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CME and eye discomfort
I had retinal detachment in my right eye in Sept. 2014. Required 2 interventions to get it settled, the last being scleral buckle and vitrectomy. Spent five weeks in face down position. By Dec. 2014 I had cystoid macular edema (CME)? I also developed a cataract, which was expected. Cataract surgery May, 2015. Yag laser Aug 2015. Have been prescribed various eye drops over these many months. Currently on Acuvail 2 x per day. STILL have CME. May end up having surgery for this....Vision slowly worsening...wavy, less intense colours, etc. But my question concerns the fact that my right eye is sore most of the time. Usually just annoying but sometimes quite uncomfortable. Anyone else have this? Anything that can help this? Anyone else have CME lasting well over a year? Thanks !
Update: Saw retinal surgeon 2 weeks ago. He recommended a series of at least 3 Kenalog injections every 4-6 weeks. Confirmed CME persists and noted a "fine" epiretinal membrane. First injection scheduled for tomorrow. Crossing my fingers. Vision in right eye continues to be problematic.
3 Comments
Best of luck. Steroids often help. Be sure intraocular pressure is closely followed as steroid glaucoma is not uncommon after several injections.
Thanks, Dr. Hagan. What you consider an appropriate close monitoring of intraocular pressure?
Your surgeon should advise you and also help coordinate with your comprehensive ophthalmologist. In our practice with steroid injections someone checks the pressure no longer than every 3 months.
I am posting this update to my CME situation in the event the information may be helpful to someone else. Last week I had my third Kenalog injection for the chronic cystoid macular edema. I also had an OCT scan. The scan results were favourable! The inflammation is decreased by roughly half. Yay! I am not sure if my vision will improve after so long with this condition. What I have read indicates it may not. But if it doesn't get worse, I will be content. The plan is to continue with the injections every 6 weeks for possibly three more.
3 Comments
Glad to hear the swelling is responding. Continued success.
Thank you.
Dr. Hagan. Thanks for the repost with all the good information. I think I have made most of the lifestyle and dietary changes I need to help my eye health, but it helps to have someone like you nudge me to see if I am getting slack in any area. I am going to look at the AREDS 2 supplements. Part of my daily routine for some time has been to take flax seed oil and fish oil, but I don't take any supplements developed specifically for eye health.
Hi pinhole, Thanks for sharing your experience. I think now it is the CME causing the discomfort rather than the scleral buckle. Or maybe it is the combination that is causing the problem. I have tried lubricating drops, but they didn't relieve the discomfort. Resting with my eyes closed helps the most. I have been prescribed Durezol and Acuvail at various times in the last 14 months but, so far, no significant change has occurred. I am keeping my fingers crossed that my retina will flatten out. I really don't want surgery if I can avoid it. I get a little discouraged looking at the OCT scans and seeing the retina raised and cystoid. I am philosophical about it most of the time though. At least I can see and I have one good eye. I volunteer in a hospital and this keeps me aware of how lucky I am when I see what others have to cope with.
Thanks again.
Thanks again.
Dr. Hagan, Thanks for your response. I have not had anyone mention the high risk factor for my other eye, so thanks especially for that. I think I was mostly looking for reassurance. I am retired and live in a rural area. I travel 2 hours for my ophthalmology appointments and six hours for the retinal surgeries. I did have an eye injection last spring of keterolac and had slight improvement for a time. I am hoping for the best with this CME but trying to prepare for the worst. This new life "adventure" is hard to explain to my friends and family so it is reassuring to read the posts of others on this forum. Again, thank you.
7 Comments
The symptoms of possible RD are sudden increase of floaters, flashes of light and possible loss of field of vision. Any of those call the retina MD immediately. Ask if there are any increased risk lesion in the unoperated eye like lattice, open holes or tears. Avoid contact sports and things that whip the head around like theme park rides. Discuss prevention with your retina MD. Live a healthy lifestyle to avoid other eye diseases like macular degeneration that might threaten your good eye. JCH MD
More good advice. I don't smoke or drink alcohol. My husband and I grow and eat lots of vegetables and fruit. But, my mom and maternal aunt had significant macular degeneration, so l do all can to keep my eyes healthy. I gave up tennis after my first retinal detachment and surgeries. I try to walk every day, drink lots of water, avoid caffeine and sugar. Any other advice is welcome. Thanks again!
