Are you
at risk for PVD or retinal detachment?
by Marcia Kester Doyle, AARP,
January 22, 2020
I was eating dinner at the table when a spark of light
similar to a mini thunderbolt flashed in the corner of my eye. The sun was
setting outside the window, so I assumed it was just the rays bouncing off the
lens of my eyeglasses. Every time I turned my head to the left, the light
appeared in my peripheral vision on the right side. I didn't think much of it
at first; it had to be the sun's glare. But when it became dark outside and the
flashes were still appearing, I began to worry. Thinking that perhaps I'd spent
too many hours staring at a computer screen that day, I went to bed early with
the hope that the strange light would disappear.
The next morning the flashes of light were
gone, but they were replaced by long, squiggly lines that resembled black worms
floating across my right eye. After Googling my symptoms, I panicked, convinced
that I was going blind from retinal detachment and immediately called my
optometrist for an emergency appointment.
Her diagnosis: posterior vitreous detachment
(or PVD), a natural, non-sight threatening eye condition that occurs when the
vitreous (the clear, gel-like substance that makes up the eyeball) pulls away
from the retina.
PVD is a common occurrence in middle-aged adults,
especially those near the age of 60. The reason it happens later in life is due
to the vitreous losing its firm, gel-like shape as it becomes more liquid with
age. This causes it to separate from the retina at the back of the eye and move
closer toward the center. Early symptoms include flashes of light (usually peripheral) and floaters —
the tiny black specks that are a result of age-related changes in the eye.
Floaters occur when tiny fibers in the vitreous stick together and cast a
shadow over the retina. They are normal and of little concern, unless there is
a sudden increase in spots or if a dark curtain appears on either side of the
eye, blocking the peripheral vision.
On its own, PVD does not cause permanent loss
of vision or pain, and the symptoms usually subside after three months. Even
so, a professional diagnosis with a dilated eye exam is recommended to confirm
that the retina has not been compromised.
When PVD occurs, the retina (the light-sensing
nerve tissue at the back of the eye) reacts to a vitreous detachment by
delivering small electrical signals to the brain, causing flashes of light to
appear in the peripheral vision.
In my case, hemorrhaging also had occurred
around the area of the vitreous humor (the gel portion of the eye) making it
difficult to view the condition of the retina. The floating black lines in my
vision were actually the result of blood leaking into the vitreous. My
optometrist urged me to see a retina specialist for an extensive exam to rule
out the possibility of retinal tears or detachment.
Unfortunately, the specialist found that my
vitreous had tugged on the retinal nerve layer hard enough to cause several
rips in the tissue and would need immediate care before the retina could
separate from the back of the eye cavity (known as retinal detachment, which
can affect vision permanently). He assured me that since my retinal tears were
diagnosed early, if I sought proper treatment my prognosis for healthy eyesight
was good.
The two most common procedures used for
retinal tears are laser photocoagulation and cryopexy (a freeze-burn
procedure), both of which are safe and effective. Laser therapy involves
sealing the leaking blood vessels in the retina by making small burns around
the affected area to create a scar. This, in turn, holds the tissue in place
and keeps it from further leakage, similar to cauterizing a bleeding wound.
Cryopexy is the process of using a cold probe,
known as a cryoprobe, to stimulate fusion of the tissue surrounding the retinal
tear.
My retina specialist felt that laser therapy
was the best option for my condition, explaining that it needed prompt
attention to avoid retinal detachment and that the procedure would take roughly
15 to 20 minutes in the office. His decision did not allow any hesitation on my
part, which was probably a good thing since I'm the type of person who would
have gone home and Googled every first-person account of laser surgery and
psyched myself out.
As promised, the surgery was quick with
minimal discomfort after the topical anesthetic drops were applied to the eye.
I had to remain perfectly still during the procedure, which felt like Darth
Vader and Luke Skywalker were battling it out with laser wands in my eye.
Once it was over, I was told that the floaters
would shrink over time and to refrain from strenuous activity for the next two
weeks while the eye recovered. I asked my specialist what caused my condition
since I hadn't experienced head trauma. He explained that PVD was very common,
especially in people over the age of 60 and added that since it had already
occurred in one of my eyes, there was a higher chance of it developing in the
opposite eye within the year.
There are several other risk factors beyond
advanced aging and head trauma for retinal tears and detachment:
·
Thinning of the retina
·
Myopia
(nearsightedness)
·
Cataract surgery or
any recent interocular surgery
·
A family history of
retinal tears or detachment
Wrinkles and fatigue I expected with age, but
never once did I consider a problem with my eyes other than needing prescription readers for small print. My
condition was truly an “eye-opener” and a reminder to anyone over 60 of the
importance of having your eyes checked regularly by an optometrist.
From now on if I experience floaters or
flashing lights, I won't hesitate to call my specialist for an exam. I plan on
living my life to the fullest and seeing it all with 20/20 vision.
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