Retinal Holes: Causes, Treatments, and Concerns

Retinal tears and issues related to the vitreous?

I have been seeking medical advice for the past six months, and the answers I received have been inconsistent.
I am currently concerned that I may be suffering from bipolar disorder or depression, and I hope to receive assistance from a physician here.
I have several questions, and I appreciate your understanding.
1.
Last October, I was diagnosed with a retinal tear during an outpatient visit.
The first doctor I consulted said it was caused by me rubbing my eyes too hard, which is true as I had been experiencing styes and had rubbed my eyes until they were red and swollen.
However, the second doctor mentioned that it was due to high myopia.
My current prescription is approximately -3.50 in the left eye and -3.00 in the right eye.
I would like to ask the doctor: if myopia is more severe in others, shouldn’t they have more retinal tears?
2.
I have had Tourette syndrome for several years, which causes me to involuntarily turn and shake my head vigorously.
Could this prolonged action have caused damage to my eyes, leading to the retinal tear?
3.
At the same clinic, I underwent laser treatment for the retinal tear.
During the procedure, I noticed that the laser exposure time was too long (over 2 seconds), significantly longer than during the second surgery.
Postoperatively, I found that part of my peripheral vision had gone dark.
When I inquired, the doctor told me it would improve in 1-2 weeks, but I still perceive a shadow.
I would like to know if this situation indicates that the laser dosage was too strong.
(I was startled during the first treatment and went to another clinic, where they informed me that only one eye can be treated at a time.)
4.
After undergoing retinal laser treatment, does the condition of floaters worsen?
5.
Does the laser light used in retinal laser treatment accelerate the progression of eye diseases such as cataracts or glaucoma?
6.
After looking at the sky or a white wall for a while, I notice slight shimmering waves, which become more pronounced the longer I stare.
Closing my eyes for a moment helps restore my vision, especially noticeable when I wake up feeling dizzy in the morning.
When I consulted a doctor about this issue, they mentioned blood pressure and genetic predisposition to diabetes.
My family does have a history of diabetes, but my blood pressure readings at work are consistently normal.
The information I found indicates vitreous degeneration.
I would like to ask what causes vitreous degeneration.
Is it related to the previous retinal laser treatment? I had just recently completed my military service and did not experience this issue while in the military.
7.
If my cornea and other factors are normal, can I undergo PRK or related surgeries in the future? Will having a retinal tear prevent me from undergoing these procedures?

Mr. Lai, 20~29 year old female. Ask Date: 2017/05/24

Dr. Cai Wenyuan reply Ophthalmology

Hello,
1.
It is likely related to myopia.

2.
It should not be.

3.
It should not be.

4.
It is unrelated.

5.
It will not happen.

6.
It is not.

7.
It is not related to retinal holes.

Wishing you peace and health,
Dr.
Tsai Wen-Yuan,
Director of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/05/24

More Info

Understanding retinal holes is crucial for anyone experiencing vision problems, especially if they have a history of eye issues like you do. Let's address your concerns systematically.

1. Causes of Retinal Holes: Retinal holes can occur due to various reasons, including high myopia (nearsightedness), trauma, or even excessive eye rubbing. In your case, both the eye rubbing and high myopia could be contributing factors. While it is true that many individuals with high myopia may not develop retinal holes, the risk is indeed higher due to the structural changes in the retina associated with elongated eyeballs. Therefore, it is not solely the degree of myopia that determines the presence of retinal holes, but also individual anatomical and health factors.

2. Tourette Syndrome and Eye Rubbing: Your history of Tourette syndrome, which can involve involuntary movements, may contribute to eye strain or trauma if it leads to frequent or forceful eye rubbing. This behavior can potentially damage the delicate structures of the eye, including the retina. However, it is essential to consult with a neurologist or a specialist in movement disorders to address the Tourette syndrome effectively.

3. Laser Treatment Concerns: Regarding your experience with retinal laser treatment, it is crucial that the procedure is performed correctly to avoid complications. If you felt that the laser exposure was excessive, it is worth discussing this with your ophthalmologist. The presence of black spots in your peripheral vision post-treatment could indicate a complication, and it is essential to monitor this closely. If symptoms persist, seeking a second opinion from another retinal specialist may be beneficial.

4. Floaters Post-Laser Treatment: It is common for patients to experience an increase in floaters after retinal laser treatment. This can be due to the changes in the vitreous gel that occurs as a result of the laser application. While floaters can be bothersome, they are often benign. However, if they significantly increase or are accompanied by flashes of light or a curtain-like shadow in your vision, you should seek immediate medical attention.

5. Impact of Laser on Eye Diseases: Laser treatments for retinal holes are generally safe and do not accelerate the development of other eye diseases like cataracts or glaucoma. However, any surgical procedure carries some risk, and it is essential to discuss these risks with your ophthalmologist.

6. Visual Disturbances: The symptoms you describe, such as seeing wavy lines or shimmering lights, can be related to several factors, including vitreous degeneration, which is common as people age. While it may not be directly caused by the laser treatment, it is essential to monitor these symptoms, especially given your family history of diabetes. Regular eye examinations can help track any changes.

7. Future Surgical Options: If your cornea and other eye structures are healthy, you may still be a candidate for PRK or similar refractive surgeries. However, having a history of retinal holes may require additional evaluations to ensure that the surgery will not pose a risk to your retinal health. It is crucial to have a thorough discussion with your ophthalmologist about your surgical options and any potential risks involved.

In summary, your concerns about retinal holes and associated symptoms are valid and warrant careful monitoring and management. It is essential to maintain regular follow-ups with your eye care provider and to communicate any new or worsening symptoms promptly. Additionally, addressing your Tourette syndrome with appropriate medical support may help reduce the involuntary eye movements that could be contributing to your eye issues.

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