The Weiss ring

A few weeks ago, as I stomped through the fields during my lunch break, I found myself wondering about the etymology of the Weiss ring. Now, before I start rambling about my thoughts on this, I should probably explain what a Weiss ring is, to those readers who are fortunate enough not to know. If you fall into this category, dear Reader, I am already insanely jealous of you, I might add.

A Weiss ring is a type of floater in the eye, caused as a result of a posterior vitreous detachment (PVD). A PVD is not the same thing as a retinal detachment. You can read more about PVDs in my imaginatively titled blog post, ‘PVD: an explanation‘, but put very simply for the purposes of this post – a PVD is what happens when changes to the consistency of the vitreous fluid in the eye cause it to shrink slightly and pull away from the retina, which lines the back of the eye. This process can cause flashes, as the vitreous pulls on the light-sensitive retina, and floaters – which are essentially bits of vitreous floating about in the eye. When the vitreous pulls away from the optic nerve head, this can result in a large ring-shaped floater, known as the Weiss ring.

When I went for one of my check ups in the Vireo Retinal Emergency clinic at Moorfields last year, I was surprised when the ophthalmologist examining me told me that he could see the Weiss ring in my good eye, as I hadn’t noticed a large ring-shaped floater. Whether this is because there’s so much debris in there anyway that it all just merges into one big mess, or whether the Weiss ring has perhaps broken up a bit and so is no longer ring-shaped, I have no idea. Many people think the Weiss ring is significant in indicating that the PVD is complete, but unfortunately from what I’ve been told I don’t think it’s quite as simple as that.

Anyway… I digress. So that’s what the Weiss ring is; but the question which has been bothering me is: why is it called the Weiss ring? Now, it’s pretty clear where the ‘ring’ part comes from, as that obviously describes the shape of the floater as being round with a hole in the middle. Apparently the word ‘ring’ comes from the Old English word, ‘hring’, which is of Germanic origin. And this brings me on to the word ‘Weiss’, which has a distinctly German ring to it. So naturally, I assumed it was probably named after the German, Swiss, or Austrian doctor who first discovered it. This seemed particularly likely after I learnt that Weiss is actually a German surname. However, despite much Googling and hunting around online, I could find no evidence of an ophthalmologist named Weiss having put his or her name to this circular floater. I did, however, unearth a few cataract surgeons with the surname Weiss, and wondered how they could have been so short-sighted as to specialise in the front of the eye rather than the back, being blessed with such a name.

Then I realised that ‘weiss’ means ‘white’ in German, and I started thinking about Edelweiss, the flower. Maybe the clumpy ring of vitreous reminded an ophthalmologist of the jagged ring of white petals on an Edelweiss flower? That seems possibly a somewhat fanciful explanation though, particularly considering the visual chaos the Weiss ring and PVD in general can cause, which seems very much at odds with the beauty of the Edelweiss flower. And I wonder what colour the Weiss ring is to the eyes of the ophthalmologist when viewed through the slit lamp? I mean, I see my floaters as various shades of grey or black; but of course that’s because I’m seeing the shadows they cast on my retina. Is their local colour actually white? I have no idea.

Although I was tempted to add, ‘what’s the etymology of the Weiss ring?’ to the list of questions to ask my consultant at my latest appointment at Moorfields, there were a number of more pressing issues requiring answers, so I decided against it. But it’s still bugging me. So if there’s anyone out there who knows the answer, please share it, because… ich weiss nicht.

