back from retinal specialist- lamellar hole and other stuf

[promethiusII]

I have a partial thickness macular hole with splitting of the retina (about midway between inner and outer retinal layers) and widespread epiretinal membrane. I do not have PVD or myopia and am 49yrs. Visual acuity is 20/30 +2 correctable to better but 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.

In particular, 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% mark 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. 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). Excuse the ignorance, but i don't know what involutional thinning is. If it's not involutional foveal thinning, then what could  that thinning on OCT refer to? of course i will eventually ask the retinal specialist all of this, but would like input on it from you folks too. (andc an there be different interpretations of the meaning of a thin yellow top layer on OCT?)

of course any comments about the currently affected left eye are welcome. i understand why waiting is advised, but i also will never get back the vision i have now if the hole reaches the photoreceptors or does further macular damage. Is one month (rather than two) enough time to assess any meaningful changes on OCT? thanks folks!

[Houman Vosoghi, MD]

It could be.  Your retina specialist should run the appropriate tests to determine which risk factors you may have for a macular hole.  I still don't think you should worry about it as there would be nothing you could do to prevent the macular hole regardless of risk.  I do understand the need to know though.  I'm not sure if "involutional thining" is a diagnosis per se but more of a description by some specialists.  You may want to look up the following article:

Ophthalmology. 1986 Feb;93(2):153-61.

Involutional macular thinning. A pre-macular hole condition.
Morgan CM, Schatz H.

[Houman Vosoghi, MD]

A high resolution OCT (seeems like it was already done) would be the best test to look for evidence of vitreous traction at the macula.  Also, a careful 78 diopter dilated exam at the slit lamp in experienced hands can look for the posterior vitreous face to see if it is still attached at the macula.  If it is detached already, the risk is significantly less of progression to macular hole.

HV

[promethiusII]

thanks much . that is helpful. I will read the article. if you could please indulge a followup question since this type of info we're talking about now is very helpful and exactly what i need. could you please elaborate on which other tests are useful to determining risk in the fellow eye? and any other refs on that topic appreciated ( I don't have the high myopia risk factor; i have done a pubmed search but am not turning up enuf info.; incidentally, "worry" is simply not a relevent issue to a medical discussion; and there are studies showing that people who want to know are helped by knowng and people who don't want to know are helped by not knowing). thanks again for your help

[promethiusII]

Regardless of whether I can do anything or not, I  still want to know. So you didn't answer the question: is the thinness the same thing as involutional foveal thinning or not?

[Houman Vosoghi, MD]

I think you are getting too caught up on the numbers.  Even if thinning was a risk factor, there is nothing you could do to prevent the same thing from happening in the other eye.  Just monitoring and treating if it happens.  My rule of thumb for choosing surgery is vision worse than 20/40 or metamorphopsia that gets in the way of normal activities of daily living.  Each person is different though so you have to follow your retina specialist's advice (as long as you trust them).  Stop worrying about what may happen, it is not constructive.

HV