I was injected with a vegetable dye. Photographs were taken through my dilated pupils at regular intervals as the dye wound its way through my retinal vasculature.

“It’s not a central serous.” He said with a serious tone. “And you can see the macular defect here on this photograph.”

“So my right eye is like an 85-year-old’s?” I asked, wondering how I’d been so fortunate to have one part of my body on the aging fast-track.

“Well, not exactly. I think it’s unlikely to be age-related macular degeneration. You probably have retinal thinning caused by your nearsightedness.”

“You mean all that straining to see the chalk board wore out my retina?”

“No. What I mean is that your eye is supposed to be shaped like a baseball, but yours is an egg shape. So your retina is stretched thin and is starting to wear in your macula area.”

“Well can you suck out some of the vitreous gel and shape my egg back into a baseball?”

“No. Unfortunately that doesn’t work.”

“How do you know?”

“The Russians tried it in the 1960s.”

“Ok, well how do I take some of the tension off my stretched out retina?”

“You can’t.”

“Well if I lose weight or eat carrots or exercise, or stop wearing contacts, or get lasik… would any of that help?”

“No.”

“So there’s nothing I can do to prevent further damage, and nothing to repair or treat it.”

“Right.”

Pause.

“I don’t like this condition.”

“Well, you’ll have to come and see me once a year so I can monitor the progression. Sometimes the body responds to the retinal damage by growing blood vessels in the area, and that can cause further visual deficits. But we can zap those new vessels with a laser and decrease the damage.”

“So my eye might overgrow with blood vessels like weeds in a garden.”

“It might. But it also may stay exactly the same for the rest of your life.”

“Well, the uncertainty is anxiety-provoking.”

“I’ll see you in a year. You’ll probably be fine. Don’t worry. Oh, and if you see any ‘floaters’ or flashes of light, come in to see me immediately.”

“What would that indicate?”

“A retinal tear that would need laser therapy right away. People with thin retinas can have spontaneous tears. Just keep that in mind.”

“Um… ok.” I said, smiling feebly.

So here I am, with one wonky eye, not knowing if it will get worse or remain the same indefinitely. There’s nothing I can do but watch the progression once a year with an ophthalmologist. Like so many patients, I’m in a gray zone where prognostication is a challenge and reversal of disease is not possible.  I have one 85- year-old eye. May it bring me wisdom, courage, and more empathy for patients.


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13 Responses to “My 85-Year-Old Eye: Dr. Val Goes To The Ophthalmologist”

  1. As people continue to live longer, the incidence of eye disease such as macular degeneration is on the rise. These types of debilitating eye diseases rob people of vision, and can result in individuals losing their independence.

    It is believed that the visual system requires up to 25% of the nutrients we take into our bodies in order to stay healthy. Impaired circulation and/or poor absorption of nutrients can significantly contribute to eye disease.

    There is a great deal of peer review research now showing the vision can be preserved through a proper diet and specific nutritional supplementation.

    Essential nutrients include lutein, zeaxanthin, omega-3 fatty acids, taurine, gingko biloba, lycopene, vitamin A, E, zinc, copper, selenium for example, that can help both prevent the onset of eye disease such as macular degeneration as well as help preserve vision for those with macular degeneration.

    For more information and specific research studies by eye condition on nutrition and vision, go to Natural Eye Care for Macular Degeneration

  2. Lisa Emrich says:

    Dr.Val,

    Don’t fret too much. I’ve had thinning retinas since I was a teenager due to severe nearsightedness. I’m so nearsighted that contacts no longer come in increments small enough to correct appropriately.

    Currently, I require -11.50 contact lenses and have been ingrained with the warning of flashing lights. Floaters, I have plenty of and there’s nothing to do about it.

    Welcome to the annual eye club.

    Lisa

  3. shellee says:

    I’m sorry about your 85-year old eye, Dr. Val, but I really enjoyed your blog. I’m an NP and I had never heard of this before. Thanks for the information.

  4. Strong One says:

    My thoughts are with you and your health Dr. V. Reality has a really rotten sense of humor when it comes to health.