The Great Unlocking… and back to Moorfields

My postponed Moorfields appointment (have a read of ‘Bastard eyes‘ if you’re wondering what I’m talking about) was scheduled for 12 April – the day of The Great Unlocking in England. This date will no doubt go down in history as the golden day that people across the land shivered over their pints in chilly beer gardens, queued for hours to enter clothing stores in order to purchase apparel produced by child labour, or suddenly regained their sight by finally having their fringes chopped short once more. Meanwhile, I had to head to Moorfields with my long fringe still intact, and not much chance of a miracle of regained sight, although I do live in hope…

As my appointment anxiety ramped up on the eve of The Great Unlocking, an idea on how to reduce my stress levels suddenly occurred to me. I would pretend that I was going to the theatre the following day! I’ve missed the theatre greatly during the past year, and it’s a particularly effective method of escapism. Yes, I know that theatres aren’t actually open yet, but let’s not be pedantic. ‘But what shall you pretend you’re going to see?’, asked my internal voice, ‘Will it be a comedy… or a tragedy?’ I wrinkled my nose as I – obviously – decided that in this instance, my favourite revenge tragedy simply wouldn’t do at all. (I might save that one for when we have to go back to the office. Mustn’t forget the poisoned chalice!) ‘Oh, I think perhaps ‘Much Ado About Nothing’, or maybe ‘All’s Well That Ends Well’ would do very nicely’, I informed my internal voice firmly. And with that I went to bed, and slept the sleep of Lady MacBeth following the murder of Duncan.

As my somewhat superfluous alarm sounded the following morning and I made my way to the bathroom on weary legs, I noticed that the light appearing through the blind seemed oddly bright considering the early hour. I hoiked up the blind and pushed open the window to investigate, whereupon I gasped in dismay. Farewell, ‘Much Ado’ and ‘As You Like It’… it was more like ‘A Winter’s Tale’! Sodding snow! And falling fast were floating flakes, covering the grey road in a thin blanket of fear. I cursed loudly and alliteratively appropriately as I leapt into the shower to warm up after the icy blast from the open window.

Thankfully, my fears weren’t realised in that the trains didn’t grind to a halt as a result of the wretched white stuff. I therefore made it to Moorfields a good forty minutes before my appointment, whereupon I stood shivering as Covid-19 protocol dictates that patients must not join the queue until 15 minutes before their appointment time, to help with social distancing in the hospital.

The time dragged slowly by until eventually I was permitted to enter. I passed the Covid questions, donned a surgical mask, and descended to the clinic with a gulp. One of the receptionists had drawn a winking smiley face on the whiteboard behind the reception desk, perhaps to ease the pain of the declared waiting time for those not accustomed to it. My next smile was provided by the nurse who did my visual acuity and pressure checks – he remembered me from my previous visit to the Vitreo Retinal Emergency clinic, at which I was something of a nervous wreck. Then it was back to the waiting room, and the world seen through my good eye gradually blurred to compete with my view through the bad one, as the dilation drops took effect.

The time dragged by again, and my internal voice kept me company by reminding me of all the potentially dire pieces of news I might receive. ‘I do wish you’d shut up’, I muttered to it, as I surreptitiously scoffed a banana beneath my mask in an effort to calm my nerves. Finally, I was called through… by ‘the Prof’ himself! Although very pleased to see him, I wasn’t sure whether being ushered straight to the top man was a good sign or a bad. I concentrated on trying not to shake as I removed my specs, popped my chin on the chin rest, and opened my eyes wide.

He examined my RD eye and then switched to my good eye. ‘Oooh, that’s bright!’, I exclaimed, as it began to water slightly. ‘That’s a good sign’, he assured me, ‘It shows it’s working properly’. I don’t remember it feeling quite that bright before, but after endless nights of particularly broken sleep, perhaps I was just more tired that usual. I concentrated on keeping it wide open as he commenced the usual drill: ‘Look up… look down… look down and right… look right…’ etc, etc. He seemed to be taking a very long time in the examination of my good eye, and my internal voice seized on this: ‘He’s found a tear; he’s found a tear! There’s something horribly wrong…’, it chorused in alarm. I was becoming more and more filled with the fear of impending doom, but managed to follow his directions as well as stick to my usual policy of not interrupting whilst the examination was being carried out, no matter how terrified I felt.

