Three months ago I noticed a waviness and grey patch in the central vision of my left eye. I went to the RS, and had a eye exam and OCT done, and it was found to be a bleeding from laquer crack. Both the waviness and grey patch has since been gone, and I believe there is a very slight effect (vision seems not as clear as before, tho it's quite slight) on my left eyesight. The RS explained that this was due to the thinning of the RPE and retina, and there is at present not much I or they can do to arrest the issue. I am 33, and have very severe myopia, L-18.00D R-20.00D. Been wearing specs since very young.
Dear doc, could you advise me based on your experiences, what will the future holds for le like me who has very high myopia? Am I right to say the potential of going blind or visually challenged in future is very high? What will the most important factor that will determine how bad my eye condition will get in future? It seems like my myopia has not stabilised, despite the fact that it should stabilised in your early twenties.
Is there any older people out there with severe myopia and still coping well with their sight?
I've been very worried ever since this episode. Before that, I never know and therefore, never worry, that high myopia will lead to so much complications later in life. And now the posibilities of all these happening seems so real. To make matter worse, my girlfriend, whom I have the intention to get married, is also very severely short-sighted (about 11D and 13D), and has lazy eye in one eye. I kept thinking what will the future holds for us if we shall get together. It certainly looks bleak, very bleak.. I really can't imagine about the future as the potential of both of us going blind one day seems so real!
Doc, what do you think we should do??? Any advices will be appreciated.
Hello Myopic 74 Things are not nearly as bleak as you seem to believe. FIrst of all none of the conditions you mention are likely to cause total blindness (no sight whatsoever). It is true that they could cause legal blindness (best corrected vision in better eye less than 20/200. People with legal blindness due to loss of central vision get around without aids and function well. True they cannot legally drive and have to use reading machines to read but they do pretty good. So erase entirely the mindset of being totally blind.
Your retina surgeon is correct. The percentage of high myopes that end up legally blind in both eyes is very, very small. The two most common mechanisms of legal blindness would be myopic macular degeneration and macular neovascularization (NV) either due to wet macular degeneration or NV from breaks in Bruch's membrane (lacquer cracks).
The genetics of myopic transmission are incompletely understood but just as your parents were not high myopes but your are you and your myopic fiancee could have non-myopic children.
What will happen to you as you get older is mostly a matter of "luck" either good or bad as myopic macular NV and degeration are not strongly driven by patient behavior.
You might adhere to the things that reduce or slow the progression of dry age related macular degeneration: diet of fruits, vegetables, fish, fiber, berries, nuts. Low in fatty food. Eat a lot of lutein containing food. Don't smoke, don't get obese, protect your eyes from UV light (hat and UV blocking glasses/sunglasses). Test you eyes weekly with an Amsler grid and consider taking a multivitamin and 2 Bausch & Lomb Preservision with lutein/day. See an ophthalmologist yearly.
To repeat you are likely to have good to fair vision all your life.
I too have a prescription similar to your although I am 50 which is quite a bit older than you. I also have all the concerns you have about losing your sight eventually. I am waiting for the docs reply to your question.
Have you considerd lens exchange, not that it will stop eye sight changing but it is supposed to improve the vision you have now. My problem at the moment is that there does not appear to be a multifocal lens in my power.
People who have good eye sight don't realise how lucky they are.
Nice to hear from you! Sorry to hear that you share similar prescription as mine, which is rather sad.
I also don't know why I developed such high myopia, because both my parents, all my siblings, grandmothers and grandfathers, all my uncles, aunties, cousins etc are normal sighted (as in some do wear specs but none has such high myopia). But mine started off on a very high base (6D since seven years old when I first started school).
I was quite concerned that the myopia will keep on progressing, though I wasn't too sure the pace. It seems to be it has been quite stabilised with some increments all these years, until the latest episode, which has began to affect me quite badly psychologically.
Have your myopia stabilised already over all these years? Is your vision still normal ie; no CNV, retina bleeding, lacquer cracks etc? I think you should go for regular eye check-up, just to make sure things are fine. I have began to notice that the gel in both my eyes has started to degenerate (more floaters, in strings etc), but so far, I would say it is slightly more than say 10 years ago, but still not so bad as to cause any significant difficulty is reading or seeing, though I don't know how bad will it progress in time to come.
