Aa
Depth Perception
Hello- this is a fairly complicated question, but I am hoping someone can put me on the right path.
I was a practicing General Surgeon until three months ago. In the past several years, I have had multiple eye procedures and problems, and am essentially facing the question of visual competency to perform surgery.
I have done quite a bit of internet searching for minimum standards for visual acuity/depth perception to practice surgery. There is apparently little published on this topic.
At this point, I have multiple blind areas and distortions, and some of this may improve over next several months- but I had a broader question about depth perception. Over the past ten years I have had an increasing sense that my depth perception was worsening, and saw several optometrists, and recvd new prescriptions.
Past history: Grandmother with detached retina. I had a lazy L eye thruout my childhood, and was eventually given glasses, at age 10, for severe myopia - @4 diopters. Thruout my adolescent and young adult life, I favored my better R eye, often covering my L eye with my hand.
By the time I was about 50, my vison in my R eye was so poor, precsription glasses couldnt fully correct it, but no organic cause was found. At about age 54, I was diagnosed with glaucoma, bilateral dense cataracts, and pigment dispersion syndrome. I underwent R catarct replaceemnt. Several months later, I had R retinal detachemnt- leading to a vitrectomy and gas bubble. I was left with good vision in R eye, excepting a small arc of blindness in low mid eye field.
I then had L cataract replacement. Two weeks later, had flashes and a debris field across my L eye- immediately went to retinal surgeon- had immediate laser treatment. Two weeks later- flashes, rapid spreading dark spot medially - on top of blind spot medially from original lasering. So, underwent immediate vitrectomy, wider lasering, and gas bubble. Once that cleared, had about 1/3 of L visual field missing, medially, had several central areas L side that are black grey. Had diplobia in L eye, Had notiiecable discrepancy between size of objects seen with r or l eye - L eye objects seen as bigger. Went to see retinal surgeon, who did OCT showing epiretinal membrane. Have been on steroid and Toradol drops for a month, with minor improvement. Had repeat OCT today which shows minimal improvement.
My question for the community is- I don't expect the 1/3 visual field loss in L eye to improve; and probably the three central blind spots. Possibly the diplobia and assymetry in size of objects will improve.
Besides the obvious damage from the recent events- I have just read that having a "Lazy Eye" as a child generally means your one eye was so dysfunctional, that your brain essentially ignored data from it, and the brain area doesnt process vision normally. Thru -out my life, my "good" eye has changed several times.
I need advice- even if my vision improves some as epiretinal membrane improves (maybe?) - I think I have an underlying depth perception problem. How can this be worked up, and documented? Hearing my story - are most readers essentially saying to themselves- "Dude, don't ever pick up a knife, except to butter bread?"
How unusual is bilateral juvenile cataracts, coupled with bilateral retinal detachemnts, and then an epiretinal membrane? I guess it seems to me that my visual problems are suddenly going to stabilize. What do the experienced Eye Drs think? Experienced eye patients? Thanks for any advice.
I was a practicing General Surgeon until three months ago. In the past several years, I have had multiple eye procedures and problems, and am essentially facing the question of visual competency to perform surgery.
I have done quite a bit of internet searching for minimum standards for visual acuity/depth perception to practice surgery. There is apparently little published on this topic.
At this point, I have multiple blind areas and distortions, and some of this may improve over next several months- but I had a broader question about depth perception. Over the past ten years I have had an increasing sense that my depth perception was worsening, and saw several optometrists, and recvd new prescriptions.
Past history: Grandmother with detached retina. I had a lazy L eye thruout my childhood, and was eventually given glasses, at age 10, for severe myopia - @4 diopters. Thruout my adolescent and young adult life, I favored my better R eye, often covering my L eye with my hand.
By the time I was about 50, my vison in my R eye was so poor, precsription glasses couldnt fully correct it, but no organic cause was found. At about age 54, I was diagnosed with glaucoma, bilateral dense cataracts, and pigment dispersion syndrome. I underwent R catarct replaceemnt. Several months later, I had R retinal detachemnt- leading to a vitrectomy and gas bubble. I was left with good vision in R eye, excepting a small arc of blindness in low mid eye field.
