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How real, big, or small is risk of scotomas from ILM peel?
A respected ophthalmologist last week recommended ILM peel to remove residual ERM (from a botched November 2013 vitrectomy with ERM peel) that's causing severe macula pucker in my right (OD) eye.
I'm extremely hesitant to go through with the procedure. I'm worried about developing scotomas due to the peeling process. I've spent dozens of hours scouring this and other eye forums about ILM peeling and the results of same.
I've not found a whole lot of material on the subject. What I did find was distressing. In many instances people developed scotomas after ILM peeling. Several persons said their OCT showed cells in the IS/OS region were wiped out. One said the missing area looked like it was 'rubbed out with an eraser'. This person has a scotoma to the right of their central vision.
I've read a fair amount (10+) of fairly recent (2009 to 2016) studies about ILM peeling versus ERM only peeling. Virtually every study concludes ILM peeling prevents recurrence of ERM. But the studies disagree as to whether or not ILM peeling results in better BCVA as opposed to ERM peeling alone. The studies also disagree as to whether or not the risks of ILM peel outweigh its results (e.g. 100% prevention ERM recurrence). A 2014 study I read a few days ago concluded ILM peeling needs more study to determine long term benefits/detriments!
Most worrisome, practically every study says you can't help removing some of the neural layer when doing an ILM peel. The ILM is only 2 (maybe) microns thick. Despite a surgeon's expertise and experience, grasp cite areas seem to show the most damage of all (according to the last study I read). Overall, photoreceptor and Mueller cells seem subject to being removed; and the remaining cells of each damaged to some extent.
** This is exactly what worries me more than any other aspect of having an ILM peel. **
If there's the slightest chance of scotomas from the recommended ILM peel, I'd rather not have the peel and live with what I've got left after the first botched surgery.
It's not a question of faith in the surgeon who advised ILM peel. It's a question of "What if I get a scotoma, then what!?"
Nobody's perfect. Anyone can have a bad day at work. When an eye surgeon has a bad day at work the patient pays the ultimate price, not the surgeon. It's just the way it is. I've already paid the price once, in 2013. Hate to pay it again.
I'm a very outdoors person. In the next year or two I hope to visit Alaska, Yellowstone Park (extended back country trekking and camping), Glacier Park (MT), Colorado's 10th Mountain Hut system, and Idaho's Hell's Canyon. I can't imagine visiting these places and not being able to fully see and thus enjoy them because of scotomas.
I'd rather keep my slightly blurry 20/50, and my slight binocular diplopia (that makes me depressed sometimes)....rather than gain 20/40 (or better) with scotomas.
I've devoured everything I could find by JodiJ on this and other boards. Like everyone else, I'm extremely comforted by her research and unfailing contributions to us who stumble around in our search for answers. Even so, after about a month of research I've still not found a large enough body of posts to answer my question "How big or small is the risk of scotomas due to ILM peel?"
When I asked the surgeon about scotomas from ILM peel he said "They'll go away". I was so stunned at this answer that I didn't stop him right there and demand a more precise answer. Before I knew it we were onto the next subject. I'm very disappointed in myself for not asking more scotoma questions. To be fair, the surgeon's answer might be absolutely correct; and thus make absolute sense to him. But to me, in my ignorance, a scotoma indicates an retinal injury that will more than likely never self resolve.
*** Am I correct in that assessment? ***
The surgeon's office is 1,200 miles from where I live. Going back for more answers requires another flight, hotel, and rental car. Until I make those arrangements I'm trying to question those who've had ILM peel about their outcomes.
I thank everyone for reading and responding.
I'm extremely hesitant to go through with the procedure. I'm worried about developing scotomas due to the peeling process. I've spent dozens of hours scouring this and other eye forums about ILM peeling and the results of same.
I've not found a whole lot of material on the subject. What I did find was distressing. In many instances people developed scotomas after ILM peeling. Several persons said their OCT showed cells in the IS/OS region were wiped out. One said the missing area looked like it was 'rubbed out with an eraser'. This person has a scotoma to the right of their central vision.
