Issues after retinal laser for small tear

[Fan24]

I believe this topic has probably been touched on before but don’t see any recent post.  Anyway, I had an FOV (floater only vitrectomy) for my right eye for some really bothersome floaters.   Surgery took care of that but I had a small retinal tear during the procedure which was lasered.  Assumed no issue.  

However, like many others I’ve discovered I have developed the flickering/shimmering light, distorted area of vision in my far peripheral, etc…. While these do not affect my central vision at all, it is still a visual disturbance.   The shimmering light being the worst.  Especially going from very bright lights to dimmer.  

After doing some research, this seems to be what called scintillating scotoma. Which is described as it can be light, dark, and has pulsating light (shimmering).

I have read where some people say they have improved over time and some even have said this has diminished after many months.  

It sounds like this is a side effect of the laser and scarring of the retina.   The scar is not going to go away so I’m curious to know how exactly to have hope for improvement.  I’m sure part of it is that the brain learns to adapt but seems in some folks the symptoms do fade over time.  

I am only 1 month out right now so hopefully this improves with time.

Thanks for any input

[FordVairogs]

@fan24 - According to your post, you are 4 months after the procedure. Can you share if the situation improved for you recently?

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

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

You should discuss this with your surgeon.  If it is from the laser/scar formation the shimmering light should be 180 degree away from where the laser was done (light rays are inverted as enter the eye). There are other things that might cause this but if started right after the laser it is most likely to be that.  Given those circumstances most, but not all, cease within 3-6 months. I have had a patient that had for years and years post treatment but that is the exception

[Fan24]

Really appreciate your response.   I just had one month  check up and everything checked out fine.  I mentioned the symptoms to my surgeon and he said it should improve with time.  I guess I don’t know if he meant it would improve cause my brain would adapt to this or it actually does fade - or maybe it’s both?

The shimmering/flickering is coming directly from that distorted area in my outside (opposite nose) lower peripheral.  So, I assume the lasered/scar is on the nose side?   When the light hits it just right I can see the area and the light pulsating through it.  The more light that is exposed to it, the lighter that area becomes with more intense shimmering/flickering.   From the outside sunny day to indoors is the worst.   It does calms down after a few minutes of adjusting to the light.   Mornings the area is darker and doesn’t shimmer.  

Final  question - when you say most improve after 3-6 months does that mean the scotoma area shrinks or dissipates? - or does it just calm down/adjust and no longer pulsate light?   The distortion in peripheral can more easily be ignored but the shimmering light is what is what is most distracting.  At least for me

Very encouraging to hear most folks see improvements.  

Thanks again for your response

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

In the cases I've seen the pulsation/light spot/shimmering goes away, not adaptation as when they look for it, it is gone.  I've never seen a study on this so this is just anecdotal experience over the last 40 years.

[Fan24]

Thanks - I appreciate your time and responses.  I’m just one month out so this gives me some encouragement and hope that these symptoms get better with time.  
Thank again.

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

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[Fan24]

Good afternoon Doctor -Sorry just wanted to circle back one more time after after doing a little more research and seeing some of your previous comments from years back on this topic.  

1.  Am I correct in my thinking that the distorted area in my peripheral - which is the same area that pulsates/flickers light under certain lighting environments and also the same area that tends to be darker in those dimmer environment would be called a scotoma?  
And if that’s the case would the scotoma  have to dissipate in order for the pulsing/flickering to disappear?  Just seems to me if that area remains it will continue to pulsate light though it.  

2. Since a scintillating scotoma  is described  (at least from my findings)  as having a pulsating/flickering light, is this the cause  of everybody that has this symptom - meaning a scrims has developed as a side effect from the laser/scar?

2. While I know there are no studies on this but do you have a professional opinion on why that tiny % of folks don’t improve.   Do they have something in common that the vast majority that do improve do not? Just seems this is a fairly common side effect so curious to know  

As I research scotoma it seems there are different types. It also appears (from this site anyway)  that some of them are temporary and some can be permanent depending on the cause -

I do appreciate your time and sorry if there are any silly questions but this is all new to me.  

Below are just some of my findings :
(Copied from website)
Types of Scotoma

There are 3 types of scotomas:

Scintillating Scotomas, Central Scotomas, and Paracentral Scotomas.
Scintillating Scotomas:

Unlike the other types of scotomas, scintillating scotomas have pulsating, shimmering light effects in the eye.

(Copied from website)
What Causes Scotoma?

A lot of medical conditions may lead to scotomas. Temporary scotomas are mainly caused by conditions in the brain like seizures, migraine, or reduced blood flow.

Long-term, permanent scotomas usually result from brain disorders like brain tumors, seizures, migraine, or reduced blood flow. Other than that, damage in the optic nerve caused by glaucoma, scarring in the retina, sclerosis, and stroke can also lead to scotomas.


Thanks again for your time and responses

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

You are over-thinking and obscessing on the definition and causes of scotoma.  I don't want to be part of that.

[Fan24]

Well that’s probably just what I needed to hear.  

I again thank you for your time and responses.  

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

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