This is a repost from Aug 2015" A Healthy Lifestyle May Prevent You From Going Blind Due to Macula Degeneration
Prepared for MedHelp.com AAO eyecare forums by
John C. Hagan III, MD, Fellow American Academy of Ophthalmology
If there is anything that modern medical research confirms it’s that the good and bad choices you make about your lifestyle (diet, exercise, smoking, alcohol, etc.) have a major effect on how long you live, how well you live and even whether your vision will fail long before you die.
This article will focus on prevention and treatment of age related macular degeneration (ARMD). Recent studies suggest that many of these recommendations may prevent or slow the development of cataracts and enhance your general health. The macula is the most sensitive part of the retina (the sight forming tissue on the back of the eye---much like the film in a camera). The macula is used for reading, looking at computer screens, driving, recognizing faces and all fine vision. Its structure provides ultra-sharp vision that the peripheral retina cannot produce; however this delicate architecture also predisposes it to the effects of age and disease. (Think of how a pair of blue jeans wears out in the knees first)
There are two forms of age related macular degeneration “dry” (non-exudative), which accounts for 90% of the cases but only 10% of the eyes that end up “legally blind”. Legal blindness means the best possible vision, even with glasses, is 20/200 or worse. The peripheral or side vision is not affected by macular degeneration so the eye is not totally blind. The other form is “wet” (exudative) macular degeneration which occurs only 10% of the time but causes 90% of the cases of legal blindness. Wet macular degeneration develops when dry macular degeneration suddenly worsens as tiny blood vessels (‘neovascularization’) break through into the macula causing bleeding and scar formation.
ARMD was once thought to be an unpreventable part of aging. The Human Genome Project has discovered that 3 or more genes cause 90% of ARMD. Testing is possible for these genes outside a few major genetic research centers. However even a person with all three genes may not get ARMD if they take preventive steps; likewise a person with none of these genes may get severe ARMD if they are smokers. Most ophthalmologists do not feel that genomic testing is helpful or worth the $800-1000 it costs
The things that are recommended to reduce the risk of ARMD or to prevent dry ARMD from worsening or turning into wet ARMD are, for the most part, the same things a cardiologist or family physician would recommend to reduce the risk of heart disease, cancer and promote general health.
This starts with a great diet: fruits, vegetables, fiber, fish, berries, nuts; low in saturated fats; low in high calorie processed carbohydrates (e.g. pastries; commercial crackers/chips) and green tea as a preferred liquid refreshment. Lutein is a substance of great importance to macular health. The body cannot make lutein. Lutein is found in dark leafy greens (spinach, kale, ‘greens’, broccoli, etc.) Lutein content of foods is easy to find on the internet. Both obese and overweight people have higher rates of ARMD than their normal weight counterparts. Nothing tastes as good as slim feels.
Smoking or using tobacco/nicotine products is one of the worst things you can do to your eyes. It more than doubles the risk of getting ARMD, increases the risk of dry ARMD worsening or turning into wet ARMD. If you are serious about protecting your health and vision, you must stop smoking completely. Trying to smoke “a little” is like trying to be “a little” pregnant. It just doesn’t work. Avoid cannabis products also.
ARMD is related to skin pigmentation and sun exposure. In general the darker the skin (and iris color—dark brown) the less ARMD; the lighter the complexion (those that sunburn easily) and with blue-gray-green iris color the higher the risk of ARMD. For sun exposure wear a hat with a bill, sunglasses that block UV and infrared light and high SPF sun block on face and exposed skin.
It is known that for people with dry ARMD that certain supplements slow disease progression. This was demonstrated in the AREDS 1 Study (Age Related Eye Disease Study). An AREDS 1 supplement contains extra vitamin A, C, E, zinc and copper. It is meant to be taken with a multivitamin. AREDS 1 original formula does not contain lutein and omega-3s (usual source fish oil); nor were they tested on individuals that did not have ARMD to see if they were preventive. A new study AREDS 2 that has lutein and omega-3s in it to see if this formulation prevents ARMD. Also vitamin A (beta-carotene) has been removed. People that smoke should not take vitamin A as it increases the risk of lung cancer. There are many quality pharmaceutical companies that make and sell these products; all are over-the-counter and require no prescription. The AREDS 2 Study found the new formulation better than the AREDS 1 formula. A beneficial effect of omega 3 could not be proven and it was removed from the commercial product now sold over the counter. I still advise my patients to take omega 2 (fish oil, flaxseed oil, kreel oil) For people that did not have dry ARMD taking AREDS 2 supplements did not reduce the risk of developing dry ARMD except in the subset that had the worst diets that had little intake of green vegetables. The minimum for a patient with ARMD is a multivitamin and 2 of the AREDS 2 capsules per day. People with a strong family history of ARMD or multiple risk factors should consider this combination also. There are so many "look alike" products on the market, many not having the AREDS 2 formula that I advise my patients to take the Preservision AREDS 2 formula which is the only products tested in AREDS 1 and 2.
