… when one of my work colleagues rang me on a Monday evening a couple of weeks ago to ask my opinion about odd things going on in her eye, I thought I knew what the problem was. She told me that she’d just got back from dog-walking the previous day when she saw white flashes down the left side of one eye. She’d also seen two big floaters, squiggly lines, and tiny dots.
I began to feel slightly sick as she described all this and quickly asked her whether she’d noticed any loss of vision or a ‘curtain’ coming across. “No, I don’t think so”, she said, before asking what I meant by a curtain. “It’s literally like a black curtain being drawn across the inside of your eye which you can’t see through; or like a shadow obstructing your vision”, I explained. She was reassuringly certain that she couldn’t see anything like this and then went on to tell me that she’d been to the doctor’s about it late the previous afternoon. “What did the doctor say?”, I asked, knowing very well that what he should have said was get to an eye clinic at a hospital or to an optician’s PDQ to get it checked out. But no. Apparently he just had a look in her eyes, commented that the blood vessels looked healthy and suggested that she pop to the opticians, with no sense of urgency whatsoever, although he did casually mention that it could be a retinal detachment. “Whaaaaat?!”, I spluttered in response. “Well, it’s no good just looking at the front of your eye – he needs to look at the back of it, and he can’t do that without dilating the pupil and carrying out a proper examination with the correct equipment!” As far as I know, GPs don’t have the expertise to do any of this, which is why he should have referred her urgently. You shouldn’t muck about with symptoms of retinal detachment, as I know very well! Oh, and he also took her blood pressure, which is unrelated to eye pressure and has absolutely no bearing on a suspected retinal detachment. Genius…
“Do you think it’s a retinal detachment, then?”, she asked me. “Well, it sounds like PVD to me”, I answered cautiously, to which she enquired nervously, “What’s PVD?” I explained that PVD means posterior vitreous detachment and isn’t the same thing as retinal detachment. PVD occurs when changes to the vitreous fluid in the eye mean that it shrinks and pulls away from the retina at the back of the eye. These changes happen as part of the natural ageing process but sometimes if the vitreous starts to pull away from the retina, it can cause flashes and floaters as it does so. As it pulls away, it can also occasionally result in a retinal tear, which can then lead to a retinal detachment. As any regular readers of my blog should know by now, retinal detachment is a medical emergency which requires surgery to fix. Unfortunately, as well as being symptoms of PVD, flashes and floaters are also symptoms of a retinal tear or detachment.
“So what do you think I should do?”, she asked, “Shall I come to work tomorrow and try and get an appointment with the optician?” “NOOO!”, I almost shrieked in alarm. “Definitely don’t come to work – you need to get it checked out first!” Realising that I may have been worrying her further, I tried to stay calm and advised her to get to an optician’s first thing in the morning, and if they wouldn’t look at it then to go straight to the closest decent hospital eye clinic. “They’ll need to dilate your pupil to have a proper look at the back of your eye. Don’t let them fob you off by saying they don’t need to dilate!”, I instructed her urgently, all too aware that a certain optician in Canterbury had tried to tell me that he could see enough of my retina without dilating my eyes. “How will they dilate my eyes?”, she asked, to which I replied breezily, “Oh, don’t worry – they’ll just put drops in.” “Oh no!”, she gasped, explaining that she wasn’t very good at having anything near her eyes. I paused, reflecting that this probably wasn’t the time to tell her that the drops sting quite a lot. After promising to let me know how she got on, we hung up and I went off to bed wondering if I should have explained about what to do in terms of head positioning in case she did start to see a shadow…
Worry made the next morning drag, but eventually I received a text: “Eyes dilated. She says it has done what it needs to do and should no longer be a problem but to be aware of any changes and if so go to hospital. Your diagnosis is correct.” Phew – it wasn’t a detachment! The optician referred her to the hospital eye clinic for an appointment the following week, at which they dilated and checked both eyes and issued the same advice about returning if she noticed any changes.
I was hugely relieved that everything was okay, as with those symptoms it could very well have been a tear or the start of a detachment. So, please be aware and spread the word that flashes or new floaters should be checked out urgently with an optician or hospital eye clinic. Any loss of vision, blurring, a shadow, or a black/grey ‘curtain’ should be checked out immediately at a hospital eye clinic. It’s worth bearing in mind that not all hospitals have eye clinics and opening hours vary so check before potentially wasting previous time on travel.
Note: You can find further information about PVD here: http://www.rnib.org.uk/eye-health/your-guide-posterior-vitreous-detachment-pvd/posterior-vitreous-detachment-PVD