I've read a fair amount (10+) of fairly recent (2009 to 2016) studies about ILM peeling versus ERM only peeling. Virtually every study concludes ILM peeling prevents recurrence of ERM. But the studies disagree as to whether or not ILM peeling results in better BCVA as opposed to ERM peeling alone. The studies also disagree as to whether or not the risks of ILM peel outweigh its results (e.g. 100% prevention ERM recurrence). A 2014 study I read a few days ago concluded ILM peeling needs more study to determine long term benefits/detriments!
Most worrisome, practically every study says you can't help removing some of the neural layer when doing an ILM peel. The ILM is only 2 (maybe) microns thick. Despite a surgeon's expertise and experience, grasp cite areas seem to show the most damage of all (according to the last study I read). Overall, photoreceptor and Mueller cells seem subject to being removed; and the remaining cells of each damaged to some extent.
** This is exactly what worries me more than any other aspect of having an ILM peel. **
If there's the slightest chance of scotomas from the recommended ILM peel, I'd rather not have the peel and live with what I've got left after the first botched surgery.
It's not a question of faith in the surgeon who advised ILM peel. It's a question of "What if I get a scotoma, then what!?"
Nobody's perfect. Anyone can have a bad day at work. When an eye surgeon has a bad day at work the patient pays the ultimate price, not the surgeon. It's just the way it is. I've already paid the price once, in 2013. Hate to pay it again.
I'm a very outdoors person. In the next year or two I hope to visit Alaska, Yellowstone Park (extended back country trekking and camping), Glacier Park (MT), Colorado's 10th Mountain Hut system, and Idaho's Hell's Canyon. I can't imagine visiting these places and not being able to fully see and thus enjoy them because of scotomas.
I'd rather keep my slightly blurry 20/50, and my slight binocular diplopia (that makes me depressed sometimes)....rather than gain 20/40 (or better) with scotomas.
I've devoured everything I could find by JodiJ on this and other boards. Like everyone else, I'm extremely comforted by her research and unfailing contributions to us who stumble around in our search for answers. Even so, after about a month of research I've still not found a large enough body of posts to answer my question "How big or small is the risk of scotomas due to ILM peel?"
When I asked the surgeon about scotomas from ILM peel he said "They'll go away". I was so stunned at this answer that I didn't stop him right there and demand a more precise answer. Before I knew it we were onto the next subject. I'm very disappointed in myself for not asking more scotoma questions. To be fair, the surgeon's answer might be absolutely correct; and thus make absolute sense to him. But to me, in my ignorance, a scotoma indicates an retinal injury that will more than likely never self resolve.
*** Am I correct in that assessment? ***
The surgeon's office is 1,200 miles from where I live. Going back for more answers requires another flight, hotel, and rental car. Until I make those arrangements I'm trying to question those who've had ILM peel about their outcomes.
I thank everyone for reading and responding.
After his slit lamp exam Dr. Charles said was the cataract was too cloudy for him to see through well enough to do ILM removal. He said it's possible to do IOL implant at same time as ILM peel but he never does it. He recommended cataract surgery 1st, ILM peel 2nd.
He named 3 cataract doctors: Kerry Soloman, SC; Robert A. Cionni, UT; and Richard Mackool, NY. He said they all use optical biometry to measure and calculate IOL factor/strength (terminology?). He said measurements to determine IOL factor/strength are taken to back of the inside of one's eyeball, behind the retina; and that OB can take that measurement despite my retina profile (looks like Wyoming's Teton Mtns).
What led me to Dr. Charles was this. After 2013 ERM my vision got worse than before surgery. My original surgeon had died. The doctors who assumed his solo practice weren't in the same league as the surgeon. I now believe my post-surgery problems may've been beyond their abilities.
After 18 months of no progress or real answers I got disgusted, got a -7.0 OD contact, and moved on. That was around April last year (2015).
At that time corrected OD monocular vision was good. Binocular corrected vision was good. No diplopia. No depth perception problems. Could drive without any hesitation or problem drive day or night.