After age 40, regular eye examinations are important to detect early signs of ARMD as well as glaucoma (pressure damage) and cataracts (clouding of the lens of the eye). People with ARMD are asked to test their eyes at home with an Amsler Grid to look for distortion that might indicate ARMD.
Ophthalmologists (MD physicians that specialize in medical and surgical care of the eyes) have made major discoveries into treating wet ARMD. This usually consists of injections of medications into the center of the eye where they cause the bleeding vessels to wither away without damaging surrounding tissue. About 75% of the time the vision can be kept from getting worse, so starting treatment when there is little blood is critical.
To summarize, there is treatment for both wet and dry age related macular degeneration but a healthy lifestyle that does not include obesity or tobacco products maximizes the chance for good vision all your life. May you live to see your children’s children’s children and see them clearly!
Prepared for MedHelp.com AAO eyecare forums by
John C. Hagan III, MD, Fellow American Academy of Ophthalmology
If there is anything that modern medical research confirms it’s that the good and bad choices you make about your lifestyle (diet, exercise, smoking, alcohol, etc.) have a major effect on how long you live, how well you live and even whether your vision will fail long before you die.
This article will focus on prevention and treatment of age related macular degeneration (ARMD). Recent studies suggest that many of these recommendations may prevent or slow the development of cataracts and enhance your general health. The macula is the most sensitive part of the retina (the sight forming tissue on the back of the eye---much like the film in a camera). The macula is used for reading, looking at computer screens, driving, recognizing faces and all fine vision. Its structure provides ultra-sharp vision that the peripheral retina cannot produce; however this delicate architecture also predisposes it to the effects of age and disease. (Think of how a pair of blue jeans wears out in the knees first)
There are two forms of age related macular degeneration “dry” (non-exudative), which accounts for 90% of the cases but only 10% of the eyes that end up “legally blind”. Legal blindness means the best possible vision, even with glasses, is 20/200 or worse. The peripheral or side vision is not affected by macular degeneration so the eye is not totally blind. The other form is “wet” (exudative) macular degeneration which occurs only 10% of the time but causes 90% of the cases of legal blindness. Wet macular degeneration develops when dry macular degeneration suddenly worsens as tiny blood vessels (‘neovascularization’) break through into the macula causing bleeding and scar formation.
ARMD was once thought to be an unpreventable part of aging. The Human Genome Project has discovered that 3 or more genes cause 90% of ARMD. Testing is possible for these genes outside a few major genetic research centers. However even a person with all three genes may not get ARMD if they take preventive steps; likewise a person with none of these genes may get severe ARMD if they are smokers. Most ophthalmologists do not feel that genomic testing is helpful or worth the $800-1000 it costs
The things that are recommended to reduce the risk of ARMD or to prevent dry ARMD from worsening or turning into wet ARMD are, for the most part, the same things a cardiologist or family physician would recommend to reduce the risk of heart disease, cancer and promote general health.
This starts with a great diet: fruits, vegetables, fiber, fish, berries, nuts; low in saturated fats; low in high calorie processed carbohydrates (e.g. pastries; commercial crackers/chips) and green tea as a preferred liquid refreshment. Lutein is a substance of great importance to macular health. The body cannot make lutein. Lutein is found in dark leafy greens (spinach, kale, ‘greens’, broccoli, etc.) Lutein content of foods is easy to find on the internet. Both obese and overweight people have higher rates of ARMD than their normal weight counterparts. Nothing tastes as good as slim feels.
Smoking or using tobacco/nicotine products is one of the worst things you can do to your eyes. It more than doubles the risk of getting ARMD, increases the risk of dry ARMD worsening or turning into wet ARMD. If you are serious about protecting your health and vision, you must stop smoking completely. Trying to smoke “a little” is like trying to be “a little” pregnant. It just doesn’t work. Avoid cannabis products also.