Upon being released to sit back, I sat on the edge of my seat with tensed shoulders and clenched fists, bracing myself for bad news. ‘It all looks okay’, he said, whereupon my shoulders dropped in relief and a treacherous trickle of tears slipped beneath my mask. ‘Get a grip! Concentrate! Focus! ‘, commanded my internal voice, ‘You need to ask some questions!’. So I did; but so relieved was I that he hadn’t found yet another tear that I neglected to ask him properly about the membrane he proceeded to tell me about, which will apparently be okay as long as it doesn’t float into my central vision. I did manage to swiftly scan my memory and ask if he meant an epiretinal membrane. He said that yes, it would have been an epiretinal membrane, but it came away with the PVD and is now floating in my chaotic vitreous. He also commented on all the debris I now have in that eye, but noted that the only solution would be a vitrectomy, which they would advise against as it would be too high risk. This came as no surprise to me, but it was sort of comforting to hear him acknowledging all the junk I have to deal with in that eye, as sometimes I’ve berated myself for being over-dramatic about it all. So at some point, I shall have to consult Dr Google about a floating epiretinal membrane, in terms of what exactly this is and what it might mean for my vision. But I think I’ll leave that for another day when I’m feeling a bit more brave.

I followed the one-way system out of the hospital, stumbled into a taxi, and managed to find my way onto the correct train. When I arrived at my destination, I discovered that the sun was shining brightly and the snow had melted away… all but an entirely intact snowman standing proudly on the village green. I thought my eyes were playing tricks on me at first, or that perhaps I’d ended up on the set of ‘A Midsummer Night’s Dream’…

Lockdown lessons

Despite the grim picture on the continent amidst rising Covid cases (sounds scarily familiar, doesn’t it?), here in the UK we’re slowly emerging from Lockdown Number Three. Or sort of, anyway. Of course, it’s different across the UK (because naturally, why wouldn’t it be when there are political points to be scored?), but here in England, up to six people or two households are now permitted to meet together outdoors in a socially distanced manner. Hurrah! And from 12 April, or National Haircut Day as I think it should be renamed, non-essential retail should be opening once again. I’m not entirely sure how McDonalds and garden centres managed to be classified as essential, but there we go. Anyway… so as we all crawl out of the dark cavern of Lockdown Number Three, barely able to see where we’re going through our overgrown fringes and desperately trying to remember the few social skills we possessed, I thought I’d take a few minutes to consider what I’ve learnt from the experience…

1. Even introverts need a certain amount of human company.
2. On some days during lockdown, I’ve gone entire days without speaking a single word aloud; yet the incessant and frequently unhelpful babble of my internal monologue is impossible to silence at times, and drives me to distraction.
3. It has been uplifting to find unexpected sources of moral support and kindness.
4. Although being isolated in my own home for weeks on end bears some similarities to posturing after eye surgery, it’s really not the same at all.
5. Even my motivation has been considerably crushed by lockdown in conjunction with the many additional stresses of the past year.
6. Working from home has many benefits, including the glorious relief of being able to adapt the room’s lighting conditions to suit my waffy eyes, without having to worry about potentially irritating co-workers (in both senses).
7. It is possible to make it through three lockdowns whilst retaining an ignorance about what a sourdough starter is and not being entirely clear on what Netflix is; or even caring, come to that.
8. I have knitted a lot of scarves whilst listening to an endless number of podcasts during lockdown. As a large number of those podcasts have been about the pandemic, this possibly hasn’t been an ideal method of distraction.
9. Mask-wearing is problematic when it causes the microscope on the slit lamp to mist up, whilst undergoing an eye examination.
10. The sheer terror of dashing to Moorfields A&E is really not helped by the additional stress of having to do so repeatedly during a pandemic.
11. I have probably received more smiles from my neighbour’s dog during the past year than I have from all the human beings I’ve seen put together.
12. Dogs have no idea about social distancing.
13. Some people STILL have no idea about social distancing.
14. I would quite happily continue to socially distance from some people for the rest of my days.
15. Although there are many people whom I’ve missed spending time with during the past year, it has been absolutely brilliant to have a watertight excuse for not seeing certain people. If anyone can think of a similarly effective excuse to use once lockdown lifts completely, please let me know…
16. I’m not anti-social, I’m selectively-social.