Myopic degeneration/lacquer crack

[wwhmustaine]

I was recently diagnosed with myopic degeneration in my right eye, and told that I have a lacquer crack in that eye. I am 40 years old, and as a practicing attorney, am obviously concerned that my condition will either worsen in my right eye, or also develop in my left eye, thus rendering me essentially disabled.  Is there any treatment, therapy or surgery available for my condition? If not, what are the best preventative measures to take to ensure the condition does not progress in my right eye or begin develop in my left eye?  Lastly, what is the likelihood that the condition in my right eye will worsen, or that it will also develop in my left eye?  In other words, is it likely that I won't notice any significant decline in my condition over the next few decades?

[wwhmustaine]

"So again, unless the people who are treating me are just completely incompetent, then there was no leakage."

Turns out they're incompetent.  Last Thursday the 25th, even though I told him the distortions had gotten worse, he said there was nothing he could do because he didn't see any leakage, never mind that any RS with a brain would give a shot of Avastin just to be safe.

Went back today, right after that last post, and there is a CNVM.  My vision in my right eye was 20/25 a week ago, and today it was 20/50.

Had an injection of Avastin, and I pray to God I regain some vision.

[wwhmustaine]

I'm not sure what an FA is (though I've probably had at least one), but I underwent an OCT last week, a few days after the distortions increased, and again, I was told that there is no CNV. On top of that, a dye test confirmed the same thing.

The way it was explained to me was that an examination of my eye after dilation would make them 98% sure that there was no CNV, and the dye test would push that # up to 100%.

So again, unless the people who are treating me are just completely incompetent, then as of last Thursday, a few days after the onset of the increased distortions, there was no leakage. And like I said, my local RS -- in addition to Ward -- said that these increased symptoms can be temporary.

Also, I have one lacquer crack. I saw it on the film that was produced as part of the dye test. The crack is "Z" shaped, and barely infringing on the macula.

[dukey]

This one is brutal. It will show ANY distortion.

http://www.vrmny.com/images/amsler_lg.jpg

[dukey]

I'm not sure that I buy that. A sudden increase in waviness is a sign that something is going on. Myopic CNV is not always easy to spot, even on an FA as many docs are more used to the more obvious ARMD type. It can be very occult but can cause some serious damage if not taken care of. An OCT scan would be very useful for you I think. My "CNV" was spotted on an OCT scan after several FAs. My doc was very undecided so consulted his colleagues and we all finally agreed the evidence indicated a CNV (based entirely on the OCT). With the very low risk of an Avastin shot, it seemed almost a no brainer that even if there was a hint of a CNV, I was going to have the injection.

Lacquer cracks progress very slowly (years) but, again, can be very difficult to spot even with FA and ICG. You could easily have an extensive LC under your fovea and not see it, which may account for your symptoms. They can literally form webs of cracks, not just a single line as is commonly believed. There are a number of articles on this. The result is that LCs have been underestimated in PM. Some think that 90% of high myopes have them.

I'm not sure what you mean by temporary. Nothing is temporary in PM. Yes some have indicated that the CNV will regress on its own but it is rare that it does this without inflicting some form of PERMANENT damage.

There is also a lot of merit in what kg17 said. Once you develop eye problems, it has a very large impact on your life and you become very tuned in to your eyes. I noticed things that were never there before and I could write a long list of mostly subjective symptoms that I have. The Amsler Grid is the ultimate test though. If there is waviness or spots on that, it is really there. Things can happen VERY fast with PM so be careful. Amsler grid everyday unless you get so depressed and then once a week is good. I find the black grids with white lines are the most revealing/frightening. Oh to have a clean Amsler grid!  

[wwhmustaine]

The distortions are definitely new, but at least as of a couple days after they began, there was no CNV. It could just be the crack expanding, for which I assume nothing can be done.

Here's the time frame:

June 23 - The distortions/wavy lines increased.
June 24 - Saw one RS, who told me there was no leakage/CNV.
June 26 - Saw another RS, who told me there was no leakage/CNV, even after dye test.

So either both guys really missed it, or there is no CNV.

I have an appt. next week at Emory Univ. Eye Center in Atlanta, but I just got a call from an RS there who basically told me that they would probably just confirm what the other 4 RS's have told me, i.e., "nothing whatsoever can be done for your condition."

[kg17]

It is my understanding that any sudden change in vision such as increased waviness and distortion is likely due to a sudden event that is occurring in the retina (e.g., CNV or new lacquer crack).  However, another possibility is that visual defects of a milder nature have been present for awhile and perhaps you have now just become aware of them because you are more attune to your vision in each individual eye.  

A good practice is to use an Amsler Grid everyday or at least once a week to determine more objectively any new distortions that are present.  Any sudden change warrants and immediate evaluation.

I have distortions from lacquer cracks and the distortions are still present if I look for them.  However, due to neuroadaptation, I don't routinely notice them.