I need some help/information concerning Vitrectomy, RD, and ERM peeling

First a bit of background on myself and my eye. I am 35 years old. I had successful cataract surgery in both eyes at 29 (yes I know...very young for cataracts). After my cataract surgeries I had 20/20 vision in both eyes and have had zero eye trouble until late last summer. I suffered my first Retinal Detachment in August of 2011 (right eye). (FYI, No trauma caused any of my RD's and they have all been in my right eye.) A vitrectomy with a gas bubble was performed to fix the RD. After a few days, the bubble went away and my vision was back to perfect. Everything was great for the next 3-4 months...I was even seeing at 20/15 on some visits to the doctor. In late December 2011, I suffered a second detachment in the same eye...but in a different spot. Again, my doctor performed a vitrectomy with a gas bubble. This time (after about a 10 days) before the bubble was even completely gone my retina detached again (in a third spot). After the third detachment, my doctor/surgeon performed a vitrectomy with the silicone oil. During this procedure, he also did extensive laser work to tack down the retina. This oil stayed in my eye for just a shade over 3 months, therefore I was basically blind in my right eye during that time period. About 3 weeks ago, the oil was removed and my doctor also performed a membrane peel (ERM). He told me that this would help my vision because there was some scar tissue and I would have some distortion in my vision without this being done. Th problem is, I now have distortion in my vision. I can read the eye chart at 20/40 with my right eye by just making out some of the letters through the blur and distortion. That being said, my vision is nowhere even close to that good (20/40) considering the distortion and blurriness. Maybe my vision would be much blurrier and distorted if he wouldn't have done the peel? I would say that after the bubble was gone (after oil removal surgery), I had 40% vision in my right eye. Today I would say that I have 60% vision in that eye. Keep in mind that my vision was 20/20 prior to this, so I am probably a bit picky about the clarity of my vision. I certainly can't read street signs or anything like that with my right eye and I would find it very difficult to function if my left eye wasn't seeing clearly. Hopefully that sums up my story!

My questions are as follows:
Is this distortion and blurriness typical after this procedure and does it typically go away over the next few months?
If so, how long does it typically take for this to happen?
If not, or if it doesn't return to "normal" (no distortion and/or blurriness), can this procedure be performed again to improve my vision? Or is there a different procedure that can be performed to fix this? Are there risks associated with this that would make it not a viable option? (i.e. blindness, or even worse vision/distortion/blurriness)

I would appreciate anyone's input on this. Please let me know if you have had any similar experiences and what was done (if anything to correct this). All comments/suggestions are welcome (professional or not).

I would also greatly appreciate all professional opinions on this as well.

Maybe I am being unrealistic about my vision?  Is this the best I will ever see out of my right eye? I will do whatever necessary to get rid of this blurriness and especially the distortion. I will be more than willing to go through more surgery if there is a chance of it giving back my 20/20 clear (non distorted) vision. If I have left out any information that may be pertinent, please let me know and I will post it.

Thanks,
~N

[Ray T Oyakawa, MD]

You have a very good result from three vitrectomies including silicone oil.  There will probably be slow improvement but it will take time.  I doubt the distortion will complete resolve.  After an ERM peel you can regain 20/20 vision but still have distortion and image size difference.

Dr. O.

[cwatt1]

I am in a similar situation as you are, although I only had one retinal detachment and it was repaired with scleral buckling surgery as opposed to a vitrectomy.  However, I too have some scar tissue on my retina and may well need a vitrectomy and ERM peel.  In my case, the distortion in my vision was caused by the fact that my macula was detached, so I probably will never regain my former vision completely.

You may want to read some of JodieJ's posts here -- she has had ERM surgery and has posted extensively about it in this forum.

Best of luck.

[poker_boss]

Dr. O,

Thank you very much for your quick response. However, I am confused and have a few questions that I hope you can answer.

Are you strictly basing 20/20 vision on the ability to read single letters on a chart in the dark? I cannot read anything on this computer screen with my right eye, yet my doctor says I have 20/40 vision in my right eye. I guess I don't understand 20/40? With 20/40 vision I could easily drive a car. If I tried to drive a car with my right eye only I would most certainly wreck.  

Should the distortion get better with time also or do you think that this amount of distortion is what I am stuck with for life?

Also, if a ERM peel reduces distortion...is it possible that after several months it could be done again and I could have increased vision in my right eye?

The distortion is significant in my opinion and is very disorienting (even after 3 weeks). I am willing to try anything to get my vision back to (what I consider) normal. Thanks for your response.

~N

[JodieJ]

An ERM is a layer of scar tissue over the macula.  If the ERM is peeled away, you will no longer have to look through the layer of scar tissue.  This should improve your acuity.  However, the degree to which the underlying photoreceptors in your macula return to a normal configuration (which was altered by your retinal detachments, your ERM, and the surgeries to correct these conditions) is uncertain.  Changes in the photoreceptor configuration in your macula are what is causing your distorted vision.  You will probably get some improvement in distortion following ERM surgery (although this improvement may take a number of months to achieve), but the vision in your affected eye may never be completely normal.

I'm not an eye care professional, but I'll try to respond to your questions.  Yes, it's certainly possible to have 20/40 acuity (meaning that you can more-or-less read the 20/40 line on an eye chart) and have terrible vision.  No, it's not possible to repeat ERM surgery to improve acuity if all of the scar tissue was removed the first time.  Yes, you will probably get some improvement in distortion following ERM surgery, but your affected eye may never have normal vision.

My recommendation is to have the ERM surgery.  In my own case, the ERM was in my dominant (right) eye.  Although I have excellent acuity in that eye post-surgery, there is some residual distortion.  However, due to neuroadaptation I'm almost never aware of the distortion.  Somehow my brain has learned to screen it out automatically in favor of the undistorted image in my good (non-dominant) left eye.  If I close my left eye, I'm always surprised by how distorted things become.  Hopefully, neuroadaptation will work for you, too.