My RS has tried to assured me that risks of high myopic getting complications at a later stage, or ended up blind, is higher than normal sighted person, but is not a definite.
I asked her what are the critical factors that will largely determines the outcome, but she has not given me a specific answer. She just said your eyes are fine now, come back immediately if you notice any significant changes such as sudden onset of curtain of floaters, light flashes. She also said that the bleeding (of the lacquer crack) will recur in the same eye, or the other eye.
What is a lens exchange? Never heard of it before. So far my vision is still quite fine, except that the power seems to be not strong enough. At present, I am wearing L 14D R 16D for my specs.
12 years ago was about L 13D, R 15D.
It was very encouraging to hear from you, and it seems like my future is not as bleak as I have imagined. Thank you very much!
However, there's a few points which I really don't understand and hopefully you can give me some guidance.
Ever since the bleeding occurred in my left eye, there seem to have a slight impact on vision on my left eye (don't see as clear as before, especially at night). It seems like vision acuity has decreased. I asked my RS why and she can't give me a clear explaination. I've read about pathological myopia and it says that in patients with pathological myopia, the eye keeps growing intermittently at any age, apparently due to the weakness in the walls of the scleral. And lacquer cracks manifest in young male adults. As far as I know, simple myopia should stabilised around age 20 plus.
I'm 33 years old now, and the specs that I'm wearing now is L 14D R 16D. About 11 years ago, I was wearing L 13D R 15D. However, it seems like the power that I'm using now is no longer strong enough (I realised this after the bleeding, though before that vision was also not very sharp, but was sufficiently ok and no complaints). It was now that I realised it was no sharp enough. The latest optical test that I went in the hospital (one month ago), the prescriptions given was L 18D R 20D. So, in consideration, there was a very significant increase, and I was very concerned what if it grows further...
Based on the facts that I've furnished, and my background, and from your experiences, how high is the prospects of my eyeball continuing to grow further? If it does, the retina will continue to be stretched even more thinner, meaning the risks of getting complications at a later stage in life will bound to increase, isn't it? I'm an accountant by profession, and I also knew the severeness of myopia do have a direct relationship with the amount of 'near work'. So, in your opinion, if I were to give up what I am doing right now and take on something less straining on the eyes, will it help to slow down the progression of my myopia, I mean, at this age, where physical growth should have stopped long ago?
How common is lacquer cracks in patients with high myopia? My RS did an OCT for me and she said in fact both my eyes have some other lacquer cracks, however, as they did not affect my macular, hence I don't really feel nor 'see' it. She said they will heal by themselves. And she seems to be quite non-chalant when she said that, like as if it's quite normal that I have lacquer cracks.
So what critical factors are myopic macular degeneration and myopic macular NV driven by? The severeness of your myopia? So considering my scenario, I may have a valid suspicion that the future doesn't look good. As I have already a bleeding from lacquer crack due to breaks in Bruch's membrane, at 33 yrs old, then I suppose as age sets in, the membrane will become weaker and thinner, and logically, more frequent and severe breaks and bleeding will occur. Doctor, how true is my presumption?
Also, as I do notice, the virteous gel in both my eyes has also starting to degenerate (more floaters now). How does the liquefaction of the gel predispose us to the risk of retina detachment? And really how high is this risk for severely myopic people like me?
Hello Myopic 74 First of all I would not recommend you make career change. The role of prolonged near tasks like reading and computer use in causing myopia to develop or progress is not firmly established. In the distant past they would try bifocals in children and even having them avoid reading but it did not have a consistent beneficial effect. I have many highly pathologic myopes that never read, some are mentaly deficient and can't read and yet they have glasses as strong as you.
Were you premature? Has your retina doctor ruled out retinopathy of prematurity? Your general health is good? You do not have pseudo-xanthoma elastica? (that's a frequent cause of lacquer cracks).