Around March this year my UCVA OD vision started getting blurry. It rapidly progressed to where I could see shapes, colors, etc; but couldn't see a 3"x3" Post It note stuck on the fridge from 10' away. Couldn't recognize faces from more than 10' away. Couldn't see a 2 liter soda bottle full of orange soda lying on a green lawn from 50' away. I was basically blind. Except this: I could see any object very clearly at about 3" distant. A movement in or out of more than 1/4" and the object became blurry.
I went to my optometrist. I'd gone from 20/200 to 20/400. He gave me a -10.0 lens. It improved my vision but not as good as the -7.0 did last year. I measured an out of focus 20/50.
Current corrected OD monovision is very blurry. Hazy. With significant horiz/vert distortion. Binocular vision shows slight diplopia and depth perception slightly off. Everything looks a little "weird".
***** I don't know if the deterioration in VA I noticed this March and which I now have is caused by a cataract or continuing traction of residual ERM, or combination of both *****
Does the site here have doctor lists by state? It'd require time off from work to travel to UT or SC due to complications or unexpected results. NY is within easy travel range but the financial costs for return visits are a consideration that can't be ignored.
Of course, if I'd bought Amazon at it's initial IPO back in the late 90's, I could fly my own jet to UT. I remember the day they announced their IPO and I said "Who'd buy stock in a place with just a web presence?"
Turns out a lot of people. Indeed.
He named 3 cataract doctors: Kerry Soloman, SC; Robert A. Cionni, UT; and Richard Mackool, NY. He said they all use optical biometry to measure and calculate IOL factor/strength (terminology?). He said measurements to determine IOL factor/strength are taken to back of the inside of one's eyeball, behind the retina; and that OB can take that measurement despite my retina profile (looks like Wyoming's Teton Mtns).
What led me to Dr. Charles was this. After 2013 ERM my vision got worse than before surgery. My original surgeon had died. The doctors who assumed his solo practice weren't in the same league as the surgeon. I now believe my post-surgery problems may've been beyond their abilities.
After 18 months of no progress or real answers I got disgusted, got a -7.0 OD contact, and moved on. That was around April last year (2015).
At that time corrected OD monocular vision was good. Binocular corrected vision was good. No diplopia. No depth perception problems. Could drive without any hesitation or problem drive day or night.
Around March this year my UCVA OD vision started getting blurry. It rapidly progressed to where I could see shapes, colors, etc; but couldn't see a 3"x3" Post It note stuck on the fridge from 10' away. Couldn't recognize faces from more than 10' away. Couldn't see a 2 liter soda bottle full of orange soda lying on a green lawn from 50' away. I was basically blind. Except this: I could see any object very clearly at about 3" distant. A movement in or out of more than 1/4" and the object became blurry.
I went to my optometrist. I'd gone from 20/200 to 20/400. He gave me a -10.0 lens. It improved my vision but not as good as the -7.0 did last year. I measured an out of focus 20/50.
Current corrected OD monovision is very blurry. Hazy. With significant horiz/vert distortion. Binocular vision shows slight diplopia and depth perception slightly off. Everything looks a little "weird".
***** I don't know if the deterioration in VA I noticed this March and which I now have is caused by a cataract or continuing traction of residual ERM, or combination of both *****
Does the site here have doctor lists by state? It'd require time off from work to travel to UT or SC due to complications or unexpected results. NY is within easy travel range but the financial costs for return visits are a consideration that can't be ignored.
Of course, if I'd bought Amazon at it's initial IPO back in the late 90's, I could fly my own jet to UT. I remember the day they announced their IPO and I said "Who'd buy stock in a place with just a web presence?"
Turns out a lot of people. Indeed.
1 Comments
Cataract surgery is extremely common and you do not have to go to the ends of the earth to have surgery. The technology that is extra and drives cost up of cataract surgery is ORA technology, femtosecond laser and "premium" IOLs. Whether they are worth it in your circumstance I cannot determine.
You have done your due diligence well. You have also answered your own question. Here is the answer: " If there's the slightest chance of scotomas from the recommended ILM peel, I'd rather not have the peel and live with what I've got" Everything in medicine, especially surgery, has risks and complications. The risks of ERM peel or ILM peel involve much more than just scotomas which may, or may not go away. These very real risks including infection, bleeding, inflammation, double vision, worse vision and even blindness.
