Recently, in an advice column in our local Chicago paper, a woman asked about her blurred visions. The columnist advised her to see a doctor! Yes, because as we age, everyone will go through what is called post vitreous detachment or PVD. Usually it happens with no symptoms. But I hope this piece emphasizes that if you have never worn glasses, or have just had a cursory exam during an annual physical…as you age, that might not be enough. Changes in vision should never be ignored.
I have worn glasses since I was two! Born with strabismus, the muscles of my eyes weren’t coordinated and images sent to my brain were out of sync. My left eye wandered. Surgery at the age of five fixed my left eye, but by then the right had become weakened or “lazy.” I traded the strabismus for amblyopia in my right eye. Definition: decreased vision due to abnormal visual development (lazy eye). I grew up aware of having only one good eye. If something was thrown at me, I learned to cover my eyes with my hands.
THE EYE EXAM: CHANGES
But then later in my life there was the checkup. I always wore glasses, needed a new pair. The nurse began the eye exam with the usual chart reading—one eye at a time, reading from top to bottom, letters in different fonts. I was having difficulty with my left eye, my good eye. This had never happened. The nurse put drops in my eyes, used a light to study my left eye. Moments later the doctor came in. Same procedure. By now I was anxious.
“I’m going to refer you to a retinal specialist. It looks like a problem with the thin covering on the very center of your retina. The macula. It determines your central vision.” He wrote down a doctor’s name, briefly rested his hand on my shoulder, and left the room.
In the car I cried—I needed my vision to read, write. I was a proofreader. How could I do that with a weak right eye? Magnification might help. If there was something seriously wrong with my good eye, my life would radically change. As tears clouded my vision it struck me, if this had to happen, why didn’t it happen to my bad eye?
A RETINAL SPECIALIST
I saw a retinal specialist. I liked this doctor, felt a sense of calm. More eye drops. More waiting, convincing myself that the chances of this being nothing were almost 100%. Then during the eye exam, the doctor stepped back. “You have a fold in the macula of your left eye. It’s not a hole yet, but a fold. It’s tiny, but it’s affecting your ability to see the letters on the eye chart.” I focused on his words, realizing yes, with my glasses I could still read print, find tiny periods and commas while proofreading work. But the eye chart was a challenge and so were street signs and license plates, until I was almost on top of them.
“I’m not sure why this has happened,” he said. “The vitreous or jelly in the eyeball is pushing on the macula and creating the fold. We want it to stop. And it might release. But if it gets worse, we have to do surgery, and it’s not a pleasant recovery. For now I can only tell you that you should be able to still do your work and I’ll see you in six weeks.”
“It could release.” Those words echoed in my head all afternoon as I tried to work. But I was struggling. Why my good eye? And if I needed the surgery, how would my vision be afterwards? Would I be able to read WAR and PEACE, my plan for retirement? Then the words echoed again. “It could release.” Yes, the vitreous would release and I would be able to use my left eye. It became my prayer. But when six weeks had passed, the doctor saw no change. “It’s the same. See you in two months.”
Good news? I just wanted to be able to read. I had been praying, but that night I forgot. The next morning, driving again, squinting at street signs, I said aloud: I will work through this challenge, through the possibility of having a permanent handicap. I had no choice.
ONE AUTUMN NIGHT WHILE RAKING LEAVES
Weeks later, I was out raking leaves. In the greying twilight, I looked down and an inky black thread crossed my vision. I closed my right eye—yes, the vision in my good eye was being hindered by this new black, thick floater. I hurried inside, saying nothing to my family. Recently I’d had silver flashes in my peripheral vision, made phone calls to the doctor, researched retinal tears. I was getting used to sorting through symptoms, trying to understand what was happening to my vision. I waited an hour, hoping my visions would right itself; hoping there would be no visit to the emergency room. And in that time period, the black threads disappeared. My vision was okay.
“Now we know what happened,” the retinal specialist said a week later. “You have gone through what we call a posterior vitreous detachment or PVD. * The vitreous jelly slowly detaches from the retina with no harm done. And it usually happens very slowly as you age, so slowly you don’t even know its happening. Yours went through like a runaway train and left a tiny fold. And maybe even that will go away, but aside from the street-sign-reading problem, your vision is good and you won’t need surgery.”
From that experience there was a change in my eye, but also in me. I would no longer take my good health for granted. I guess you could say I was seeing clearly.
- Definition: During PVD, floaters are often accompanied by flashes, which are most noticeable in dark surroundings. Most patients experience floaters and flashes during the first few weeks of a PVD, but in some cases the symptoms are hardly noticeable. If PVD is complicated by vitreous hemorrhage, retinal detachment, epiretinal membrane, or macular hole, the flashes and floaters may be accompanied by decreased or distorted vision. Floaters are most bothersome when near the center of vision and less annoying when they settle to the side of the vision. They may appear like cobwebs, dust, or a swarm of insects—or in the shape of a circle or oval, called a Weiss ring.