Rapid progressive myopic degeneration

[Sridhar_Iyer]

I am 52 year old male, with sever bad eyes, left eye at 20/400, correctable only to 20/200 with glasses, amd 20/80 with glasses with pin-hole viewer.  Left eye experienced recent posterior vitreous detachment, now has rampant floaters, and onset of cataract, degree 2 on scale of 4.  Right eye stable so far, 20/140, corrected to 20/30 with glasses.  Suspect that all my reading and distance vision is pretty much occurring with just the dominant right eye.  Experience severe eye ache on routine basis, due to almost zero vision on left eye, plus the high stress being caused by attempting to fuse 2 very different size images from teh 2 eyes. Current suggestion is to try on hard contact lens to press teh cornea inwards + corrective lenses to try & get teh left eye to 20/80 vision.

Are there any other options?  Most improtant is to get some improved vision on left eye, plus reduce the severe high eye ache.

[John C Hagan]

If your reduced vision is due to cataracts then you should consider cataract surgery as most people do not function well with that level of visual acuity. If you have myopic degeneration then remail under close care of an ophthalmologist Eye MD anad was carefully for neovacularization.

JCH III MD

[Sridhar_Iyer]

Much thanks for your quick response.  I rec'd feedback from my eye doctor that they are not sure that even if they perform the catarct surgery that it will fix my acute vision problem in left eye, so for now they are recommending postponement of cataract unless I declare that I cannot tolerate the poor vision resulting from cataract.  So I suspect that I am facing myopic degenartion on my left eye, that too rapidly progressive myopic degeneration.  I am seeking an appointment with a specialist for this, but I am unable to get a quick appointment, it is few weeks away in late January. I am getting worried that my vision is worsening by the day...  Not sure what neovacularization is, anything I can do in the interim to arrest the progression of the problem?  Any way to get a bit better vison on left eye vs the current 20/200 with glasses?  Also, my eye ache is very severe, often taking me down for 2 days in bed with eyes shut, before I can back to normal activity.  This acute eye-pain seems to be occurring at a frequency of once very two weeks, and lasts 36hrs to two days, it is intense and unbearable the entire duration before it starts clearing up...

[John C Hagan III, MD, FACS]

If at all possible your eye exam should be moved up, in my opinion as an emergency. Several reasons not to wait any one of which would be declared an emergency in our office and you would be seen the next day:  1 the severe pain 2 the rapid worsening of the vision 3 the possiblity of wet mypic macular degeneration.

Neither cataract nor wet mypopic macular degeneration is painful. you would need to be checked to see why you have this pain. In some cases a cataractous lens can swell and cause intermittent angle closure glaucoma. This also is an emergency.

Wet myopic macular degeneration has been dramatically helped by intraocular injections of Lucentis and Avastin and Macugen but they are far more effective if injected when there is very little blood in the eye. With large bleeds as can occur with delay in treatment they are far less successful.

Bottom line if there exists a pathway to be seen soon than January as an EMERGENCY then I would move heaven and earth to get in to the retina specialist sooner.

PS What country do you live in?

JCH III MD

[Sridhar_Iyer]

I have been able to secure an emergency appt for next week.  Thank you very much for some of your insights.  I am originally from South India, moved to US 31yrs ago, at present I live in Sacramento area in Northern California...

[John C Hagan III, MD, FACS]

Good luck and if you have a chance let us know how the consultation goes and what the diagnosis and treatment are. I was pleased that you did not live in a country with socialized medicine as the people seem totally unable to expedite urgent and emergency exams and treatment.
'
JCH III MD

[Sym 11]

I also want to find out how the consultation go.  I also have the concern with progressive myopic degeneration.

[John C Hagan III, MD, FACS]

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[Sridhar_Iyer]

I did have consultation with two ophthalmologists and a top flight retinal specialist.  Nothing encouraging to report.  Rec'd a confirmed diagnosis of "Progressive High Degeneratibe Myopia".  And that tehre is no cure for it.  What is pretty distressing is that my left eye has shot up from a visual acuity of -14 diopters to a -18 diopters within a few months.  Seems like it will just progress into oblivion.  I asked for any experimental treatment, they said they would let me know if anything is available, nothing right now that I can jump into.  Apparently there was some surgical attempts to address progressive myopia a few years ago, but it showed no consistent remedy so that line has been discontinued.  New attempts are underway.  I am ready to go visit the topmost folks specializing specifically in progressive myopia and nothing else, if I can find this expert. On a separate note, they also have found corneal aberrations on my left eye, which may be helped by using a hard lens, so I will be seeing a cornea specialist to get my cornea mapped, and see if a hard lens  can help improve the vision...  The severe pain that I routinely experience, which is increasing even more recently, is being attributed to teh severe strain that my eyes go thru fusing two images of very different size, which is getting worsened by teh galloping myopia on the left eye...  The cataract is not as bad as thought, it is defeinitely there with early onset, but given teh risk of retinal detachment, all the ophthalmologists and retinal specialists I have seen feel it is a "last resort" measure..  

[John C Hagan]

Often myopic macular degeration causes very poor central vision by the mechanism of a choroidal neovascular membrane forming (CNV).  the treatment of this has improved dramatically in the last couple of years due to the use of VEGF inhibitors Avastin and Lucentis and intravitreal steroids (macugen). So there is a great deal that can be done now that couldn't as recent as 3-5 years ago.

JCH III MD

[Sridhar_Iyer]

I really do appreciate your advice on this thread.  I woul dbe very open to trying out these VEGF inhibitors, once I understand any side effects or associated risk factors.  Is tehre anyone in Northern California (Sacramento / Davis / Berkeley / San Francisco / Stanford) that I can consult for this treatment?
Regards

[John C Hagan]

It is now standard treatment and can be done by almost all retina ophthalmologists in communities all acrros the US. Any of those places you mention can provide top level care.

JCH III MD

[Sym 11]

For you progressive myopia degeneration, you can see Dr Brian Ward, Retinal Diagnostic Center at Campbell, California for the consultation.  Hope this'll help.

[John C Hagan]

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[Sridhar_Iyer]

Thank You

[Clod]

     Hi, Sir Iam 30 yrs old Male here in the philippines Have myopia degeneration at left eye start when iam 15 yrs old. due to poverty in our family iam not been consult to the doctor as early as it start the decease. until iam finish my college and got a job iam very sad and desperate its hard to work under the heat of the sun painful headace almost everyday because my unbalance vision. i wish you can advice me doctor.            

                                                                                           Clod

[Shelley928]

As to Dr. Hagan's unfounded remark: "I was pleased that you did not live in a country with socialized medicine as the people seem totally unable to expedite urgent and emergency exams and treatment. "

I have lived in both England and France and always received top notch medical care. Whenever there was an emergency, I was seen immediately as were all members of my family. This is a strange myth  in the USA that countries with socialized medicine don't receive care. This is not true. We always had excellent care. Not only did I have access to specialists, I had access to a personal physician at all times. I've only lived in the USA for a year, but this bizarre slander of excellent medical standards in Europe must stop.