Exercise after PVD?

[cholla]

I am on my 50's and just had a sudden onset of floaters in my left eye on Sunday.  I saw an ophthalmologist the next day and was diagnosed with a posterior vitreous detachment.  The doctor said to avoiding any "jarring" type activity for the next few weeks such as running and boxing.  I have a mountain biking two day trip starting on Friday.  He thought that would be OK.  However, I'm not sure that he realizes that riding a bike over rocks/roots and jumping over logs is quite jarring. He also said that there is really no data that says you need to limit your activity except for boxing (blows to the head is bad)  I really want to go on this trip, but I also don't want to risk a retinal tear.  So ... what is the consensus - should vigorous exercise like mountain biking be avoided right after a PVD? Thanks!    

[John C Hagan III, MD, FACS, FAAO]

A vitreous detachment is a normal part of aging. By age 50 about half the population has a vitreous detachment (also know as a posterior vitreous detachment or PVD) and by age 70 the figure is about 75 %. The back of the eye is filled with a sustance called the vitreous gel. It is very similiar to clear Jello. When Jello is made in a mold and put in the refrigerator it becomes a firm gel. If Jello is set on a plate and left for a week or more at room temperature it turns back into a liquid and the Jello collapses into a watery mixture of liquid and gel. In like fashion as we age the firm vitreous of our youth softens and liquifies as we age. When this happens the vitreous strips off the retina. The retina is the sight forming layer of the eye (like the film in a camera). A membrane connects the vitreous to the retina. Usually it peels off smoothly and does so spontaneously without trauma. In some cases if the vitreous is liquified in the center and there is trauma such as an automobile accident, a blow to the eye, a bad fall this can cause a PVD.   Pieces of the membrane fall into the center of the eye and 'float' around--hence the name 'floaters'. Usually there are several large or moderate floaters.
While these floaters are annoying and distracting they are not a serious problem in most cases.  Most floaters will settle down to the bottom of the eye and are no longer seen over a period of days, weeks or months. Alternately they may drift to the front of the eye making them less conspicuous, or the brain simply tunes them out and they are not noticed. There is no cure for floaters, no medication or eye drop to make them go away. Laser treatment to break them up has not proved useful and an operation called a vitrectomy to remove the floaters is far too risky to do for routine floaters.

As the vitreous strips off the retina in some cases it will 'snag' the retina and jerk on it. The retina responds to pressure with a flash of light. Because the retina is so much more sensitive to light (and pressure) when dark adapted the floaters are usually seen at night and in the dark. Because inertia causes a tug on the retina the flashes often occur with head or eye movements.  In most cases the flashes will stop over a few days to several weeks.

In a very very small number of people the vitreous that has snagged the retina can tear it. A retinal tear can lead to bleeding in the eye and/or a retinal detachment. A retina detachment is a very rare problem that may occur in 1 in 4000-5000 people that have not had cataract surgery. A retinal detachment can cause loss of sight and needs surgical correction. Retinal detachment is more common in people that have had cataract surgery (perhaps 1 in 500 to 1000), those that are severely near-sighted (myopic), have a family history of retinal detachment or in eyes with severe trauma.

In my practice I do not limit the activety of my patients who have only floaters and in whom I have checked the vitreous and retina (as has your ophthalmologist). If they have flashes I ask they avoid heavy bending, stooping, lifting and 'jarrying' activities. If the flashes worsen, start to occur in the daytime or without eye movement, of if a sudden increase of small black floaters occur (like a handfull of soot dropped from the top of the eye--that is what blood in the eye often looks like) or if the flashes persist greater than one week they return for retinal re-examination. Once the flashes stop regular activities can be resumed.

Also to belabor the obvious, both eyes are the same age. When a PVD occurs in one eye it will invariably occur in the other eye sooner or later (sometimes years later). When this happens they eye should be examined and the same recommendations apply again to the other eye.

So my recommendations agree with those of your ophthalmologist. I have done mountain biking myself and agree that it is pretty jarring and there is always the risk of a 'face-plant'. Face it-- mountain biking is a high risk behavior. Your risk for an orthopedic or soft tissue injury is much higher than the risk of retinal detachment. I'm sure you know that you need to wear proper head, face and extremity protection and ride cautiously and within your skill level.

I stopped my mountain biking career after an especially bad face plant. Be careful. Enjoy your weekend.

JCH MD Ex-mountain biker

[abacus99]

A related discussion, pvd and exercise was started.

[John C Hagan III, MD, FACS, FAAO]

Hello longputt.  Number 1 this is not the sort of thing you should put off. Flashes and floaters of a sudden onset need a dilated retina examination by an ophthalmologist (Eye MD). Until you are examined and given the green light by the ophthalmologist that examines you I could not tell you that slogging-jogging is okay.

JCH III MD

[docjohn]

I am the lucky 53 year old high myopic who witnessed the massive floater and wasn't going to do anything (internal medicine physicians are indestructible) until two of my colleagues insisted ... my ophthalmologist found a small flap tear from my PVD and so the retina consultant saw me within the hour and that morning I was lasered.  Good news ... got the 1 out of 5 complication from the needle anesthesia of the 7th cranial nerve ... a shiner and subconj. hemorrhage ... eagerly awaiting my right eye to do the same ... told only a 10% chance ... Wow.  So fun to get older.  JMR

[longputt]

I'm a 59 year old male, good health. Few days ago I noticed flashes of light in the far corner of my right eye, followed by a few floaters..stringy looking, dark. They would subside. No headaches whatsoever, no dizziness, etc. That went away for a couple of days..Then yesterday morning before playing golf, I had quite a number of these spider web like and stringy floaters appear, which was pretty disturbing. Again, no pain, nothing..and the subsided. They were not accompanied by flashes(in fact, have had no flashes since the ones stated above "a few days ago." As the round moved on, the floaters disappeared, only a few now..very slight, and still, no flashes. However, my vision in that eye is not what the left is..that being crystal clear. Think of it as looking at video versus film. Just slightly softened.

May I jog..and when I say jog, I don't mean "run." It's walking fast basically in reality..like 12.5 minute miles. Or, if I feel up to it in this 85+ degree weather, may I actually run some..?

I haven't seen an opthamologist, and know I should..but can't now for 13 days as we're going out of town.

Thanks.