I would be encouraged. The most serious threat to your macular is "wet" macular degeneration and with Visudyne therapy and intra-ocular injections of VEGF inhibitors or steroids the prognosis for all forms of macular neovascularization has dramatically improved and will get better and better as new drugs are developed.
Please remember that only 5% of your eye is threatened by myopic mac degen.
I don't believe I could give you a percentage of patients with your problem that end up with bad vision (worse than 20/200 in the better eye) but I would estimate that your chances are excellent that your condition will stablize.
There are some things that you can do to help your macula. Live a healthy life, don't smoke, protect your eyes from sunlight, don't get obese, exercise, eat a very good diet, take a multi-vitamin, consider taking an ARMD supplement like EyeCap, Occuvite or Preservision with lutein, do a daily amsler grid test.
Take heart. The advances in wet macular degeneration in the last few years has been phenomenal.
I don't think I am premature, as I never heard from my family saying that I am. As for pseudo-xanthoma elastica, I really don't know what is that, and my RS did not mention that I have that. Btw doctor, what is that? As for my general health it is so far so good. Healthy and physically ok.
Your words really makes me feel more comforted and optimistic about my future, though I still feel abit distressing at times whenever I think of that, as I am constantly reminded of the fact that I am living in uncertainty, akin to with a time bomb.
Dear Doctor, is lacquer cracks a common phenomenon among myopes? And how serious it is to have lacquer cracks? From the way my RS conveyed to me, the impression is it's fairly common for high myopes to have it and there's nothing much we can do about it. What will be the long term implications of lacquer cracks? ie; Is it a prognosis for future CNV?
You mentioned that chances are excellent that my condition will stabilise, are you refering to the progression of the myopia or the vascular changes in the retina? Perhaps, given my profile and the conditions which I've described, and history of high myopic patients which you have came across and treated, maybe say on a scale of high, medium or low risk, if you were to guess, what do you think will be my risk of getting 'wet' macular degeneration at an older age?
The distressing part is, after this episode, I realised that my left vision (the affected eye) was not as good as it used to be, though the effects are slight. But it is especially pronounced whenever I am in certain indoor areas like some shopping malls or even office buildings which are more dimly litted, and maybe in the evening when the sun begins to set and street lights are not on yet. Could this be a result of increased myopia or due to the destruction of the photoreceptor cells in the macular?
I remembered what my RS told me is the blood has 'disappeared' and there's no scarring on the macular. But does no scarring equates to no destruction of the photoreceptor cells?
PXE is a skin and connective tissue disease. If you had it your physicians would have probably easily made the diagnosis. You can likely cross that off the list. I do not have the time to look up studies in the medical literature about the incidence of lacquer cracks in high myopia. My clinical feeling is that the incidence is low. You can use an internet search engine and look up the frequency yourself if you want to. Realize that lacquer cracks themselves usually don't do the vision damage. It is when abnormal blood vessels (neovascularization) grown from the choroid into the retina/macula that problems develop. As I said there is new treatment for this that dramatically reduces the chances of severe damage (photodynamic therapy, Avastin, Lucentis, intraocular steroids).
I think the risk of wet macular degeneration is low (higher than the normal eye but much more likely NOT to get it than get it).
With most medical conditions they are better at some times, worse at others and some things bother them but other things don't. This is what you're noticing.
There has never been a time when ophthalmology has been able to do as much for the high myope to keep good vision all their life and medical research done by Eye MDs offers even more hope and success in the near future.
I just went for an appointment with my RS yesterday.
I realised that my left eye was in a more bad shape compared to the right. Both has got some lacquer cracks, which I incidentally came across from an article in the internet that it occurs in only 4% of high myopes (those above -6D). Besides that, I also read that having lacquer cracks will significantly increase our chances of getting CNV later on, as the process of tissue repairs and wound healing may trigger the growth of abnormal blood vessels in time to come. Besides, these blood vessels may also have a better chance of penetrating and leaks into the retina through these cracks. So far, the retina bleed in my left eye has healed and I couldn't see the blood patch that has been obsturcting my central vision earlier on. However, I am really quite uncertain and fearful what kind of future that I will be facing, if one day CNV shall occur.