So since you are unwilling to assume these risks then you may as well stick with what you have which is acceptable. At some point things might get worse and they the risk/benefit profile might appear differently to you.
So since you are unwilling to assume these risks then you may as well stick with what you have which is acceptable. At some point things might get worse and they the risk/benefit profile might appear differently to you.
6 Comments
Thank you for your answer, Dr. Hagan. Might you kindly expound a bit on:
a. how scotomas self resolve,
b. what kind of scotomas self resolve,
c. approx percentage of scotomas that
self resolve?
To my own shame and disappointment, I didn't push the ophthalmologist hard enough for more specific answers to my most important questions during my visit; scotomas being the number 1 question on my list.
As I live 1,200 miles away from this doctor, another flight, hotel, and rental car would be necessary for a follow up visit. Something I might indeed do after cataract surgery as the ophthalmologist suggested; for which I'm extremely thankful.
The doctor showed enormous integrity and pride of workmanship when he said my right lens was just cloudy enough that he'd not feel comfortable doing the ILM peel until I had cataract surgery.
I plan to see one of the cataract specialists which the ophthalmologist recommended. Dr. Richard J. Mackool is closest to me but may be out of my league due to certain parameters.
Binocular diplopia resulting from improved VA due to cataract surgery and/or ILM peeling is a real concern. My current blurry vision in the "bad eye" prevents full blown BD; although what's present is a great annoyance at times.
From all I've read on these subjects, it seems the best one can do is due diligence through reading and asking the right (key word) questions.
To that I've been reading all I can about IOL's. There's a gazillion ton of posts here on the subject and I'm trying to begin with basic definitions and IOL concepts. The ophthalmologist said I should get monovision IOL and forget about AOL or Multifocal IOL due to retinal conditions and history.
I'd be grateful for any direction or information you might have for me on the basics of IOL and selection for ERM peeled eyes, Dr. Hagan.
Thank you again for your time, your expertise, and a wonderful place where we with eye concerns can go for answers and encouragement.
a. how scotomas self resolve,
b. what kind of scotomas self resolve,
c. approx percentage of scotomas that
self resolve?
To my own shame and disappointment, I didn't push the ophthalmologist hard enough for more specific answers to my most important questions during my visit; scotomas being the number 1 question on my list.
As I live 1,200 miles away from this doctor, another flight, hotel, and rental car would be necessary for a follow up visit. Something I might indeed do after cataract surgery as the ophthalmologist suggested; for which I'm extremely thankful.
The doctor showed enormous integrity and pride of workmanship when he said my right lens was just cloudy enough that he'd not feel comfortable doing the ILM peel until I had cataract surgery.
I plan to see one of the cataract specialists which the ophthalmologist recommended. Dr. Richard J. Mackool is closest to me but may be out of my league due to certain parameters.
Binocular diplopia resulting from improved VA due to cataract surgery and/or ILM peeling is a real concern. My current blurry vision in the "bad eye" prevents full blown BD; although what's present is a great annoyance at times.
From all I've read on these subjects, it seems the best one can do is due diligence through reading and asking the right (key word) questions.
To that I've been reading all I can about IOL's. There's a gazillion ton of posts here on the subject and I'm trying to begin with basic definitions and IOL concepts. The ophthalmologist said I should get monovision IOL and forget about AOL or Multifocal IOL due to retinal conditions and history.
I'd be grateful for any direction or information you might have for me on the basics of IOL and selection for ERM peeled eyes, Dr. Hagan.
Thank you again for your time, your expertise, and a wonderful place where we with eye concerns can go for answers and encouragement.
Retina and macular surgery is extremely unique and individualistic and thus defies talking about "usual outcomes" as we do with cataract/IOL surgery. There are no studies that I am aware that will give you the information asked. You are facile with lnternet literature searches and you may be able to find a paper that deals with it. You can also search PubMED. With your macular problem you are not a good candidate for multifocal IOLs. If you have a standard cataract/IOL there are hundreds of good cataract surgeons in NYC area. McKool has great reputation but doesn't accept insurance and is very pricy. An eye with ERM is more prone to complications (macular edema) than a normal macula. Bottom line is you don't want any chance of risk and that does not ever happen. Just like taking a car trip. Any trip could result in death or severe disability and scores will die today across the USA.