  5. Vijay says:

    Like I said on twitter, I was diagnosed with high-myopia-related retinal degeneration when I was 17. The degenerated areas were all peripheral, so I was treated with cryotherapy. I guess, since yours is in the macula, cryo is not an option.

  6. If it makes you feel any better at all, my girlfriend has the same problem – it actually had caused some tears in her retina. All but one were fixed by laser, and the last was fixed with surgery. After, her doctor implanted a plastic “belt” around that eye – to basically support the eye and keep it from tearing in the future. It’s been a few years, and she’s been fine ever since.

    You’re right – that gray zone is one of the most anxiety-producing situations around. Hope this story helps.

  7. Sinyet says:

    I wonder how common retinal thinning is in highly myopic eyes? I noticed that my eyes didn’t adapt to darkness as quickly as they had in the past, and was told that was due to retinal thinning at the edges of the retina. Surely we can’t be the only ones with this problem?

    Good luck, and thanks for the blog!

  8. You should see a retina specialist if you did not. Rather than using lasers on proliferative Myopic Macular Degeneration, retina specialists are now using Macugen, Lucentis, or Avastin (all off-label for MMD) to treat the neovascularization. the anti VEGF drugs are as effective against the neovasc from MMD as they are that in AMD.

    good luck!

    PS: Wear sunglasses, take your vitamins, eat your veggies, take fish oil. Those may not help with MMD, but you don’t need AMD on top of MMD.

  9. Kim says:

    Geeze, is this common to myopic folks? I’m nearsighted and have been for 32 years. I get an eye exam every year with no sign of this.

    If it makes you feel any better, one eye may be 85 but the rest of you looks like early 30s! : D

  10. Rachel says:

    My childhood ophthalmologist stressed the importance of regular screenings once I reached high school age for this very reason. Thank you for bringing it to light for me once again.

  11. Dr Benway says:

    Sorry to hear about your old eyeball.

    I’m also myopic. That chart with the big E? I couldn’t see any of it. My acuity was, “can count fingers at 3 feet.”

    In 2001 I had Lasik, although I was a borderline case. The laser had to burn off a lot to correct my vision.

    After the procedure I had 20/30 both eyes and was very happy. But my vision has continued to decline. My eyes are apparently made of mush.

    A few years ago I noted that telephone poles were curving. I saw a retinal specialist and learned that I’ve got an epiretinal membrane growing over each macula. Trauma may be a trigger. Perhaps the suction cup on the eyes during the Lasik procedure was a factor.

    No treatment. S’posed to go back annually for monitoring. However, I’m a terrible patient only marginally conscious of my body unless something is terribly wrong.

    I consult part-time at a rehab facility in New England. Enjoy your blog.

  12. Gary Levin says:

    Myopic degeneration is not uncommon. The eyeball basically is longer than normal. The sclera (outer coat of the eye stretched because it is somewhat elastic (like the outerpart of a soccer ball). The retina does not stretch well and becomes thinner, so the number of cones per sq mm is less and the vision becomes less. Also in myopes a hole can develop in the retina becomes too thin. The more important risk is that of a retinal tear since the retina is stretching, holes or thin spots can devellop near the insertion of the retina in the anterior part of the retina. As a hole or traction increases patients will develop flashing lights and ‘spider webs’ and floaters in their vision. This is an urgent development and needs to be evaluated by a vision professional who is highly skilled using what is called indirect ophthalmoscopy. If a hole developed it can be sealed with either laser photocoagulation or by freezing the area (called cryopexy). Ignoring the symptoms may lead to a retinal detachment which would require surgery. Sealing the retinal hole before the retina detachment occurs is important, because the prognosis is better. In general, myopia is a risk for retinal holes and detachment. Gary M.. Levin MD F.A.A.O.

  13. Dr. Val says:

    Thanks for that info, Dr. Levin. I will keep an eye out (pun intended) for floaters and spider webs… and rush myself to an ophthalmologist if I notice any! ;-)

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