ARMD is related to skin pigmentation and sun exposure. In general the darker the skin (and iris color—dark brown) the less ARMD; the lighter the complexion (those that sunburn easily) and with blue-gray-green iris color the higher the risk of ARMD. For sun exposure wear a hat with a bill, sunglasses that block UV and infrared light and high SPF sun block on face and exposed skin.
It is known that for people with dry ARMD that certain supplements slow disease progression. This was demonstrated in the AREDS 1 Study (Age Related Eye Disease Study). An AREDS 1 supplement contains extra vitamin A, C, E, zinc and copper. It is meant to be taken with a multivitamin. AREDS 1 original formula does not contain lutein and omega-3s (usual source fish oil); nor were they tested on individuals that did not have ARMD to see if they were preventive. A new study AREDS 2 that has lutein and omega-3s in it to see if this formulation prevents ARMD. Also vitamin A (beta-carotene) has been removed. People that smoke should not take vitamin A as it increases the risk of lung cancer. There are many quality pharmaceutical companies that make and sell these products; all are over-the-counter and require no prescription. The AREDS 2 Study found the new formulation better than the AREDS 1 formula. A beneficial effect of omega 3 could not be proven and it was removed from the commercial product now sold over the counter. I still advise my patients to take omega 2 (fish oil, flaxseed oil, kreel oil) For people that did not have dry ARMD taking AREDS 2 supplements did not reduce the risk of developing dry ARMD except in the subset that had the worst diets that had little intake of green vegetables. The minimum for a patient with ARMD is a multivitamin and 2 of the AREDS 2 capsules per day. People with a strong family history of ARMD or multiple risk factors should consider this combination also. There are so many "look alike" products on the market, many not having the AREDS 2 formula that I advise my patients to take the Preservision AREDS 2 formula which is the only products tested in AREDS 1 and 2.
After age 40, regular eye examinations are important to detect early signs of ARMD as well as glaucoma (pressure damage) and cataracts (clouding of the lens of the eye). People with ARMD are asked to test their eyes at home with an Amsler Grid to look for distortion that might indicate ARMD.
Ophthalmologists (MD physicians that specialize in medical and surgical care of the eyes) have made major discoveries into treating wet ARMD. This usually consists of injections of medications into the center of the eye where they cause the bleeding vessels to wither away without damaging surrounding tissue. About 75% of the time the vision can be kept from getting worse, so starting treatment when there is little blood is critical.
To summarize, there is treatment for both wet and dry age related macular degeneration but a healthy lifestyle that does not include obesity or tobacco products maximizes the chance for good vision all your life. May you live to see your children’s children’s children and see them clearly!
Hi,
I'm sorry you've been through all that. You're not alone. I've had detachments in both eyes (a few years apart) and got CME in the second one. I was scheduled for surgery for the CME until I sought a second opinion, which I went with: prednisolone drops plus ketorolac but no surgery unless the drops didn't fix it. The macula soon flattened out, and I have been on ketorolac twice daily for nearly a year (tapered off the steroid drops after a couple months). The eye with the CME feels uncomfortable all the time, like the lid is having to close over scar tissue in the sclera. Do you use lubricating drops or anything to address the soreness in your eye?
I'm sorry you've been through all that. You're not alone. I've had detachments in both eyes (a few years apart) and got CME in the second one. I was scheduled for surgery for the CME until I sought a second opinion, which I went with: prednisolone drops plus ketorolac but no surgery unless the drops didn't fix it. The macula soon flattened out, and I have been on ketorolac twice daily for nearly a year (tapered off the steroid drops after a couple months). The eye with the CME feels uncomfortable all the time, like the lid is having to close over scar tissue in the sclera. Do you use lubricating drops or anything to address the soreness in your eye?
Dr. John, does the diet work for lattice too? Can obesity affect lattice? Is there any thing to prevent lattice degeneration and to keep the retina healthy? Also, is there any food or living style to stop or slow the PVD?
I have lattice and PVD in both eyes. PVD and lattice not affected by diet or body weight. The above long post details how healthy lifestyle and diet can help vision.
Use the search feature and archives and read the many posts by people that have had RD surgery and scleral buckles. Redness and pain lasting many months is a common complaint. Persistent CME is also a common problem. You may well need injections of a VEGF inhibitor such as Avastin, Lucentis, or Eyelea or you may need intraocular steroid injection for the chronic CME. You might try seeing another group of retina surgeons for an independent second opinion. Remember to take excellent care of the other eye as it has a high risk of RD also.
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