Your Questions (2012 Jul - Dec)

Your questions and comments about any aspect of your eye health not covered in this website are most welcome. To submit your question or comment, please click here.

December 2012

SP Jain from Gurgaon, India, asks:
I wish to submit that my wife, 65 years old, has been feeling some problem with her vision for the past few weeks. So she had her glasses checked 22.11.2012 & was advised to get her fundus checked, as she was finding it difficult to view clearly.

I may submit:
She had laser encirclement of lattices in both eyes in May 1993. Phacoemulsification cataract surgery was performed in the right right eye on April 1997 and in the left eye in March 1999.

On examination in June 2006, her fundus examination revealed macular hole with cystoid macular edema and ILM wrinkling in the right eye. An OCT confirmed presence of cystoid macular edema with a full thickness macular hole with vitreomacular traction. Her surgery for macular hole in the right eye was carried out on in February 2006. She underwent vitrectomy, internal limiting membrane peeling with trypan blue staining and gas injection in the right eye under local anesthesia on 21.2.2006. 2 weeks later, her retina was attached with closed macular hole.

She visited an Eye Centre on 05.12.12 with blurred vision and black spotsin the left eye. Thank Almighty that her OCT has not indicated so far any hole formation in the left eye and the right eye operated for macular hole appears to be fine.

After checking the OCT she was advised to take some medication (Gloeye - 1 tablet a day , Acular LS 3 times a day in the left eye & Refresh Tears Eye, 3 times a day in both eyes) for about a month, and to be examined again after another month.

Remarks appearing on the OCT are:
OD - Altered foveal contour with inner layers' undulations
OS - Foveally attached PVD with Traction with sub-foveal neurosensory detachment with cystoid macular edema.

I shall be highly obliged to have your expert comments or advice to prevent macular hole formation in the left eye please.

Brian replies:
Dear SP, thank you for your question and sorry for my very brief reply. In short, based on what you have mentioned, there is already impending macular hole formation in the left eye and there is nothing that can be done to prevent it. The options are either to do a vitrectomy procedure now to relieve the vitreomacular traction, or to wait until the macular hole forms first before performing the vitrectomy. Good luck!

October 2012

Seema from Mumbai, India, asks:
My brother-in-law has retinitis pigmentosa. For the past 20 years, he has not been to see a doctor for any treatment. Please advise on any treatment options. I am really worried.

Brian replies:
Dear Seema, thank you for your email. Retinitis pigmentosa is a genetic disease affecting the retina, and is usually present from birth. Vision loss occurs as the cells in the retina start to die and atrophy. Unfortunately, this condition is not treatable or curable at present. Research looking at genetic therapy for retinitis pigmentosa has shown some promise, but it'll be a few more years yet before any conclusive results are achieved.

Having said that, it may still be worthwhile seeing an ophthalmologist to make sure that there aren't any other treatable eye problems, such as cataract. Secondly, even if substantial irreversible vision loss has already occurred, there may be low vision aids (such as magnifiers and lighting) that can help your brother-in-law maximize his remaining visual potential. Good luck!

Muhamad from Georgetown, Malaysia, asks:
I`m 49 yrs old with my left eye nearsighted slightly above 6 diopters & my right eye less than 4 diopters. I first had symptoms of flashes and posterior vitreous detachment (PVD) in my left eye on 27.8.12 with one horse shoe tear and shallow retinal detachment at 10 o`clock on the same day. The doctors in the general hospital did laser to barricade the tear later on the same day. After 2 weeks I went to a private retina specialist for a second opinion and he said that it was better to do Pneumatic Retinopexy. It's been exactly 6 weeks now, Alhamdullillah, there are no symptoms of flashes or increase of floaters since the first day.

My questions Dr:
1) How long does it take for the gas bubble from the Pneumatic Retinopexy to go away?
2) How long does it take for the PVD to complete in the left eye and will my right eye have PVD too?
3) Am I still at risk of another retinal tear or detachment?

Thanks Dr.

Brian replies:
Dear Muhamad, thank you for your email. Here are my replies to your questions.

1) It can take several weeks, sometimes up to 6 to 8 weeks, for the gas bubble to be completely absorbed from the eye.

2) Yes, you will most likely develop posterior vitreous detachment (PVD) in your right eye, if not already. It's difficult to say how long it takes for a PVD to 'complete' as this depends on the individual. Some people do not have complete PVD for their entire lifetime. The important thing is to monitor your eyes for symptoms of retinal detachment and to have your eyes examined if you are worried.

3) Yes, both your eyes are at higher risk of a retinal tear or detachment compared to the normal population due to your myopia and previous history, so make sure you look after your eyes properly.

Good luck!

