Detachment!! Symptoms, Sunday Surgery

I'm writing this blog to try to help fellow retinal disease patients who are undergoing retinal detachment and repair surgery to gain from my own experience some idea of what one patient experienced as his recovery progressed.  I am not a medical professional and this blog is not intended to serve as medical advice or as a substitute for appropriate counsel from a doctor or other licensed professional. I am just one patient and my experiences may not be typical or representative of what other patients can expect.  I advise you to consult a licensed and trained medical doctor for medical advice. 

On a Friday afternoon in early December 2014, I noticed something strange in the vision of my right eye.  There were no new floaters.  There were no flashes of light.  But up in the top left corner of the vision of my right eye, I saw what looked like an after-image from when you look at a bright light too long and then you look away.  I couldn't be sure that I was seeing anything for sure.  I'd look up to the left and sometimes I'd see something there and sometimes I wouldn't.  We were headed out to babysit for our granddaughters, so I didn't think much about it.  While we were at the kids' house I kept looking for the spot and I still didn't always see it.  We got home late and I went to bed and didn't worry about it.

The next morning, I had a social breakfast out planned with some friends. I got up early and drove the 25 miles to the restaurant and I had a nice time for three hours or so.  Throughout the breakfast I kept looking up to the left to see if I could see anything there, but I still wasn't sure.  I drove home and took a nap.  By the time I got home, there was definitely a blank spot in the upper left corner of my right eye's vision, but for some reason I didn't do anything about it.  I think that it was because it was a Saturday, I didn't have a regular ophthalmologist and the eye wasn't changing much.  So I took a nap.  When I woke up around 3 pm the spot had gotten bigger and had elongated into a strip.  I got pretty concerned and I realized that my optometrist was open on alternate Saturdays, so I called him on the chance the office was open and it was.  I asked if I could come in and have him take a look to see if something was going on or not. He looked at my chart and told me to call the retina surgeon's office who had done my laser surgery.  He realized that I had had a retinal tear three years previous and cataract surgery as well, and I needed to get hold of a retina surgeon right away and that there would likely be a doctor on call.

If there is one message that I want to pass on to everyone reading this, it is DON'T WAIT!  It doesn't matter what time of day or night it is, and trouble often happens on weekends and holidays.  Retinal detachment is always a medical emergency and nobody will doubt you on that.  Don't wait because you don't want to bother the doctor on his weekend. Don't wait because your insurance won't approve a specialist visit without a referral from your GP.  This is an emergency.  Don't wait because it'll just be 24 hours and the office will be open on Monday morning.  Call your ophthalmologist or your retinologist on call or go to the Emergency Room, but get going!  Hours count and days definitely count.  This is your vision and the only vision that you'll get for the rest of your life.  Surgery can repair most of the damage, but while the outcome in terms of the quality of your vision is uncertain, the sooner you catch it, the better.  The only thing that is certain is that the longer you delay, the outcome can potentially be worse.  And if you do nothing, it is very likely that you'll go blind in that eye.

I called the answering service and the retinologist on call called me back quickly.  He is a partner of the doctor who had done the laser repair of my retina three years earlier.  He had me describe the symptoms and told me to call him on Sunday or if it changed.  Later Saturday night I noticed that the spot was getting a bit bigger and the color was changing from grey to yellowish. It was late, so I didn't bother the doctor again that night.  I went to bed and the doctor called around 8:30 the next morning.  He asked how the eye was doing and he told me that he was going to be in the office at 10:30 and that I should meet him there.  He dilated my eye, looked around in there and he told me that I was going to have surgery that afternoon.  

He had me read the eye chart and since the center of my vision was still just fine, I was able to read the chart well, probably at 20/30 or 20/25 corrected by my eyeglasses.  With later reading, I realized that this meant that I needed emergency surgery because I still had good central vision, and if I waited for surgery, the macula could detach and that the visual results of the surgery might not be as good.  I also read that the most important determinant of the quality of the visual outcome of the surgery is the quality of the vision right before surgery.

The doctor asked if I'd eaten anything that morning and I had eaten some cereal and coffee.  So I needed to wait until around 3 pm to have the surgery.  I was lucky that my doctor has surgery privileges at a small hospital and that he could get surgery scheduled for that afternoon.  

The doctor told me that I was going to have a vitrectomy where he would remove the vitreous humor of the eye, use a laser to repair the detachment and that he would put a gas bubble in the eye and that I would need to position myself looking at the floor for five days or so.  

I checked in to the hospital. I found that the doctor had called ahead, so after a bit of a delay, the admitting staff knew what to do.  I was briefly seen by an ER doctor who confirmed the diagnosis of a retinal detachment.  This was key because insurance won't deny the reimbursement for the surgery if it is an emergency.  I was put in an ER bed and told to change into a hospital gown.  An IV was started and I met the specialty nurse who would be helping with the surgery and I met with the anesthesiologist.  He told me that they would be using managed sedation.  I would be awake but I wouldn't be aware of much that was going on.  He said that he would be monitoring my heart rate and if I became anxious, he would be able to tell and would give me more sedation to keep me comfortable.

I was relaxed and chatty as they wheeled me into the OR.  I remember being lowered onto a reasonably comfortable operating table and my head was put in a cup shaped support.  I remember a drape being placed over me with a cutout for my eye.  I don't remember much else and I wasn't uncomfortable except for a brief period when I woke up.  There was no discomfort from my eye, but my back was a bit sore from lying still, and I had a strong need to readjust my back and my head!  I knew that I shouldn't move a muscle, but I knew that I had to.  I tried to use calming imagery, but I was way too anxious for that.  I finally moved a bit, and my surgeon immediately said "Don't move!".  I said that I was trying but that I was having trouble keeping still.  I asked for more sedation and I felt a warm sensation and then nothing else but waking up when they were done with the surgery.

I was awake and alert when I went to the post-op area.  The nurse said that the doctor wanted me face down or on my left side, so we settled on my left side.  Then my doctor came by and firmly told her that he wanted me face down, so we readjusted with pillows and I settled into a face down position on the gurney.  I had an eye patch on my eye and the doctor told me that he wanted to see me the next morning in his office for a follow-up visit.  I was to remain face down at all times and to sleep face down. I could take Tylenol ES for pain.  

My lovely wife drove me home around 6 pm.  I sat looking down in the car and I went straight to the sofa to lie face down once we got home.  I had a light dinner of chicken soup and crackers, all eaten sitting up while looking downward.   When I needed to go to the bathroom, I walked with my head facing the floor.  Sleeping was difficult.  I had plans to make a nest for myself with pillows, with a space for my face to look downward at the bed.  But I just couldn't get comfortable.  I'd say that I got about two half hour sleep stints that night.

I'll always be grateful to my optometrist and to my retinal surgeon for getting me moving and getting me into surgery on a Sunday afternoon, and giving me a chance to keep my vision.