Doc, I heard that Omega 3 fatty acids (from fish oils such as salmon) can be beneficial in preventing the growth of abnormal blood vessels, do you think it helps? Is it also true that the longer it is (say between 10 years and 20 years), the more likely the chances of getting CNV?
My RS said I also had some chloriorentina atrophy and some signs of virteous degeneration in both eyes, and very mild posterior staphyloma and some lattice degeneration in my left eye. I had the axial length measured using A-scan and it was about 30.6mm in the left and 30.8 in the right. In view of all these, do you still seriously think I am likely to have fair to good vision all my life as what you have previously mentioned?
To be very honest, I have lost confidence already in my eyes' ability to be able to last trouble-free till even 50 years old as everything that is bad (chlorioretina atrophy, lacquer cracks, posterior staphyloma, sub-retina bleeding, lattice degeneration, virteous degeneration), my eyes have it.
I really appreciate the invaluable advises that you've given me and for so many other people who are like me and who otherwise may have difficulty in finding the advises elsewhere. THANK YOU VERY MUCH!!
I am sure they are many severe myopes out there who are also suffering from retina degeneration and is in the same state of hopelessness and facing with a uncertain future and I believe whatever advises that you may give to me will also help to address some of their worries and anxieties.
I would be very grateful if you could perhaps give me some clues or glimpses on my future visual prospects based on my conditions described above (25/8/07). Afterall, with your vast clinical experiences and expertise, I am sure you will have seen enough pathological myopic patients than most of us to give a well informed opinion.
Finally, I would like to extend my gratefulness to you and other doctors who contribute in this forum and I am sure everyone here recognise and appreciate and benefitted tremendously from the good work that you'all have done.
Hello myopic 74, thanks for the kind words. I have a very large practice and have been in the practice of ophthalmology for over 30 years. I have many, many highly myopic individuals. I have none of them that are totally blind. Most of they function quite well. Often because of myopic macular degeneration they don't have perfect 20/20 vision. Probably 90% of them are between 20/30 and 20/50. That is good enough to drive and read. Probably 5% see 20/20 to 20/25. The remaining 5% see worse than 20/50. Some of these would see much better had their neovascular "wet" macular degeneration occured now that we have photodynamic therapy and VEGF inhibitors. I can think of only one woman that is legally blind in both eyes and she functions extremely well in spite of her handicap.
Things will just get better and better because of research that is coming to the fore now and in the near future.
I've worn glasses since the age of 6, probably needed them for many years before that. At the age of 53 I wore -14.5D in one eye and -16D in the other. I started to have problems in my late 40s, seeing double in my left eye. It took four doctors, but finally one detected the cataract that caused the problem. Being so myopic, I was focusing about an inch from my eyeball, so I was seeing a tiny aberration of the lens that wouldn't bother a person with normal vision.
The doctor did cataract surgery, put in an IOL with my prescription, and a month later did the same procedure on the other eye - which didn't have a cataract - to balance the two eyes. Apparently it's difficult to get an exact hit when you're starting with minus 16 diopters, and also he corrected my vision to monovision (distant in my bad eye, close in my good), but I now i am able to read for short periods of time unassisted, and can drive without glasses. However, I prefer wearing glasses, with a minimal prescription, because I like to see as sharply as possible. I'm now 63, and my vision, in glasses, is 20/20 in one eye and 20/25 in the other.
Thanks for sharing! Hearing from you is an encouragement for me!
I am glad that you are still seeing such good vision. Really hope I can also be like you (still seeing well) when I am at your age, though I think that may not be quite possible due to the already existing degenerative changes at the back of my eyes.
Maybe can you share with me about how old then your myopia began to stabilise?
I wish you good health and good eyesight always! And don't forget to go for regular eye check-up, which I believe is quite important for highly myopic people like us.
My myopia is not stable. Right after surgery I needed a half a diopter and a little bit of astigmatism correction in one eye, and a diopter and a half plus astigmatism in the other (that's for distance - for reading I had another prescription, and yet another for computer work). These prescriptions are a bit complicated, because the surgery aimed to give me monovision, and in an imperfect manner it did succeed - at least for the first few years. As of this date, I can still read a bit without glasses, but unless I absolutely had to, wouldn't dare drive a car unassisted.