Thank you Dr. Hagan. I appreciate your ability to highlight the important things. If risk of ILM induced scotoma was about equal to my driving record (accident free 35 years) I'd not hesitate to fly back to TN and have it done.
As you've noted, future circumstances may make ILM peel more attractive.
You correctly note my concerns with Dr. Mackool. The ophthalmologist I saw last week believes I'd benefit from IOL, so I'm pursuing IOL. If Mackool won't work perhaps I can find someone as qualified - who can work with my current wrinkled retina - in my home state of CT.
As time goes by the reality of my eye situation seems to hit me a little harder, a little bit at a time. Besides looking into treatment options I'm also trying to learn my limitations and figure out what I can and can't do as good as before.
Josey Wales was right when he said a man's got to know his limitation. Someone else said to not let what I can't do get in the way of what I can do. Good advice.
Downhill skiing will be interesting (occasional black diamond, mostly intermediate these days). Informal competition shooting is forever gone, as I'll never be as fast lefty as I was righty (dominant eye).
Deer, turkey, and small game hunting are possible as I can shoot left handed fairly well for hunting and target activities. Hiking steep, rocky trails is a bit of a challenge. The ground is always about 2 - 3" farther away from my foot than I think it is.
Time will tell how it all shakes out.
Thank you again for your well written responses and the understanding behind them.
As you've noted, future circumstances may make ILM peel more attractive.
You correctly note my concerns with Dr. Mackool. The ophthalmologist I saw last week believes I'd benefit from IOL, so I'm pursuing IOL. If Mackool won't work perhaps I can find someone as qualified - who can work with my current wrinkled retina - in my home state of CT.
As time goes by the reality of my eye situation seems to hit me a little harder, a little bit at a time. Besides looking into treatment options I'm also trying to learn my limitations and figure out what I can and can't do as good as before.
Josey Wales was right when he said a man's got to know his limitation. Someone else said to not let what I can't do get in the way of what I can do. Good advice.
Downhill skiing will be interesting (occasional black diamond, mostly intermediate these days). Informal competition shooting is forever gone, as I'll never be as fast lefty as I was righty (dominant eye).
Deer, turkey, and small game hunting are possible as I can shoot left handed fairly well for hunting and target activities. Hiking steep, rocky trails is a bit of a challenge. The ground is always about 2 - 3" farther away from my foot than I think it is.
Time will tell how it all shakes out.
Thank you again for your well written responses and the understanding behind them.
I'm somewhat confused. Your vision is 20/40-20/50. Now you have jumped to talking about cataract surgery. How big is your cataract. How much of your reduced vision is cataract and how much is ERM? What did the esteemed retina surgeon say about cataract surgery? (Did you see Steve Charles MD in Memphis?). And perhaps the most important thing is keeping your good eye good. Is your other eye healthy? Any macular disease? Cataract? Glaucoma? Did any of the physicians make recommendations to keep your LE healthy? Be sure you read this article I wrote about cataract surgery http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You ;
Dr. Hagan;
Thank you for the thought provoking questions. I really appreciate your insight here, and my thanks seem almost insignificant compared to the assistance you've provided in such a short time span..
Yesterday evening I read the article you referenced. I'll read it again.
Yes, I saw Dr. Charles last Wednesday (7/27). He didn't tell me what 'stage' (if that's correct terminology) the cataract was. Neither did he tell me how much of my vision reduction (a blurry, slightly hazy 20/50 in 'bad' eye) was cataract related vs. ERM related.
All he said was the cataract was too cloudy for him to see through well enough to do the ILM peel. He also said he didn't recommend doing IOL insert at same time as ERM/ILM peel. Finally, he said cataract surgery would eliminate the mild haziness I sometimes notice in my right eye. Cataract surgery would also, he said, restore some clarity of vision/sharpness of focus.