I then had L cataract replacement. Two weeks later, had flashes and a debris field across my L eye- immediately went to retinal surgeon- had immediate laser treatment. Two weeks later- flashes, rapid spreading dark spot medially - on top of blind spot medially from original lasering. So, underwent immediate vitrectomy, wider lasering, and gas bubble. Once that cleared, had about 1/3 of L visual field missing, medially, had several central areas L side that are black grey. Had diplobia in L eye, Had notiiecable discrepancy between size of objects seen with r or l eye - L eye objects seen as bigger. Went to see retinal surgeon, who did OCT showing epiretinal membrane. Have been on steroid and Toradol drops for a month, with minor improvement. Had repeat OCT today which shows minimal improvement.
My question for the community is- I don't expect the 1/3 visual field loss in L eye to improve; and probably the three central blind spots. Possibly the diplobia and assymetry in size of objects will improve.
Besides the obvious damage from the recent events- I have just read that having a "Lazy Eye" as a child generally means your one eye was so dysfunctional, that your brain essentially ignored data from it, and the brain area doesnt process vision normally. Thru -out my life, my "good" eye has changed several times.
I need advice- even if my vision improves some as epiretinal membrane improves (maybe?) - I think I have an underlying depth perception problem. How can this be worked up, and documented? Hearing my story - are most readers essentially saying to themselves- "Dude, don't ever pick up a knife, except to butter bread?"
How unusual is bilateral juvenile cataracts, coupled with bilateral retinal detachemnts, and then an epiretinal membrane? I guess it seems to me that my visual problems are suddenly going to stabilize. What do the experienced Eye Drs think? Experienced eye patients? Thanks for any advice.
I know CBCT - you have to be careful. I was in the military for several decades. They disallowed the use of any phrase that could be construed as racist. Couldnt say Indian Summer, Couldnt say Dutch Treat- and saying French Kissing was a requisite Court Martial.
I actually loved my years in the military- but I knew my days were numbered when the Commander stood up in front of 300 of us, and used that tedium, "There is no "I" in TEAM".
I raised my hand, and when called upon, said, Sir, I would like to point out, for accuracy's sake that there is a "ME" in TEAM.
Anyway, that was the military- still very interested in anyone contributing advice on my eye problems. Thanks.
I actually loved my years in the military- but I knew my days were numbered when the Commander stood up in front of 300 of us, and used that tedium, "There is no "I" in TEAM".
I raised my hand, and when called upon, said, Sir, I would like to point out, for accuracy's sake that there is a "ME" in TEAM.
Anyway, that was the military- still very interested in anyone contributing advice on my eye problems. Thanks.
1 Comments
MarinaDalmas please review my post on your other discussion thread about your vision problem. Thank you for your service. I was in USAF during Viet Nam.
Thank you for your advice. Once I reach some sort of baseline - I will try as many possible solutions as I can.
As a surgeon- if I do go back to operating with diplopia - possibly I could bill twice for each procedure. Looking at the upside of all this.
As a surgeon- if I do go back to operating with diplopia - possibly I could bill twice for each procedure. Looking at the upside of all this.
Like you, I have had many eye issues: bilateral cataract, YAGs, positive dysphotopsia, post surgical vitreous prolapse, bilateral lens exchange with vitrectomies, OD retinal tear, cryopexy and gas bubble followed by laser photocoagulation, and ERM with a 13% image size discrepancy (more pronounced at distance) and blur of fine print. I was evaluated for ERM peel, and was advised against it.
The image size discrepancy was very disorienting. I tried prisms to no avail and then learned of Retinally Induced Anisiekonia and Dragged Fovea Diplopia Syndrome. My central vision does not fuse so I apply 1/4 square inch of Scotch Satin tape to the inside glasses lens of the affected eye. It obscures the central fusion and forces me to use peripheral vision which does fuse. It is a simple solution for a complex problem.
Here are some resources that you may find useful
http://www.opticaldiagnostics.com/info/ri_aniseikonia.pdf
http://cscro.com/Vol23-6/files/assets/basic-html/page14.html
Best wishes.
The image size discrepancy was very disorienting. I tried prisms to no avail and then learned of Retinally Induced Anisiekonia and Dragged Fovea Diplopia Syndrome. My central vision does not fuse so I apply 1/4 square inch of Scotch Satin tape to the inside glasses lens of the affected eye. It obscures the central fusion and forces me to use peripheral vision which does fuse. It is a simple solution for a complex problem.
Here are some resources that you may find useful
http://www.opticaldiagnostics.com/info/ri_aniseikonia.pdf
http://cscro.com/Vol23-6/files/assets/basic-html/page14.html
Best wishes.
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