It's been close to ten years since the surgery, and my myopia has increased by about a diopter. But I'm starting from close to 0.0, so I figure I'll be wearing 4 diopters at the age of 93. I can live with that.
As far as degenerative changes, I - like so many high myopes - have several retinal holes, which were monitored for years and which appear to have healed themselves. Had vitreous detachments in both eyes, including one in Israel where the doctor smoked a cigarette while examining me. That was a trip.
Good health and good eyesight to you too. Be well.
In re-reading the conversation thread I don't think I commented on fish oil supplements. There is some evidence that it might help the blood vessels on the back of the eye stay healthy, help dry eyes, obviously help the heart a lot and possibly reduce the risk of neovascularization.
Be sure the fish oil is high grade and free of impurities. As your personal physician or ophthalmologist for the recommended dosage. If you have problems with a fishy taste and burping when you take them try enteric coated fish oil.
There are many good brands out there. The one I use is from cardiotaps (omega 3's) www.cardiotabs.com All profits from these sales are used for heart researach.
Also AREDS supplements (age related eye disease studies) may help, I would pick one that has lutein in it (vitimen's like Centrum have virtually no lutein). Popular brands are: EyeCap, Ocuvite and Preservision with Lutein. Be sure and take the proper dose which will be listed on the bottle. NONE OF THESE ARE ONE PER DAY. They are either two or four per day.
As an aside: any doctor that smokes in front of a patient ought to be put on administrative leave and sent to a smoking cessation camp and doctor behavior school. Sad, sad, sad.
Thanks so much for the supplement advice. I'll look into it ASAP. And yes, it's mind-boggling that a doctor would smoke in front of a patient. But I gather that they're getting a bit more anti-cigarette in Europe and Israel since I was there last in the late 90s. Sure hope so. I live in California where smokers are pariahs, which is fine with me.
Thank you for your attentiveness and professionalism! I really can't thank you enough for all the good work which you have done for me and everybody here.
Nowadays I take fish oil capsule and Scots cod liver oil emulsion as supplements everyday. Besides that, I also take steamed green leafy veges (kailan veges) once every two day.I read that green leafy veges is supposed to be rich in lutein.
One question though. I heard from somebody on the web that the fact that bleeding has been observed in the lacquer cracks (my left eye) means that CNV may have already developed to some extent. However, my RS said there is no active leakage nor new blood vessels growth after having done a dilated exam on my eyes. She said there is no clinical suspicions, and hence didnt even asked for a FFA or ICG, and just asked me to come back 4 months later, or whenever I find something wrong with my vision. Right now, four months after the bleed in th left, there don't seem anymore bleed and the waviness and blood patch has also since been gone. So I'm really confused and wonder which is true?
Right now I am wearing my old specs (L -13.75D R-16) which I am seeing something like 6/9-6/12. My new prescription is L-18 R-20, which will give me a VA of 6/7.5. Though I am not seeing too well with my old prescriptions, especially at dimly lit condition, but is still manageable, and I have been wearing them for the past 5-6 years. I heard that it is not good to overcorrect for high myopia. So do you think by changing to the new prescription, will it be better off or worse off?
To Sym11: I've asked my RS about Sclera buckle, but she said it was not available here in where I stay and so far results for such procedures done elsewhere has not been very promising nor proven to be effective. Furthermore, there is also considerable risks involved. So I don't think will be considering it at this stage, maybe until it is more proven or my situation gets worse. But, thanks for your suggestion!
It's hard to over-correct a person in their 50's. The problem is with young people. If you give them too much minus lens than can focus or accommodate and clear their vision. A 50 year old won't do this. It's also why ophthalmologists usually do the glasses test (refraction) on young people after their eyes are dilated.
You are missing a great deal of the world's beautify by wearing such a weak correction. I don't think there's evidence that going to your full myopic correction would make your myopia worse and certainly will not cause neovascular membranes in your lacquer cracks.