Thanks to your questions, Dr. Hagan, now that I think about it, the doctor who did the OCT 15 minutes before I saw Dr. Charles said the cataract wasn't very bad. I'm not sure how to tell a bad vs. not very bad cataract.
My vision through the cataract eye is a bit hazy but not like looking through cellophane or a smear of vaseline. It's more like looking through a very mildly - almost unnoticeably so - opaque glass. At times, though, my vision is decidedly hazy more than opaque.
This haziness/opaqueness is more prevalent when I look towards a light source, whether the sun or an overhead light. Such a view is decidedly "cloudy", like the vision you have topside after swimming under water with your eyes open.
Through the bad eye details aren't very clear. Looking at a large tree full of leaves with my good eye, I see all the shadows and details of leaves, branches, and various depths of branches and boughs deep into the tree body, so to speak..
Through my bad eye I don't see much if any of that detail. I see a tree but not the individual leaves, branches. Most of all, I don't see the various depths into the boughs, etc. It's just a tree without any fine detail. The tree also appears a few shades darker through my bad eye.
Dr. Charles didn't tell me if he saw signs of CME or DME (I'm a Type 2 with good 3x/day glucose numbers).
I wish I'd asked why Dr. Charles couldn't try ERM removal rather than go straight to ILM removal. However, the two ophthalmologists I saw this June here in CT both said the ERM was very thick and had enjoined itself to the ILM. Dr. Charles may've seen that on the OCT and felt no need to explain or expound on his opinion that ILM removal was necessary.
Sadly, I failed to press Dr. Charles for more detailed answers on certain things. A few hours before my appointment I received very bad news from home of a personal nature. And so it was that I was very distracted during my visit with Dr. Charles. My mind wasn't in the visit and I failed to thoroughly prosecute the list of 17 questions I'd written to ask him.
If I was in a doctor's office at home I'd have cancelled the visit and took care of the personal business. But I was 1,200 miles from home.
What I took away from my visit was (1) I need cataract surgery for Dr. Charles to do what he does best, and (2) cataract surgery would improve certain aspects of my right eye vision (reduction cloudiness, maybe sharper detail, etc).
After that I'll see how my vision looks (puns intended) and decide then about ILM peeling. If need be I'll make a return trip to see Dr. Charles. I know he did an ILM peel in March 2009 for JodiJ, and that in 2011 she said she was very pleased with the outcome. Her aniseikonia had reduced by 50%; something Dr. Charles told her ILM peel would accomplish (although she didn't say if he gave her a percentage figure for aniseikonia reduction).
My LE has partial PVD with no evidence of ERM (per OCT). BCVA is 20/20. If I said 20/40 I was probably thinking UCVA in LE, as it's 20/40. None of the 3 ophthalmologists I've seen in the past three months (including Dr. Charles) have noted any macula or other retina issues with the LE.
I guard my LE zealously, even wearing wrap around safety glasses when riding in the car with the windows down. I sure feel kind of dumb, like the kid who's mother made him always wear a helmet when bike riding. But I'm like a biplane flying with 1 good and 1 damaged wing instead of two good wings. I gotta protect the good wing that's keeping me up.
Should I see yet another ophthalmologist (Dr. Charles' assistant doctor who took my OCT mentioned a Dr. Packer in CT)?
Is a trip to a good cataract surgeon for a thorough evaluation in order, Dr. Hagan?
What else would prudence dictate at this point?
Thank you for the thought provoking questions. I really appreciate your insight here, and my thanks seem almost insignificant compared to the assistance you've provided in such a short time span..
Yesterday evening I read the article you referenced. I'll read it again.
Yes, I saw Dr. Charles last Wednesday (7/27). He didn't tell me what 'stage' (if that's correct terminology) the cataract was. Neither did he tell me how much of my vision reduction (a blurry, slightly hazy 20/50 in 'bad' eye) was cataract related vs. ERM related.
