Vitreous Detachment and Its Impact on Vision Distortion

Q: Vitreous Detachment and Its Impact on Vision Distortion

Hello： <br>1. <br>Does the vitreous traction in the right eye require early surgery? If the vitreous traction in the right eye is severe and symptoms such as shadows or vision abnormalities are present, early vitrectomy may be necessary. <br>This can prevent further retinal damag

Vitreous traction distorting the retina?

Hello Doctor, I would like to ask you the following questions: Due to vitreous traction causing a retinal macular hole, the recent examination showed that it has expanded downward.
The doctor mentioned that it might develop into a full-thickness retinal tear and scheduled a follow-up appointment in August for further observation.
If it continues to progress into a full-thickness tear, surgery will be necessary.
I also mentioned to the doctor that my left eye had a vitreous traction that could not be surgically addressed in time and it ruptured on its own.
Subsequently, within six months, the right side of the macula in the left eye may have developed a hole due to the vitreous being partially torn in the middle while still exerting traction on the right side, resulting in an enlarging hole over two follow-up visits.
However, during this recent visit, the doctor stated that the hole in the left eye appears stable with no significant changes.

Last September, before the vitreous rupture in the left eye, I had already experienced distortion in my vision, which rapidly worsened before the rupture occurred, maintaining the level of distortion afterward.
Recently, I feel that the distortion sometimes improves slightly, but at other times it worsens.
Overall, I sense some improvement.
The distortion (which I later realized occurs when reading) manifests as a slight missing corner on the upper right of the letters, which only appears distorted when the font is smaller or viewed from a distance.
One doctor suggested that the distortion is due to the deformation of the macula, while another indicated that it results from a thin layer remaining above the hole (since there was a hole in the middle before the rupture, only a thin layer remains above), causing tissue loss (it is unclear whether this tissue loss pertains to the thin layer above or the original hole), resulting in the current macula being more concave and deformed than normal.
However, I had experienced distortion before the vitreous rupture.
It is possible that the distortion is related to the tissue loss from the original hole.
In any case, the shape of the macula in my left eye now differs significantly from normal, with a deep central depression.
I would like to ask the doctor: 1.
My right eye is now experiencing severe traction, and I am more prone to fatigue and seeing shadows, which improve with rest.
I am concerned that the right eye may also develop distortion like the left eye.
Should I consider undergoing a vitrectomy? 2.
If I undergo surgery to remove the vitreous now, will the hole that is progressing downward towards a full-thickness tear improve? Or after the surgery, even if there is no more traction, will it still gradually evolve into a tear requiring another surgery? I am worried that multiple surgeries could cause more harm to my eyes.
Should I let the vitreous detach naturally or wait for a tear to occur before considering surgery? 3.
After surgery, if cataract surgery is needed, will there be issues with monocular diplopia? The hospital's refraction showed right eye 825 and left eye 725, while the optical shop fitted glasses in mid-May with right eye 800 and left eye 700 (the prescription was adjusted to right 775 and left 675).
If I undergo cataract surgery, will this create issues with visual disparity in my glasses? I mentioned to the doctor about leaving some prescription, and he said not to leave too much because he is concerned that residual prescription might still cause visual disparity or discomfort.
4.
I have read online that some people experience photophobia and afterimages after surgery, and I am somewhat worried about the likelihood of this occurring.
I appreciate your clarification on these questions.
Thank you!