Hi, I am currently undergoing treatment for a PVD in my right eye. I was able to catch the symptoms of the Retinal Detachment through the large retina detachment in my left eye. I am 30 years old and scared of becoming totally blind since my right eye is the only useful eye I have.
My question is will retina stem cell research be available soon, and if so will it be able to help me and others like me beat this cruel condition?
Hello Brown 33 While stem cell researach both adult and embroyonic offer great promise in many fields of medicine including ophthalmology, the ability to "grow" a new retina or a new eye is likely many years of hard research down the road.
In the meantime: have you eye examined frequently, never longer than a year, wear protective eye glasses, avoid activities with high eye injury rate (contact and racquet sports, firearms, firecrackers, etc), don't go on amusement rides that throw the head about, don't smoke, eat a good diet, keep your blood pressure, body weight and cholesterol under good control, take a multi vitamin and consider taking a ARED eye supplement like EyeCap, Ocuvite or Preservision with lutein (all over the counter).
Regarding sclera buckle, my RS did not specifically mentioned what are the risks, as no one was doing it in where I live, in Singapore. Moreover, as far as I read, the results has not been particualrly proven.
I guess as in any surgery, there is a considerable amount of risks involved, not to mention risk of RD for high myopes.
sorry.. messages were sent errorneously while typing halfway..
To continue from the above post.. how do you tell when you got PVD? My RS did mentioned to me that my virteous is beginning to show signs of degenerating. I can see quite a few floaters, in strings and more prominent if in well-lit places like under the sun, in both eyes. Sometimes, it looks like tiny cell structures in a magnifying glass if I take out my specs and look the bright lights. I read that is the virteous is beginning to liquify.
Until what stage the degenration process will it be considered a PVD? Will all PVD lead to Retina detachment? What is the percentage like and what contributing factors will lead a PVD to a RD?
This thread is SO WONDERFUL!! My husband (age 54) was diagnosed with myopic degeneration in July, and so we have been on a journey of finding out all we can about the treatment, prognosis, causation, etc. I completely understand myopic74's concerns and questions about the future. Even for my husband and myself, the fears of him facing blindness were not easy to deal with. We're actually very stable, well-grounded people, but it's hard not to imagine the worst! But, because of an excellent specialist, great treatment options (injection of avistin), and all the knowledge and research that being done, we are both far less fearful than we were a month ago. Three weeks ago there was already significant improvement...he'll find out more after today's visit. Thanks to all who've posted!
Hello Myopic 74 Symptoms of PVD sudden increase in floaters, sometimes in showers, flashes of light like lightening in eye. Loss of peripheral vision is NOT a sign of PVD. A PVD occurs when the central vitreous is so water like it doesn't support the outter layers of the vitreous and it peels or detaches off the eye. All retinal detachments (RD) do not start from PVD, example would be penetrating or blunt eye injury. PVDs are a normal part of aging, but occurs earlier in those of us that are myopic. Huge disparity between incidence of PVD (1 in 2 people by age 50) and RD (1 in 3-5,000 people that have NOT had cataract surgery).
Also good to point out that legal blindness due to loss of central vision is NOT the same at total blindness where there is no sight at all.
My PVD's came on suddenly, but I'm told that with many people it occurs gradually until they the floaters become bothersome. The symptoms of sudden-onset PVD resemble the symptoms of retinal detachment, so anybody who hallucinates curtains of lights and flashing showers like rainbows, it's not an acid flashback from the 60's. Go to your ophthalmologist ASAP.
BTW, after many years, the floaters settled on the bottom - below my field of vision. They don't trouble me anymore.
I hope your husband's condition will remain stable for long time to come.
Does your husband has an active leaking or any new vessels growth?
I agreed with you that it is indeed a nerve-wrecking experience learning about the condition, and even now, even though there's no active bleeding and my vision has returned to normal, I still feel very frightful and uncertain where my future is heading, when is another bleeding going to come and when will new vessels start growing, and eventually having to cope with the potential prospects of visual disability, and yet not knowing when will all the bad things come.
I really hope you husband will be alright and respond well to treatment if any.
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