Retinal Flashes: Concerns for Young Patients with Vision Issues

Retinal flashes

Hello Doctor, I have amblyopia and hyperopia of over 600 diopters in my left eye, and my right eye has myopia of about 150 diopters.
I discovered floaters in my second year of college, and after examination, the doctor diagnosed it as vitreous degeneration.
Since then, I have been undergoing dilated eye exams approximately every six months, and the intraocular pressure in both eyes is around 18 mmHg.
I am currently in my fifth year of medical school.
Since I first noticed the floaters, they have gradually worsened, and in the past six months, I have even experienced flashes of light.
Although it is not common, I have had this phenomenon three times in the past month, which many describe as meteor showers or lightning.
Recently, I also noticed that when I look at a bright sky, the entire peripheral vision appears to flicker and darken (a very clear phenomenon, although it is hard to see due to the brightness of the sky).
This flickering slowly fades away, but if I cover my right eye for a few seconds and then uncover it to look at the sky, the phenomenon reappears immediately (I emphasize the right eye because it has better vision and is easier to notice).
Today, I went to a clinic where the doctor dilated my eyes to examine the retina and found no issues with the retina, but there is significant degeneration of the vitreous around both eyes.

My question is, being so young and not part of the high-risk group for severe myopia, and with only my right eye having better vision, I am really worried about the future...
I feel very sad and anxious.
I have endured the inconvenience of floaters for these past few years, but beyond that, I am concerned about the implications for my retina.
The doctor expressed helplessness regarding my vitreous degeneration and mentioned that we can only hope that if unfortunate events occur, such as retinal detachment or tears, they can be treated early.
I would like to know if the prognosis for retinal detachment surgery is good? Will there still be some degree of visual field loss? (Because the surgery essentially involves damaging the retina, right?) Additionally, what is the procedure for vitrectomy? After removal, is there a need to fill the space with any substance? Will there be any long-term side effects? Lastly, if my retina is being pulled like this for a long time, even without a tear, will there still be adverse effects? I have asked many questions, and although I am a fifth-year medical student, there is still so much I do not understand...
I feel ashamed.
Of course, I am feeling very down and worried right now; I really want to cry...
My future cannot withstand the loss of vision...
I only have good vision in my right eye, and now both eyes are severely degenerating...
Thank you, Doctor, for your response.
Wishing you good health.
From a helpless and sad An...

An, 20~29 year old female. Ask Date: 2007/01/17

Dr. Hu Yusheng reply Ophthalmology

Hello Mr.
An, based on your description, the phenomenon of flashes occurring only in the presence of a light source or within two minutes after the light source disappears is more likely to be an afterimage phenomenon, which is a normal physiological occurrence.
Flashes related to the retina can also occur in darkness and may happen under gravitational acceleration.
Additionally, there is a type of visual illusion that can be caused by pressure on the eyeball, which is also a normal physiological phenomenon.
You mentioned that vitreous degeneration is not uncommon; if it does not cause retinal traction, there is no need for concern.
In the unfortunate event that retinal detachment does occur, you can self-check for any peripheral vision loss.
If you notice any, seek immediate attention from an ophthalmologist, as prompt surgery should lead to a favorable prognosis.
Wishing you success in your studies and good health and happiness.

Reply Date: 2007/01/17

More Info

Dear An,
Thank you for sharing your concerns regarding your vision issues, particularly the retinal flashes and the progression of your symptoms. It's understandable to feel anxious about these changes, especially as a medical student who is aware of the potential implications of eye conditions. Let's break down your concerns and provide some clarity on the situation.

Firstly, the phenomenon of seeing flashes of light, often described as "lightning" or "shooting stars," can be associated with vitreous detachment or traction on the retina. Given your history of myopia and the recent reports of worsening symptoms, it’s crucial to monitor these changes closely. While your recent eye examinations have shown no retinal tears or detachments, the presence of flashes can indicate that the vitreous gel is pulling away from the retina, which is a common occurrence, especially in individuals with myopia.

Your concern about being young and not fitting the typical profile for high myopia is valid. However, vitreous degeneration can occur in individuals of all ages, and it does not solely correlate with the degree of myopia. The fact that you have been experiencing these symptoms for some time and that they are becoming more pronounced warrants ongoing vigilance. It’s good that you are having regular dilated eye exams; continue to do so, and report any new symptoms immediately.

Regarding your question about retinal detachment surgery, the prognosis can vary depending on the extent of the detachment and how quickly it is treated. Many patients experience good outcomes, but some may have residual visual field defects or other complications. The surgery itself involves reattaching the retina, which can sometimes involve creating a scar that helps hold the retina in place. While the surgery can be effective, it is important to understand that any surgical intervention carries risks, including the potential for complications.

As for vitrectomy, which is the surgical removal of the vitreous gel, this procedure is often performed when there are significant issues such as persistent vitreous hemorrhage or traction on the retina. After the vitreous is removed, the space may be filled with a gas bubble or silicone oil to help maintain the retina's position. While many patients do well after vitrectomy, there can be side effects, including changes in vision, cataract formation, or retinal re-detachment.

Your concern about long-term effects from vitreous traction, even in the absence of tears, is also valid. Chronic traction can lead to changes in the retina over time, potentially affecting vision. It’s essential to maintain regular follow-ups with your ophthalmologist to monitor for any changes.

Lastly, I want to emphasize the importance of managing your anxiety regarding these symptoms. It’s understandable to feel overwhelmed, especially with your academic pressures. Consider discussing your feelings with a counselor or a trusted mentor who can provide support. Remember, you are not alone in this, and many people experience similar concerns about their vision.

In summary, continue your regular eye examinations, report any new symptoms promptly, and maintain open communication with your healthcare providers. Your proactive approach to your eye health is commendable, and I encourage you to seek support for your emotional well-being as well.

Wishing you all the best in your studies and health.

Sincerely,
Doctor Q&A Teams

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