PVD

[wallypedal]

I had a new pattern of floater 'dots', and needed a post IOL exam, so scheduled and went in. Exam consisted of dilation, eyelid cup, and "look at my ear".  Result -" this happens when you're getting older, especially to serious myopes like you. The elongated eyes are more susceptible. Watch it yourself, let us know if there are any changes, and come back in a month."
One week later, weird short black zig zag line, floating blob that changes shape with eye movement (looks like an amoeba cell!) and flashes in very dark conditions. Called early, my doc was in surgery, so another did the same type of examinatiion. "Well, I don't see any retinal tearing, you had a hemorrhage, these things happen when we get older. Did you get this pamphlet on floaters? Goodbye. Let us know if it changes."

What is the likelihood I have PVD? The 'blob' has sort of a granular interior or a higher concentration of dots. The bottom of it swings sort of and changes shape when I look rapidly left and right.

Based on my exam description, should I consider changing clinics?
Thanks


This discussion is related to Weiss Rings.

[LynneAV]

Thank you for corresponding. My frustration and suggestions for changes in doctor-patient communcation are exactly the same as yours. From the posts I read in this forum, it was seeming to me that everybody else in the world is allowed to know their own personal diagnosis and prognosis and plan for treatment -- except me. As I said, I have excellent doctors, but they and their staff refuse to share any information about me, to me; the "pat on the head" you described. For my cataract surgery, I was not allowed to know what lens I was getting, what the power would be, or what my eyesight would be like afterwards, except in very vague terms ("don't worry, it will be fine.")  It did turn out fine, but why couldn't I have simply been told something like, "Presently your nearsightedness in the cataract eye is X, and afterwards it will be Y, so with the two eyes together it will likely be Z."  I would have said "Fine" and stopped bugging them with my questions.

I am the caregiver at home. I take care of every body and every thing. Everything. No problem, and I do not ask for special considerations. But I can't waste time being confused and uninformed and I have no tolerance for fooling around being patronized and treated like a simple-minded child. I could do well if they would merely hand me a copy of my medical record so I can go home and look it all up on the internet. I need to plan! Other people depend upon me (as if simple curiousity about ones own life isn't sufficient reason for deserving ones own medical records, but apparently it isn't).  

On July 1, several days after I started experiencing flashes and floaters and a shower of tiny dots in my vision,  A friend was able to drive me to my regular ophthalmologist, who saw a retinal tear and referred me "urgently" to  a specialist two hours away. My friend was able to make the trip with me and ended up spending the whole day with me on my problem. The specialist did NOT see the retinal tear but told me to come back in six weeks. Well, at the six-week appointment, he did see the retinal tear after all, and expressed utmost urgency that he repair it immediately, right now!  (Yeah, I'd been going around for six weeks with this tear, thinking I was getting all better because the floaters and blood screen had diminished and hoping that the PVD was "finished.")  I had driven myself to the second appointment, not expecting both eyes to be dilated, bad news of a retinal tear, and numbing and laser treatment in the affected eye (unpleasant and disturbing).  

I still don't have any idea what probable prognosis to plan for. I got only one question answered (What about exercise and exertion?), but nothing else. I don't know about the PVD progress, I don't know about the bleeding situation (do I still need to sleep sitting up and do without aspirin?)  and I don't know if I need to plan ahead assuming blindness that eye ... it seems to be none of my business.

My doctors are good, and I do prefer an excellent doctor to a good communicator who provides inferior medical care ... but in a perfect world there would be some test they could give patients coming in, for intelligence and access to research and personality (and perhaps some extra points if you are the caregiver as opposed to the care receiver at home?), and with a high enough score you could be allowed to know your own medical status, succinctly and in big person official words.

Good luck to you and I, for one, am very interested to hear your further experiences.

[wallypedal]

I'm going back in another two weeks. I don't even know what finished means for a PVD! And since the fill-in doc saw the blob, but not the regular guy, it will be brand new to him and he won't know if it's changed.

I think with the tech advances out there, it shouldn't be that tough to have digital photo capability once we're dilated like the Grand Canyon. Then maybe more than one doc can know what it looked like historically.

Thanks for your response, you let me know that I'm not alone in having PVD, OR in having vague generalist info to work with. It's just as easy to say " you have a PVD, and it looks like it's done forming. Here is a DETAILED info sheet, including web references if you wish. You do not have a retinal tear."  I don't think disenchantment with the profession, or insurance and government payback policies are valid reasons for being gruff and non-informing.

Thanks!

[wallypedal]

Thanks for your feedback. I have made it clear (no pun intended) that I am a thorough student of my own vision from way back. I understand medical and anatomical terms and try to learn as much as I can about my own physiology. I am disappointed neither doctor mentioned PVD or what it means, what all the symptoms are, what I should expect going forward, or what changes or conditions warrant notifying them now. "let us know if things change" is a little too vague for me.

I will make my next scheduled appointment, and if I feel like I got patted on the head again I will consider changing clinics.

Thanks again.

[Ray T Oyakawa, MD]

Both doctors examined you appropriately.  You probably had a PVD with vitreous hemorrhage.  I get more concerned when there is a hemorrhage and I see the patient back in a month or sooner depending on the amount of hemorrhage.

I am not sure why you are considering changing clinics?  Are you unhappy with the bedside manners?  If so this is the reality of the decrease in reimbursement for healthcare and doctors have to see more patients to make up for it.

Dr. O.