Lattice Retinal Degeneration Questions

[av2016]

I am in my 40's and diagnosed a few years ago with lattice retinal degeneration (peripheral), and have worn glasses since childhood for distance.  No known family history of this.  Went for retinal exam with ophthalmologist a few weeks ago, and they found a small retinal hole in my left eye which they lasered.  The Dr didn't seem concerned at all and told me to follow-up in 3 months.  During the exam, he seemed fine with the right eye (said he liked what he saw), and didn't even want to call the hole he saw a tear.  Asked my optometrist, and they seemed fine with that 3 month period also. I really don't have any more information to include how long I had the hole, although Optomap taken after surgery the Optometrist said he saw 'scar tissue' in both eyes in the degeneration area.

Long story short, looking online it is quite scary regarding this.  There doesn't seem anything that can be done, but it is hard to determine if I am low risk, or to the extreme where I can go blind.  I know there is of course no way to predict the future, but I saw in some old posts where Dr. John C Hagan III M.D. replied to one poster that he has this also and never had to have anything done, and that checking throughout the year for this is overkill.

My questions are:  1) I'd like to be proactive and have holes or tears lasered rather than having a retinal detachment...so how do we do this?  If not frequently throughout the year, how do we know when to go in?  2) If we have lots of floaters, and it is hard to tell when we get more (minus a retinal detachment flood of floaters), how can we determine if a new hole or tear happened so we can go in?  3) to cut down on the worry and anxiety, what is the real risk with lattice retinal degeneration...is it low overall for getting a detachment?, etc?  4) Is getting lasered beneficial at all with no tears/holes...saw online that asymptomatic holes/tears have no benefit to be lasered...so I don't know what I had, or if it was necessary, or basically what to know/do.  5) is there anything in the pipeline that will help beyond surgery (I saw that NT-501 ECT is in trials for retinal degeneration, but don't know if this applies) 6) can the retina heal itself with lattice retinal degeneration?  I don't understand how I have "scar tissue" and didn't have holes and tears.  and 7) anything else you can recommend, explain, or help to understand how to live with this...and thrive in spite of it.  It seems either nothing can really happen, or you can go blind in both eyes instantly with this...extremes.

I trust in the experience of my doctors, and I presume that laser treatment caught early has high success rates (but understand new holes or tears could occur), and surgery for detachment also is fairly high success rates, but I'd prefer to NOT have a detachment (I'm sure most would say the same)! :)

I know this is a lot of questions, but appreciate it!  Just trying to understand this better in the months before I can go back to see the Ophthalmologist.  

[JohnHaganMD]

You need to step back and take a deep breath. Your information is incomplete.  Fully 6-8% of the population have lattice degeneration if it is actively sought with dilated exams and technique called scleral depression. I have it in both eyes.  A retinal detachment in the general population of people that do not have high risk factors for retinal detachment (myopia >6 diopters, previous cataract surgery, family or personal history of RD or severe trauma to the eye) have a risk of RD of about one in 7000. So you can see very very very very few people who have lattice will get RD. Lattice does not affect the vision.  99% of lattice does not require treatment.   Treatment is not without risk including macular epiretinal membranes. If your retina surgeon advises no further treatment get on with your life and see the retina Eye MD at least yearly. I do suggest to my patients with lattice and other RD risk factors that they avoid amusement park type rides that whip the head around and jerk it back and forth.    Scar tissue can occur from inflammation or infection or trauma and thus not be related at all to holes or tears.  Many holes and tears do not require any treatment.   As I have said the "danger signals" are sudden occurrence of new floaters especially those in showers of hundreds of black dots that look like soot in the eye, flashes of light like lightening going off in the eye or loss of peripheral vision.  

[av2016]

Thank you so much Dr. Hagan!  I truly appreciate you replying back with this information, it has helped me understand this better!  My OS is -7.00 (and this is the eye where I had the small hole they lasered around).  In your opinion, what does this mean for me...basically, is using laser even beneficial with that eye (etc)?

[JohnHaganMD]

That is a question I cannot answer. It would take looking into your eye and doing special examinations.  Even highly trained and very competent retina surgeons often disagree about which holes/tears need to be treated.  Lattice rarely ever causes major problems given how many people have it.  You would need the retina Eye MD that examines your eyes to discuss pros and cons of treatment.

[av2016]

Thank you Dr. Hagan!  Yes, I will definitely talk to my ophthalmologist about this when I see them again in 2 months.  One final question...since my OS is -7.00, does that place me in the "risk" category for RD?  If so, statistically is it still low overall for getting RD?  I appreciate all your time with answering my questions, it has helped!

[JohnHaganMD]

In the general population without special risk factors the incidence of RD is only about one in 7000 to 10,000   For myopes in your range -7.00 the risk is much higher but in an absolute sense still very low about one in a thousand.  After cataract surgery maybe one in 500

[teller4]

This is helpful for me, too, thank you for this important information.  It's good to know that while cataract surgery does raise the risk of RD, the risk is still fairly low as you say (1/500) and my myopia is similar to this poster's (like -7 to -8.25 or -8.50 or so).  
I appreciate your addressing it.

[JohnHaganMD]

You are welcome

[av2016]

Thank you Dr. Hagan for all your answers :).  One last question:  minus a flood of floaters or lights, is there anytime we should go in for a re-exam?  For example, random flashes of light, or a new floater or two (when field of vision already has lots of floaters).  I don't want to overreact and go in for nothing, but also don't want to wait and have it progress (possibly) to a RD where I would then see all those bad warning signs.  Just a little confusing to me for the non-emergency floaters/flashes/curtain symptoms of "when" to go back in for a dilated exam.  Thank you!

[av2016]

Thank you as well Dr Hagan!  I am sure you are very busy with your practice, and also personal life, so it is greatly appreciated you help on this website.  It is a great service you (and others) give!

[JohnHaganMD]

Flashes that are worrisome: Extremely bright light lightening or a flash bulb in the eye especially if occuring in daytime without eye movement  Floaters: not one or two but showers, soot, smoke, hundreds of floaters  visual field loss of any kind.

[av2016]

Would they be worrisome if they are random, or should they be frequent/continuous?  For example a bright light or flash bulb in the eye, but it only happens once or infrequent or hours apart?

[JohnHaganMD]

Honestly I've taken this as far as I can from sitting in front of a computer in Kansas City.  I have given you the common major guidelines. I can't parse it out further. You need to discuss with your examining ophthalmologist not the optometrist that was so vague.