September 2012

Paul from Boston, United Kingdom, asks:
I had corneal grafts 13/14 years ago because of keratoconus. All went ok for a few years. As expected I needed spectacles to correct my vision, but it got to the stage where my prescription was changing every couple of months. My optician often commented on the grafts looking milky in appearance and after contacting the surgeon that carried out the operations (now working privately only) was advised to refer me to a consultant. After been seen at my local hospital, I was referred to Lincoln Hospital where the consultant told me he had never seen anything like this but thought it could be solved with contact lenses.

I was not happy with that conclusion so I made my own arrangements to see the original surgeon in London. He was very understanding, but also he had never seen anything like this too. Both grafts have worn flat in the centre leaving the tissue very thin. He understood the reasons I did not want to go down the contact lens route because I had worn them with great discomfort before the grafts. He offered regrafts but unfortunately I would have had to pay and the price was more than I could afford so he sent a letter to my GP about his findings.

I was referred to Queens Medical Centre to see a Professor. On the first visit a sensitivity test was carried out which revealed I had no sensation in my left eye and very little in the right eye. I was told regrafts was not an option at this stage but he wanted to try various lenses first. Being very frustrated by now, I decided to give the lenses a go, 18 months later I am worse off than I was on my first appointment. I have tried most rigid gas permeable lenses and mini scleral lenses in my right eye. My left eye has been left with only close up finger counting vision after two epithelial ulcers, and a poor fitting lens in the right eye. On my last visit to QMC, the Professor was not there but one of his consultants checked me over. For the first time I was told there looks to be a cataract in the left eye, and would have to wait another 3 months to see if a cornea graft would be offered by the Professor, although I was told this would be doubtful because of the low sensitivity.

Is this the normal procedure? Would it be advisable for a second opinion? I can not understand why one surgeon would have carried out a regraft in a matter of weeks and the the other one has allowed my vision to deteriorate in my left eye.

Brian replies:
Dear Paul, thank you for your question. Your situation sounds quite complex, and it is very difficult to be able to make any specific comments without knowing in greater detail about your clinical history and without examining your eyes. I can therefore only make some general comments:

1. The shape of a corneal graft can change after many years if it was performed for keratoconus. However, having a milky appearance in the cornea sounds odd, and I hope that the corneal specialists have looked into it and managed it appropriately (whatever it may be).

2. Cataract is well-recognized to form earlier than in the normal average population after corneal graft surgery. It would be a good idea to know a bit more about the other potential corneal transplant complications so you have an idea of why sometimes repeat surgery is not the best way forward for some patients.

3. If you are not happy with the information that you have received so far, then I think that you are well within your rights to request for a second opinion from another corneal specialist.

Good luck!

Madhu from Bangalore, India, asks:
My husband has been diagnosed with ocular tuberculosis uveitis. His ATT regime has started. He is a technical person with very minimal contact with outsiders, also he is very healthy and lives in a very good locality in Bangalore, India. He is mildly diabetic and hypertensive. All his health problems are under control. Then how did TB infect his eyes. Please guide and help me with the right answers. I am very worried. Thank you.

Brian replies:
Dear Madhu, thank you for your question. It is very difficult to say exactly how and when your husband contracted tuberculosis (TB). However, TB is actually a reasonably common infection, with around 14 million active TB patients worldwide. In India, TB is very prevalent, in part due to the high population density and poor healthcare among those living in poverty. The mycobacteria causing TB is mostly transmitted via air droplets, so you do not need to touch someone with TB to get it. So your husband may have been infected when in a packed train or in a business meeting. Additionally, diabetes lowers the immunity, thus making your husband more susceptible to infection.

It does sound like your husband is having the correct treatment for the TB, so I am sure that he will make good recovery. However, please make sure that the uveitis is not neglected in the meantime.

Good luck!

Scott from Chestermere, Canada, asks:
Originally got this info from the Medical Posting in the March 2004 issue of Chatelaine magazine (I know that was a long time ago). Looking into corrective eye surgery (conductive keratoplasty), any ophthalmologist and surgeons. Need to know who performs this specific procedure in Calgary, Alberta, Canada? May we also have a 1-800 phone number for more personalized info. Thank you.

Brian replies:
Dear Scott, thank you for your question. I don't personally know of any ophthalmologist or surgeon who performs conductive keratoplasty in Canada. However, I am sure that if you perform a web search, you will be able to find details (including 1-800 numbers if available) of ophthalmologists who are experienced in this procedure in your area. Give several of them a call to see which one makes you feel the most comfortable. Also try to speak to some people who have previously undergone conductive keratoplasty with these ophthalmologists to find out how the experience was for them.

Disclaimer: Replies to your questions are only general in nature, and in no way are to be considered as replacement for a proper ophthalmology consultation and examination. If you require a more specific evaluation, please consult your ophthalmologist for a full eye examination.

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