Should I seek further advise re eye pain after PVD

10 years ago, at age 44, I was referred to an Opthalmologist for review of what I describe as cloudiness or blobs of brown clouds moving through my right eye and causing visual disturbance.
My eyesight had generally always been quite good and I only occasionally needed to wear glasses with a very light prescription –when tired, basically.

I was advised I had a large floater from PVD and what appeared to be some blood in the vitreous. No further review was required unless things got worse or I did not ‘adjust’ to the presence of the large floater. Over time this floater became less noticeable to me but I am advised is still there.

3 years ago, after  a regular eye exam I was referred again to an ophthalmologist, as this time  it was noticed that I had ‘cupping’ and some optic nerve abnormality in both eyes.

Was examined and also given visual field tests and was advised there were some small areas of visual loss both eyes. Glaucoma suspected but pressures within normal range.

Two weeks ago I had another routine eye exam and a new prescription for glasses was required. The cupping and optic nerve problem was again noted for both eyes and I was referred to an ophthalmologist again. A few days later, and before my ophthalmologist appointment, I just simply sat on the couch and noted a quick rush of floating material in my left eye which disturbed my vision greatly.  Looks like a white blob of cotton wool.  I attended an emergency clinic as it was the weekend.

Was found I had another PVD,  this time in left eye but that the ‘debris’ was difficult to see – was really very visible to me, but took a while for the doctor to locate and she said it was like a ‘ring’ .

Was  advised to see the ophthalmologist within a week and have reviewed further – did that and was advised that the floater was indeed not as big or visible to him as the one in my right eye (which is still there) and that the cupping and optic nerve problem seemed quite  progressed since 3 years ago and that I have a cup to disc ratio of 0.8 in both eyes – not sure what that means.

My ophthalmologist was about to leave on an overseas trip and says I should come back in a month when he returns and then have a scan and some Visual Field tests done.

That was a few days ago. In the meantime my left eye is really sore, it has constant ( really constant) twitching, feels gritty and stinging and I cannot stand bright light. I cannot get to sleep as the eye feels ‘heavy’ and the twitching is driving me insane.

For the first time in my life – I feel like ‘seeing’ is an actual  effort, that it is difficult to focus on things. I don’t think that using my new prescription ,while all this is going on, is helping at all or just adding to the discomfort

What should I do – just wait till my Ophthalmologist gets back from overseas or go see someone else?

Thanks

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

Your biggest problem is a cup disc ratio (cupping) of 0.8 or 80%. My strong suggestion would be to see an eye MD ophthalmologist that specializes in glaucoma therapy. Glaucoma is a very complex disease. You can have glaucoma and have normal pressure in the eye (normal tension glaucoma) or the pressure which changes from hour to hour like your blood pressure may be high at night or evening when the Eye MD cannot measure it. Also damage from glaucoma shows up frist in optic nerve cupping then visual field. So you can have glaucoma and still have normal VF.  A new test optic nerve OCT is often helpful as is stereoscopic photographs.

Find a glaucoma specialist near you at www.aao.org

The floater/PVD stuff in your vitreous is a different problem and while annoying generally does not require treatment.

JCH MD