Retinal Vessel Twisting and Vision Fluctuations in Teens

Q: Retinal Vessel Twisting and Vision Fluctuations in Teens

Hello Claire： It is possible that your retina is unstable due to retinopathy of prematurity, which may cause a tugging sensation similar to that of blood vessels, resulting in unstable vision and images. <br>As for the exact cause, further examination is necessary, as there are m

Retinal vascular tortuosity and vision impairment?

I am 17 years old and have undergone laser surgery in both eyes due to retinopathy of prematurity.
As a result, I have developed myopia as a complication and have been returning for check-ups every three months.
Since February of last year, my corrected vision in the left eye suddenly dropped from 0.9 to 0.5 over the course of three months.
Additionally, my intraocular pressure has been somewhat elevated, fluctuating between 20-22 mmHg in both eyes.
Consequently, my doctor arranged a series of examinations (including optic nerve assessment, visual field testing, and optical coherence tomography), but no significant abnormalities were found.
During this time, my left eye vision remained stable at 0.5-0.6, while my right eye vision also unexpectedly dropped from 1.0 to 0.6.
In February of this year, a fluorescein angiography was performed, revealing no bleeding in the retina; however, the blood vessels appeared somewhat distorted due to scarring from the laser treatment.
Interestingly, during this recent refraction, my left eye measured 0.8 and my right eye 0.9 (both were 0.6 a month ago).
Additionally, I noticed that when I look at the eye chart, if I first see a clear gap to the right, after blinking, the gap shifts to the upper right, indicating that with each blink, the gap changes direction.
I would like to ask Dr.
Gao: (1) What is the relationship between the distorted blood vessels and the vision deterioration followed by a sudden improvement? (2) Regarding my experience with the eye chart, what could be the possible cause? Note: I was diagnosed with amblyopia in my left eye during early childhood, but it has been corrected to 1.0.
I apologize for the lengthy message.

Claire, 10~19 year old female. Ask Date: 2021/03/21

Dr. Gao Pilin reply Ophthalmology

Hello Claire: It is possible that your retina is unstable due to retinopathy of prematurity, which may cause a tugging sensation similar to that of blood vessels, resulting in unstable vision and images.
As for the exact cause, further examination is necessary, as there are many reasons for poor vision, and it may not solely be a retinal issue.
The Ophthalmology Department at Puzi Hospital in Taiwan is available: Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 2:00 PM to 4:30 PM.
Please note that online responses are for reference only; it is essential to seek medical attention at a healthcare facility if needed.
We hope to have the opportunity to serve you.
Best regards, Gao Pilin.

Reply Date: 2021/03/21

More Info

Understanding the complexities of retinal health, especially in young individuals with a history of conditions like retinopathy of prematurity, is crucial. Your situation involves several interconnected factors, including retinal vessel twisting, fluctuations in vision, and the implications of previous laser treatments.

1. Retinal Vessel Twisting and Vision Fluctuations: The twisting of retinal vessels you observed is likely a result of the scarring from the laser treatment you underwent for retinopathy of prematurity. This scarring can lead to changes in the normal architecture of the retina, potentially causing the vessels to appear distorted. The fact that your vision fluctuates, with periods of improvement and decline, can be attributed to several factors, including changes in intraocular pressure (IOP), the health of the retinal nerve fibers, and the overall stability of the retina. Elevated IOP, which you mentioned is between 20-22 mmHg, can be a concern as it may indicate a risk for glaucoma, especially in someone with a history of retinal issues. Regular monitoring and management of IOP are essential to prevent further complications.

2. Sudden Changes in Vision: The sudden drop in your visual acuity from 0.9 to 0.5, followed by a recovery to 0.8 and 0.9, suggests that there may be transient factors affecting your vision. These could include fluctuations in the clarity of the optical media (like the lens or vitreous), changes in the retina's function, or even temporary effects from eye strain or fatigue. The fact that your vision improved significantly in a short period is encouraging, but it also highlights the need for ongoing monitoring. It’s not uncommon for individuals with a history of retinal issues to experience such fluctuations, and they can be influenced by factors like lighting conditions, fatigue, and even emotional stress.

3. Visual Perception Changes: The phenomenon you described, where the perceived location of a visual target changes with each blink, could be related to several factors. One possibility is that it reflects a form of visual instability or a slight misalignment in how your eyes are working together (binocular vision). This could be exacerbated by your history of amblyopia (lazy eye) in the left eye, which may affect how your brain processes visual information from both eyes. Additionally, the brain's adaptation to changes in visual input can sometimes lead to perceptual shifts, especially if there are underlying issues with the retina or optic nerve.

In summary, your case illustrates the complex interplay between previous retinal surgeries, current visual acuity, and the dynamic nature of vision in young individuals. It’s crucial to maintain regular follow-ups with your ophthalmologist, who can monitor your retinal health, IOP, and visual function closely. They may also consider additional imaging or tests if your symptoms persist or worsen. Engaging in good eye care practices, such as taking breaks during prolonged screen time and ensuring proper lighting while reading, can also help manage visual fatigue and maintain your overall eye health.

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