All he said was the cataract was too cloudy for him to see through well enough to do the ILM peel. He also said he didn't recommend doing IOL insert at same time as ERM/ILM peel. Finally, he said cataract surgery would eliminate the mild haziness I sometimes notice in my right eye. Cataract surgery would also, he said, restore some clarity of vision/sharpness of focus.
Thanks to your questions, Dr. Hagan, now that I think about it, the doctor who did the OCT 15 minutes before I saw Dr. Charles said the cataract wasn't very bad. I'm not sure how to tell a bad vs. not very bad cataract.
My vision through the cataract eye is a bit hazy but not like looking through cellophane or a smear of vaseline. It's more like looking through a very mildly - almost unnoticeably so - opaque glass. At times, though, my vision is decidedly hazy more than opaque.
This haziness/opaqueness is more prevalent when I look towards a light source, whether the sun or an overhead light. Such a view is decidedly "cloudy", like the vision you have topside after swimming under water with your eyes open.
Through the bad eye details aren't very clear. Looking at a large tree full of leaves with my good eye, I see all the shadows and details of leaves, branches, and various depths of branches and boughs deep into the tree body, so to speak..
Through my bad eye I don't see much if any of that detail. I see a tree but not the individual leaves, branches. Most of all, I don't see the various depths into the boughs, etc. It's just a tree without any fine detail. The tree also appears a few shades darker through my bad eye.
Dr. Charles didn't tell me if he saw signs of CME or DME (I'm a Type 2 with good 3x/day glucose numbers).
I wish I'd asked why Dr. Charles couldn't try ERM removal rather than go straight to ILM removal. However, the two ophthalmologists I saw this June here in CT both said the ERM was very thick and had enjoined itself to the ILM. Dr. Charles may've seen that on the OCT and felt no need to explain or expound on his opinion that ILM removal was necessary.
Sadly, I failed to press Dr. Charles for more detailed answers on certain things. A few hours before my appointment I received very bad news from home of a personal nature. And so it was that I was very distracted during my visit with Dr. Charles. My mind wasn't in the visit and I failed to thoroughly prosecute the list of 17 questions I'd written to ask him.
If I was in a doctor's office at home I'd have cancelled the visit and took care of the personal business. But I was 1,200 miles from home.
What I took away from my visit was (1) I need cataract surgery for Dr. Charles to do what he does best, and (2) cataract surgery would improve certain aspects of my right eye vision (reduction cloudiness, maybe sharper detail, etc).
After that I'll see how my vision looks (puns intended) and decide then about ILM peeling. If need be I'll make a return trip to see Dr. Charles. I know he did an ILM peel in March 2009 for JodiJ, and that in 2011 she said she was very pleased with the outcome. Her aniseikonia had reduced by 50%; something Dr. Charles told her ILM peel would accomplish (although she didn't say if he gave her a percentage figure for aniseikonia reduction).
My LE has partial PVD with no evidence of ERM (per OCT). BCVA is 20/20. If I said 20/40 I was probably thinking UCVA in LE, as it's 20/40. None of the 3 ophthalmologists I've seen in the past three months (including Dr. Charles) have noted any macula or other retina issues with the LE.
I guard my LE zealously, even wearing wrap around safety glasses when riding in the car with the windows down. I sure feel kind of dumb, like the kid who's mother made him always wear a helmet when bike riding. But I'm like a biplane flying with 1 good and 1 damaged wing instead of two good wings. I gotta protect the good wing that's keeping me up.
Should I see yet another ophthalmologist (Dr. Charles' assistant doctor who took my OCT mentioned a Dr. Packer in CT)?
Is a trip to a good cataract surgeon for a thorough evaluation in order, Dr. Hagan?
What else would prudence dictate at this point?
When an ophthalmologist looks at a cataract he/she can not tell how much it bothers a patient. A small cataract may bother a pilot a great deal while a large cataract may not bother a 90 year old person that doesn't drive or go out at night. Dr. Charles is among the absolutely best in the world. If he said your cataract was too dense for him to do the macular surgery then it likely is at least moderate in size. If you are certain he said that then you might want to see cataract surgery consultation. The part of your vision down due to cataract can be treated much easier than the macular part. Don't go for any multifocal IOL Get at least 2 opinions.
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