My Vision Progression and the Bubble After Vitrectomy Retinal Detachment 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. 

I'm going to change the way I write these posts from now going forward.  Instead of reporting the details of my surgery recovery experience each week, I'm going to focus (pun!) on the reason why I'm really writing this blog: To give fellow patients an idea of the changes in my vision as the weeks after surgery went by. 

First of all, I found out that I had been given the longer acting of the various gases that are used in vitrectomy surgery.  The gas is called perfluoropropane or C3F8.  My doctor told me that it would take about eight weeks for the bubble to disappear.  As I said before, there is no way that a person can see anything but light and dark with a big gas bubble in the eye (except that I was able to see things held directly below the eye a few inches away).  But as the bubble gets smaller over time, we are supposed to be able to begin to see again.  But since the shrinking of the bubble is such a slow process, especially with C3F8, I think it is natural to be impatient and to wonder what we should be seeing and what we should look for and where in our field of vision we should look for it.

As the bubble shrank, the edge of the bubble showed up as a dark line in my vision, near the top of my visual field.  Strangely, even though the bubble sits at the top of the eye, it looks to the patient like the bubble is in the bottom of the eye.  That's hard to get used to at first.  When you start to see the dividing line near the top of your vision, it looks like a bubble is floating on the surface of liquid in your eye.  But what looks like a bubble at the top of your vision is really the liquid in your eye.  And the blur that you're still seeing in most of your vision is because you are still looking through a gas bubble.

My doctor told me that I should look above the line to see my returning vision.  He said that I would see a sliver of good vision and that sliver would get larger and larger as the bubble shrinks.  Web sites I read said much the same thing.  The problem was that when the line first appeared for me, I still couldn't see anything over the line.  I just saw a blur.  Nothing I was told and nothing I could find online explained this adequately.  So I worried if the blur that I saw above the line was an indication that the vision that I'd get after my recovery would be poor.  This wasn't the case, but I didn't understand what was really going on.  With my slow-acting bubble, this uncertainty took about two weeks, between the third and fourth weeks after surgery.  The dividing line between the bubble and the liquid in my eye slowly got lower, but when I looked above the line, I still only saw a blur.  Eventually, as the bubble shrank further and the line got lower, I was able to start to see some detail above the line.

Here's what I finally concluded.  When the bubble was still fairly large, like still taking up about 70% of my vision or so, when I looked upward above the bubble line I was forced to look up at too high an angle to be able to see any detail.  The dividing line was still above my macula, the part of the retina that sees detail, so I was forced to look upward to see around the bubble.  And though the bubble looked to me like it was at the bottom of my vision, in reality it was still up there.  So I think that I was still looking up through the gas bubble.  So I still couldn't see anything.  But by the fourth week after surgery, the bubble line had dropped lower, about half way down through my visual field and opposite the macula, I was excited to be able to see some detail.  I was able to see the tops of words on a movie screen.  I was able to see the tops of the picture frames on our walls. Everything still looked like I was looking through a whitewashed window, but I could actually start to see some detail.  I was very relieved and excited.  As more time went on, the lower on TV and movie screens I could see detail, until by the sixth week, I was able to see the entire screens.  My vision wasn't, and still isn't clear by seven weeks after surgery.  It is blurred and small details shimmer so that small letters are hard to read, but at least I'm seeing almost an entire visual field above the shrinking bubble line. 

So one of my main messages to other recovering patients is not to get too concerned when you start to see the bubble line get lower in your vision, but you still can't see anything above the line.  If your recovery is similar to mine, as time goes along and the bubble line drops lower, you may be able to start to see some detail.  Of course, there is no guarantee and each patient's visual progress will be different.

At this time, seven weeks after surgery, I can read the second or third line of an eye chart.  The bubble sits as a sphere at the bottom of my vision so I get some peripheral vision and I can merge the vision from both eyes, with some difficulty and some double vision.  I can't read newspaper print easily, mostly because we usually read by looking downward, and the bubble is still in the way of my downward vision.  But I seem to be seeing slow improvement in my detail vision as the days and weeks go by.  

I've read and I've been told not to expect to be able to know my eventual vision improvement until at least six months after surgery. But I'm encouraged at this point that I have a full field of vision and I can see the detail that I can see at this early stage.