Friday, August 17, 2012

Eye Robot - torn, detached retina, cryo&vitrectomy&gas bubbles - my life so far

Eye robot: - the  couple of months s of my life have been dominated by two eye operations - first for
cataract, second for torn and detached retina

If you are sqeamish about stuff like this, do not read on....

In June ago, after a 1 year wait, I had a succesful operation to replace the lens in left eye with intra-ocular fixed focus (near, for reading) plastic one - for 6 weeks, this was great affording better (and binocular vision) for the first time in 35 years...

however, then went on holiday in crete - about 2 days in, started getting  shadow over half the vision in the left eye - went to see GP and called up UCH (where the cataract op was) and they said might be a problem but couldnt really I let it lie for ten days

[ I should add that I was swimming 2k a day in slightly wavy seas, and had been on a 200k bike ride a week before....but I had specidically asked UCH people if it was ok to cycle and swim and the y said, yes, after 4 weeks...)

Got back from crete got appointment next day at UCH -
curiously enough, saw the very same surgeoon who referred me for the
Cataract operation a year back, which was finally done 2 months ago...
he said "oh could be coz of that, but could just have happened"...

Anyhow, he immediately referred me to
Moorfields Eye Hospital with suspect detached retina -

Moorfields do half a day of staring into my eyes
with all sorts of Sci Fi weird technology and
say "you have 5 or more tears in your retina and detached
areas on both sides and you need an operation right now",
(I ask "is it because I had the cataract op,
and two of them say "in all likelihood, yes" - its a 1% chance but I
got unlucky)...

So I go into the operating theatre under local anaesthetic
(coz I am crazy right and want to see them operate - ha the option of
general anaesthetic, but I dont like those)...
and they do 1.5 hours of poking around in my eye with a light,
microscope, laser and cryogenic gadget to find all the tears and seal
them up, then they remove the vitrous humour :-

(not humerous at al -
This is the liquid that  fills your eyeball
and normally keeps it all in nice shape -
this is probably the cause of the
retinal tears and detachment -
for 1/100 eye operations, the liquid
mysteriously gets more viscous, and starts to pull at the retina
whenever the eye moves around, and can result in what I got...)

They  replace the liquid with a gas bubble
which is designed to push the retina
back onto the inner surface of the eye,
but takes about 2+ weeks to do so -
because said gas is pressurized,
I'm not allowed to fly for 3+ weeks
(as the eye would, basically, explode:) -
nor can i see much out that eye,
as the gas isn't really the same refractive index
as the normal liquid in the eye...

After 2 weeks (i.e. 1 week from now) the gas is absorbed and
the eye generates new vitreous humour (this time, more humerous)
and it should all be working ok - what they say is
that they can't tell how much damage was done in the tears
(and fixing the tears doesn't repair so much as "weld" the gaps shut)
and how much retina will be operational at that point,
so I am basically in the dark almost literally
until late next week

The most tedious bit has been having to lie on one side for a few days
("to help the gas bubble push the retina the right way) -
i didn't draw the shortest straw here
as some people have to lie on their face for 2 weeks, which precludes
reading or TV - I just got three days on one side so books
and olympics final medals and closing ceremony  were an acceptable

I'm on an array of antibiotics, steroids, and various special eye
drops to promote repair, all of which seem to entail causing
severe soreness and light sensitivity....oh joy - only a week more of
most of those tho....

So I missed the conference in Helsinki this week  -ironically,
if i had decided not to go to that at all in the first place,
we;d have come to greece in our normal time and maybe the retinal
thing might not have happened (though I suspect it would have).

If I'd gone to Chania Hospital and they'd operated, I'd have been
stuck in Crete for 3 weeks (insurance would have covered it) which
would have been ok (assuming that they have the right gear for the op)
anyhow, those are all "might have beens"...

Am able to get around (even cycle if I choose routes carefully) and
certainly driving is ok - will be ok even if I lose some left eye

A good article about the gas they put in is here:
I had SF6 (1-2 weeks before absoprs/dissipates)

A good blog entry about what it looks like to see through the bubble as it dissipates:

As it says there (but they didn't advise at the hospital) you start out looking through a nearly opaque bubble that fills the whole field of vision. Over the next 2+ weeks, the bubble slowly shrinks as the gas is absorped into the bloodstream (presumably it diffuses into the veins that supply the retina) and the bubble also becomes less opaque, but becomes quite annoying as it bobbles around a lot in a jittery way and also distorts the vision in the area it covers - it appears to float around the bottom of the eye but in fact is at the top (remember basic optics) - if you remember the old 60s TV classic show, The Prisoner, it looks like a dark version of the bubbles chasing people out to sea when they try to escape from "The Island" (aka Portmeiron)....

Since my right eye vision is almost ok, it gives me a headache (poor eyes and brain are trying to restore binocular vision but not quite getting the right info yet)

As of today (friday 24 aug, just under 2 weeks after the operation) the bubble is down to about 10% of the vision area - the main area is slightly wavy, but looks like I have nearly 100% - focus is about what it was 8 weeks back before all of this but after the cataract op - i.e. reading without glasses may be ok - need to wait a few more days to tell....

Update: As of Monday 27, bubble is gone - image is stil wavy - I am assuming this is due to the 5 repairs/buckles on the retina where it was torn and cryo-welded back together - wonder if that will get sorted by the brain learning the inverse function? Reminds me of the story that El Greco (the painter) may have had eye trouble like this, at least people infer that from the distortion in his view of faces in his paintings...

Update: As of Sep 6, have still got wavy sight but can read 10pt text at 20cm from screen with that eye, so brain is doing something I think!

Update: As of Oct 9, wavy sight mainly gone - have had some pain (eye strain) as left eye focal depth was altered so with or without glasses (bought for the lens for after the cateract operation, but not for the vitrectomy effect:), poor old brain is telling eyes to try and focus (which they can't do any more) - for most the month had lost binocular vision, but it seems to be coming back, which i assume menas the left eye is healing and coming back into old form factor/shape/size - night vision is good...

Tomorrow, off to Moorfields for "final" checkup...

What puzzles me is the tech. they use to look at the retina which is
basically bright lights and a magnifier - there's no scanner/computer
imaging tech, which seems quite primative - it does seem that there's
a LOT of "interpretation" necessary by the opthalmic surgeons as the
retina have a lot of glitches naturally as you get am talking to various people about slit lamps and opthalmoscopes - seems they are rather ancient and there ought to be a way to use modern image intensifiers and priocessing cheaply - looking at the various historical things about opthalmoscopes, it seems they were invented by no lesser beings than Charles Babbage (of difference engine fame) and Helmholtz! Smart chaps, but somewhat ancient historical figures now

it seems there might be room for new computer based diagnostic assistant tools
plus Moorfields could update their leaflets on this operation to add a few useful hints.....when I go in, I'll try to remember to bring them an FAQ:) - something like this

detached retina/vitrectomy/intra-ocular gas bubble FAQ


bubble in vision more annoying at 50% -
        wearing eye patch advice?
wavy vision -
        would be nice to know prognosis/long term
scratched cornea (as well as infection:) -
        good reason to be v. careful with drops

any excercise (particular things to look at)
        to speed up brain/eye retrain?
chances of re-detach -
        not independant - in other eye?

vitrectomy:: interaction with focus...?
        new glasses/prescription (again!)

use of slit lamp to examine inside of eye -
        can you do better? (e.g. image intensifier/digial image processing)



could be more careful - e.g.
        don't cycle 200k or swim 2k in waves


peripheral vision -
        more annoying (focus?)

Sep 8 - last day of eye drops- that's a relief - don't like steroids at the best of times.

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