Surgery help Macular pucker with moderate to severe distortion for 18 months?

[GrandKK]

Acuity is 20/40 and mostly stable, but distortion is preventing my eyes from working well together. I'm getting some double vision. Wondering if surgery at this point will help distortion?

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

Only an exam by a qualified retina surgeon could tell but I doubt any reputable specialist is going to do a relatively high risk procedure on a stable 20/40 eye.

[GrandKK]

Thank you Dr. Hagan for your response. Two retinal surgeons have told me the decision for surgery is up to me. Hard decision. I should clarify that while acuity is stable, the membrane is getting thicker. It's progressed from 466 to 535 in the last 18 months. Do you feel that would be a reason to proceed with surgery?

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

If the membrane is getting thicker, more distorted and vision is falling and/or you are having a hard time functioning with your vision then surgery by a highly skilled and experienced retina surgeon would be acceptable if you clearly understand the risks and that a cataract will develop.

[MrPresley]

Speaking as a patient and not as an MD ophthalmologist, I would probably have ERM surgery in your situation based on the double vision you report. As Dr. Hagan replied however be aware of the risks, assume that a cataract will develop requiring another surgery 1-2 (estimated) afterward, and only proceed based on the advice from a qualified retinal specialist. I had both surgeries performed on my left eye and would have again if symptoms in my right eye progressed to the point where one or both surgeries were warranted.  

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

As always Mr. P thanks for your comments. Offers a perspective that physicians can't.  i.e. the other side of the knife.

[GrandKK]

Thank you both for your input. It is a difficult decision. At this point vision distortion is annoying but functional.    
Who knows if it will get worse and I'm concerned about waiting too long to the point where surgery wouldn't help.

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

Your concerns and frustrations are intrinsic in this type of problem.  these cases are all different and its not possible to generalize. Your retina surgeon is the best source of information. you can also get a 2nd opinion if that would be helpful.

[GrandKK]

Do you have any thoughts on using ICg dye to peel the ILM? I know my surgeon, as well as where I got my second opinion both use a diluted version. Dr. Charles in TN still does not use it, but I feel many if not most do. It seems as though they should have come to some type of consensus by now.

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

Even among surgeons that use ICGreen dye they don't necessarily use it every case.  Pick your surgeon then let her/him use the instruments/technique that works best for them in a case like yours.

[GrandKK]

Thanks, good advice.

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

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[DesperateRetina]

I am in a similar situation and share your frustration.

If your surgeon does not wish to do surgery on your eye - you may be best looking for a more experienced/skilled/confident surgeon.  If your surgeon accepts Medicare, you can query the ProPublica website that shows each MD, the procedure codes they have billed to Medicare, and the number of times they have coded each procedure to Medicare.  Comparing the number of times different surgeons have performed a given procedure can give you an idea about their level of 'practice.'  Please keep in mind that the ProPublica website shows only the Medicare claims ...which may represent 75% or more of the instances for some or many of the retinal surgery procedures.

In my experience, finding highly skilled retinal surgeons that are covered by insurance is extremely difficult if you do not live in a large metro area which I do not.  Moreover, I have found it extremely challenging to get a sincere and thoughtful recommendation on who to turn to for a 2nd opinion - asking an Ophthalmologist who they would recommend for their surgeon friends has not seemed to help.

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

One of the most important things an excellent, experienced surgeon does it to know when it is best NOT to do surgery.  We have several surgeons in KC that will operate on anything that walks into the door. But the # they do does not indicate skill or judgment or honesty.

[DesperateRetina]

Dr. Hagan, this also is an excellent point.  How do we get good referrals for 2nd opinions then?

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

Make sure they are Board Certified, belong to the American Academy of Ophthalmology and American College of Surgeons. If they have academic appointments and/or affiliated with medical school so much the better. Be sure they have completed a fellowship in what your problem is (retina/vitreous)  check to see if they do clinical research and/or teach/lecture at local and national meetings.   Ask comprehensive ophthalmologists who they use for speciality referral (don't ask optometrists because many have fee splitting (co -management) arrangements with surgeons.