back from retinal specialist - lamellar hole with other stuff

  I'm back from the retinal specialist but still have questions. I have partial thickness macular hole with splitting of the retina and widespread epiretinal membrane. I do not have PVD or myopia. Visual acuity is 20/30 +2 correctable to better than that with distortions on Amsler grid. He thinks we should wait 2 months to see if hole or splitting has changed. My primary questions concerns whether the other eye is affected with very early signs.

One thing that I wonder about in this regard is that in the right unaffected eye the ILM-RPE thickness is LESS than normal- thinner. In the very central region (center of the bullseye) it is 210um, which is below the 5% of normal population. This is from a cirrus oct and in a stratus  oct from a few days earlier it was below the 1%ile at 156um.  Back to the cirrus oct, the 4 quadrents that immediatley surround it are also below the 5th percentile at 298, 289, 293, and 285 in superior, nasal, inferiorer, and temporal quadrants respectively. In addition, one general optho thinks that the very top yellow layer on the his res line scans of the cirrus of right eye is an epiretinal membrane that is currently not visible elsewhere; he then said maybe right eye ok because the ILM views and ILM-RPE photos looked good. The question is whether the abnornal thinning described above is the same thing as "involutional foveal thinning". (The reasons I ask is that from what i've read, if you have that in the fellow eye, it is more likely to develop the macualr hole like the affected eye). If it's not involutional foveal thinning, then what might that thinning be? and what of the yellow line that indicates a new epiretinal membrane?

of course any comments about the currently affected left eye is welcome. i understand why waiting is advised, but i also will never get back the vision i have now once the hole reaches the photoreceptors or does further macular damage. Can I at least go back in one month rather than two to see if there are any changes and if so consider surgery?

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

You need to get on the phone 1. move your appointment up to a month 2. ask your question to the staff for an answer my your ophthalmologist who is the only person that can answer.  We answer call in questions from our patients many times every day.

Also many partial thickness holes or pseudo-holes never progress and surgery is not necessary.

JCH MD

[promethiusII]

thanks.i'm sure i'll be asking the retinal specialist plenty. there's no reason i can't get input from others though as to what thinning on the OCT in the fellow eye can be indicative of. i will ask for one month appointment instead-thanks. (so far been given roughly 50-50 chance that this will not progress on its own).

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

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