[poker_boss]

Thanks for your reply JodieJ. I appreciate any input...health care professional or personal experience is certainly welcome. I already had the ERM peel. My surgeon mentioned before my last vitrectomy that he saw some scar tissue and that he would take it out if he thought it was warranted. He did decide to do the ERM peel while he was removing the silicone oil during my 4th vitrectomy (3 weeks ago). Hopefully the distortion will go away (at least for the most part) in time. I guess I just expected perfect vision after the bubble went away (just like my first couple of vitrectomies). I never noticed any distortion after my 3rd vitrectomy (when they inserted the silicone oil for 3 months)...but I assume that I had the scar tissue after that, but couldn't see it because my vision was blocked by the oil. I also understand that my eye didn't function normally for over 3 months while the oil was in (and my vision was blocked)...so I know that it will take time for my brain to "re-calibrate" (for lack of a better term). I am trying to be optimistic, but I also don't want to have unrealistic expectations and be let down if proper vision doesn't return. I was just hoping to get a better idea of what to expect over the next few months. Also, I wanted to know if there is anything else that can be done if the distortion doesn't go away. I have been told that corrective lenses may help with the blurriness, but that I need to wait a few months because my eye will be adjusting for the next several months.

Was this the experience that you had JodieJ? How many months did you continuously see noticeable improvement from the distortion and/or blurriness? Did you wear corrective lenses before the peel and if not, were you fitted for corrective lenses after the peel? If you were, did it help? How much?

Thanks for your help.
~N

[JodieJ]

Maybe my experience isn't typical.  I didn't notice the distortion in images seen with my right (ERM) eye, although it had become quite significant before my first vitrectomy.  Maybe this was because it developed gradually over time, and my brain was able to adapt to it.  When I used both eyes together, things looked "normal,"  although I did recognize that my depth perception was off.  However, when I closed my left (good) eye, everything was wavy and weird.

My first surgery to remove the ERM was not a success.  The surgeon left pieces of ERM in my macula.  After the surgery I noticed that the image in my right eye was larger than the image in my good eye (caused by changes in the photoreceptor configuration.)  This became a major problem for me when I began experiencing double vision.  There was also mild distortion when I used my right eye alone.

I had a second retinal surgery to remove the remaining ERM.  Afterward, I kept careful records of changes in the vision in my right eye using special tests.  My retinal surgeon predicted that it could take up to 18 months for the distortion to improve.  I got no changes at all until my 4th month post-op, when I had a short period of rapid improvement.  Then no change for many months.  I used the same tests about two years later and was surprised to discover that there had been more improvement.  I had corresponded with a British researcher in this area, who told me that improvement can occur 10 years later (but I don't think this is common.)

If you have problems using both eyes together, there are various options that can make your binocular vision more comfortable.  None of these options work for everybody.  Try googling to find the full text version of "Retinally Induced Aniseikonia" by Dr. Gerard de Witt, which discusses some of these options.  They include blurring the vision slightly in your bad eye, which helps your brain to screen out the distorted image and rely on the one in your good eye.

[9505sharon]

How long did it take to have your brain adapt to the distortion. I have been going insane! Everything in my life is different now. I have lost all confidence in myself.
Thank you for your input.
(I had EPM peel in June, '12 after developing a macular pucker from detached retina surgery - vitrectomy- in Oct, '11.  It has left my 'out of my mind' with distortion)

[JodieJ]

Unfortunately, your brain is not going to adapt if it hasn't already done so.  Try to find a patient and sympathetic eye care professional who will work with you--maybe a low vision specialist.  One possible solution for you is suggested in the Milder & Rubin text, "The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself."  One of the authors prescribed glasses with the wrong prescription for the left eye of a young anesthesiologist, who had suffered botched refractive surgery in his left eye.  These glasses reportedly worked out just fine for the anesthesiologist.  Another possibility involves using a special foil (or even Scotch tape) worn on the underside of the glasses lens to blur the vision in your affected eye.  You can find other options in Dr. Gerard de Wit's paper, "Retinally Induced Aniseikonia."  (Try googling to locate Dr. de Wit's website or send me your email address in a personal message and I'll send you the paper.)

Which option(s) would be best for you depends on characteristics of your eye and the type/degree of distortion you have.  I don't always keep up with the posts on this website, but you can always send me a personal message and I'll get back to you.

[Markaustralia]

Hello dear sir,
Had 3 Retina tear surgeries in the left eye, over the past
3 months. last surgery 1 month ago, eye was filled with
silicon oil. there is bleeding over the white of the eye,
where there was a cut to insert oil inside the eye and
cut was stitched. stitch was removed last week but it
continues to bleed over the white of the eye, few times
a day, especially when I gently clean the eye. is this
normal to bleed after A month? Anything to help, please?

[Markaustralia]

Hi there! Looks like I have been following your footsteps! At the moment I have my left eye filled with oil(1 month now). Where my left I was cut to place
oil and stitched, keeps bleeding over the white of the eye (on & off). is this normal? did you experience the same thing?
My surgeon does not seem to care much about that.
How is your vision now? Hope it is much better.
Merry Xmas & all the best for 2013.
Regards,
Mark

[DavidDixon97]

I had double cataract surgery in 2008 when I was 65. Since then I have had distorted vision in my right eye: a horizontal line 'dips down' where I am looking at it. My left eye has been excellent. I have had to try to ignore the image from my right eye, but this is more difficult at my age. I am soon to see a specialist, and so and extremely grateful for all the posts here, not to say, very sympathetic!