s, 40~49 year old female. Ask Date: 2024/07/13

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Does the vitreous traction in the right eye require early surgery? If the vitreous traction in the right eye is severe and symptoms such as shadows or vision abnormalities are present, early vitrectomy may be necessary.
This can prevent further retinal damage and avoid severe visual distortion issues similar to those in the left eye.
It is advisable to have an in-depth discussion with your ophthalmologist to assess the risks and benefits of surgery and make a decision based on their recommendations.
2.
What is the impact of surgery on a retinal tear? Vitrectomy can reduce the traction of the vitreous on the retina, thereby decreasing the risk of the tear expanding.
However, the surgery itself cannot repair an existing tear, and if the tear is close to a full-thickness break, additional repair surgery may be required.
While such surgery may have some impact on the eye, not addressing it could lead to more severe vision problems due to retinal detachment.
The specific timing and method of surgery should be determined by your ophthalmologist based on your particular situation.
3.
What about disparity issues after cataract surgery? During cataract surgery, the ophthalmologist will select an appropriate intraocular lens based on your needs.
If you are concerned about disparity issues post-surgery, you may choose to retain some degree of prescription to minimize the difference between the two eyes.
However, even with this approach, some disparity may still exist, which may require subsequent adjustments with glasses.
Discuss with your ophthalmologist to choose the best option to reduce post-operative discomfort.
4.
What about photophobia and afterimages after surgery? The likelihood of experiencing photophobia and afterimages post-surgery exists, but it is not high.
These symptoms are usually temporary and will gradually diminish over time as recovery progresses.
If you are particularly concerned about these issues, you can discuss them with your ophthalmologist to learn more about post-operative recovery and potential side effects.
In summary, your situation requires a comprehensive consideration of various factors, especially the health of the retina and the risks and benefits of surgery.
It is recommended to continue close discussions with your ophthalmologist and follow their advice for treatment.
Wishing you good health.

Reply Date: 2024/07/13

More Info

Understanding vitreous detachment and its implications for vision distortion is crucial, especially for individuals experiencing symptoms like yours. Vitreous detachment occurs when the vitreous gel, which fills the eye, separates from the retina. This condition can lead to various visual disturbances, including distortion, floaters, and flashes of light. In your case, the pulling of the vitreous gel on the retina, particularly in the macular area, can indeed cause the symptoms you are experiencing, such as the distortion of letters and shapes.

1. Vitreous Detachment and Symptoms: The distortion you describe, particularly the "missing corner" of letters, may be attributed to changes in the shape of the macula due to the vitreous pulling on it. When the vitreous gel exerts traction on the retina, it can lead to structural changes, which may manifest as visual distortions. The fact that you experienced these symptoms even before the vitreous detachment suggests that there may have been pre-existing changes in the retina or macula that were exacerbated by the detachment.

2. Surgical Considerations: Regarding your concern about the right eye, if it is showing signs of significant vitreous traction, it is understandable to consider surgical intervention. Vitrectomy, the surgical removal of the vitreous gel, can relieve traction on the retina and potentially prevent further complications, such as the development of a full-thickness retinal tear. However, surgery carries its own risks, including the potential for cataract formation and other complications. It is essential to weigh the risks and benefits with your ophthalmologist, considering the severity of your symptoms and the likelihood of progression.

3. Impact of Surgery on Vision: If you undergo vitrectomy, it may help stabilize the condition of your retina and prevent further tearing. However, it is important to note that surgery does not guarantee that you will not experience further changes in your vision. The underlying condition of the retina and macula will still play a significant role in your visual outcome. Your concern about the potential for cataracts and the need for additional surgeries is valid, as some patients may experience cataract formation after vitrectomy, necessitating cataract surgery later.

4. Visual Discrepancies Post-Surgery: Regarding the potential for visual discrepancies post-surgery, especially concerning the difference in prescription between your eyes, this is a common concern. After cataract surgery, some patients may experience anisometropia (a significant difference in prescription between the two eyes), which can lead to visual discomfort or difficulty with depth perception. Your ophthalmologist's advice to minimize residual refractive error is prudent, as it can help reduce the risk of visual discrepancies.

5. Post-Surgical Symptoms: The concerns about light sensitivity and afterimages following surgery are also valid. Some patients report increased sensitivity to light and the perception of afterimages after vitrectomy or cataract surgery. These symptoms can vary widely among individuals and may improve over time as the eye heals.

In summary, it is essential to maintain open communication with your ophthalmologist regarding your symptoms and concerns. Regular follow-ups and monitoring of your condition are crucial, especially given the potential for changes in your right eye. If you are considering surgery, ensure that you have a thorough discussion about the risks, benefits, and expected outcomes. Additionally, addressing any anxiety or concerns about your vision with a mental health professional may also be beneficial, as managing stress can positively impact your overall well-being during this challenging time.

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