The persistent presence of pernicious Mr Pip

Mr Pip is on the prowl again.  While most of us are bemoaning the end of summer after reluctantly switching the heating on and setting the clocks back, Mr Pip looks on gloatingly as he points a skinny well-manicured finger and curls his thin lips in a satisfied smirk.  He seems to enjoy these dark, damp, chilly mornings, and takes delight in taunting me through the thick duvet just after the alarm clock has announced that it’s time to move, informing me gleefully: “It’s cold, and dark, and miserable outside.”  When I fling back the duvet in his face and pad, shivering, across the room to peep through the curtains, I see that he’s quite right.  It is cold and dark, and it makes me feel miserable.  I suspect that Mr Pip crosses the paths of a fair few people at this time of year, so you may well be familiar with him already.  If not, you might like to read ‘The unwelcome visitations of Mr Pip‘, which provides a full description of this most unpleasant fellow.  I’d strongly advise you to cross the street and avoid him if you spy him approaching.

Mr Pip is irritatingly omniscient, so as well as being aware of my dislike of the short, cold days and the challenge of driving in the dark at this time of year, he also knows fully well that appeals season – my favourite time at work – is now over and I’m suffering with a bad case of Appeals Withdrawal Syndrome.  Symptoms of this include: a reluctance to go to work, more frequent purchase of lottery tickets, increased frustration when the lottery people don’t select the correct numbers (i.e. mine), excessive yawning, and an almost overwhelming desire to hurl a stapler at my office buddy when she persists in talking to herself all day when I’m trying to concentrate.

Naturally, Mr Pip is also aware of the fact that I have a check-up appointment at Moorfields the week after next.  “They might find something wrong and want to operate again”, he constantly whispers into my ear, spitting slightly as he does so.  “Maybe they’ll whip you straight into surgery again”, he continues gleefully, “Or perhaps they’ll tell you that they need to remove your eye altogether!”  He claps his hands in delight and prods my forehead with his skinny fingers until he sees me reaching for the paracetamol, whereupon he announces, “A-ha!  A headache!  It must be your eye pressure increasing!  That’ll mean they’ll want to take your oil out.  They’ll take it out; they’ll take it out; they’ll take it out and throw it away, and then your retina will detach again!”, he sings, mockingly.  He dances around me, tapping his shiny black shoes on the floor in an irritating rhythm which causes an answering drum to beat loudly in my head.  Each time I summon up the energy to try and swipe him away, he simply dodges and laughs again as if he’s having the time of his life.

Sometimes it’s not even possible to escape Mr Pip when I go to sleep.  I’m convinced that he has the ability to shrink himself down until he’s the size of a Borrower, whereupon he creeps through my ear and into my brain where he settles down and narrates bedtime stories to me from inside my head.  Stories about being late to hospital appointments; stories about writing down the wrong information from the consultant in my little eye book; stories about being trapped in some kind of dark underground world filled with dangers;  being chased; unable to see some horrendous threatening presence looming, coming closer and closer, faster and faster, until it’s right THERE!  And then I wake with a huge jump, heart pounding, and raise my head to stare at the dim rectangle of light coming in through the curtains as I open first one eye and then the other to check that I can still see.

As is usually the case, there’s no point in applying logic to the problem of Mr Pip or attempting to argue with him.  Pleasant distraction seems to be the only thing that really works in banishing him for a while.  Fortunately, I’m reading rather a good book at the moment and retreating into a fictional world is always an effective method of escapism.  There are also cakes which need baking, in preparation for an imminent fundraising event for Moorfields Eye Charity and Marie Curie.  Despite Mr Pip’s constant whining voice telling me that it’s cold and damp and grey outside, at weekends I layer up and go out for walks, defiantly pointing out to him that the air is still fresh, there’s much beauty to be found in nature, and it’s good to make the most of these short hours of daylight.  This causes Mr Pip to sulk, and he hunches his skinny shoulders and scuffs his shiny shoes along the ground as he drags himself away like a moody teenager.  Perhaps I should treat him as such and, next time he starts whining in my ear, tell him in that particular parental tone favoured by parents who also happen to be teachers, “If you don’t have anything nice to say, then don’t say anything at all.”  Yeah, pipsqueak!

 

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Don’t pretend to be a stupid person!

If you read my last blog post, ‘Hunt the optometrist: round 4‘, you’ll know that I went for my ‘normal’ eye test a couple of weeks ago.  I use the word ‘normal’ loosely, as sadly my pesky peepers will never again fit into that longed-for category.  So fearful was I that the optometrist might find something wrong that I booked the very first eye test appointment of the day, just to ensure that I had time to hot-foot it up to Moorfields on the train if necessary.  But I digress…

The reason I’m writing today’s blog post is not to talk about my own eye test, but yours, dear reader.  Yes… yours!  When did you last have an eye test?  Normally (there’s that word again), people are advised to have one every two years.  That includes children, in case you’re wondering.  In fact, it’s particularly important for children to get their eyes tested regularly, as they may not be aware of what ‘normal’ (aaarrggh!) vision should look like, and any visual problems are likely to affect their educational development.  It can be tricky keeping up at school with waffy vision.  A standard eye test will take approximately 30 minutes every couple of years – that’s really not much of a commitment to make in order to look after your vision, is it?  If you’re in the UK, you can even find vouchers for free eye tests – just Google ‘free eye test vouchers’.

Since my eye problems began, I’ve been keen to nag harass threaten encourage people to realise the importance of taking care of their eyes by going for regular eye tests.  Of course, the main reason for my concern is that if more people do this, any problems are likely to be picked up far more quickly and hence there won’t be even more people clogging up the already packed hospital eye clinics.  This will be a huge plus for myself and my long-suffering eye buddies.  But apart from that, here are a few more reasons why regular eye tests are so important:

  • Some eye conditions don’t have any obvious symptoms and can progress very gradually – for example glaucoma, macular degeneration, and cataracts.  An eye test can pick up early signs of sight-threatening conditions such as these, so that they can be treated swiftly, allowing a better chance of a successful resolution.
  • Other health conditions – for example diabetes – can be detected as a result of an eye test.  Again, once diagnosed, people can get treatment more quickly.
  • Often people don’t realise that they need glasses or contact lenses because changes in eyesight can occur very gradually and people just assume that as they get older their eyesight will get worse.  By having an eye test and sorting out any problems, people can improve their vision and therefore their quality of life.  Why peer and squint if you don’t have to?!
  • With the above in mind, it’s particularly important for people who drive to get their eyesight checked regularly, to ensure that they meet the requirements for driving.
  • Eyes are the second most complex organ in the human body, after the brain, and you only get one pair.  Treat them with respect.
  • Finally, a frightening statistic from the International Agency for the Prevention of Blindness: 80% of blind people in the world are avoidably so.  Don’t find yourself contributing towards that statistic!

Faced with all that, why on earth do people not just ruddy well go and get their eyes tested regularly?  I’m not entirely sure, but I think the main reasons are: misplaced confidence (i.e. “My eyesight is great; I don’t need an eye test!”); fear of having to wear glasses as it’s often associated with getting older; or just plain laziness.  Regarding the first reason – if that’s the case, then go and get it checked and then you can gloat freely about having perfect eyesight.  Concerning the second reason – your vision is far more important than your vanity: get a grip.  As for the third reason – pffft, I have no time for laziness!

It frustrates me when people appear to be so blase about their sight, and when family or friends treat their eyes so casually I actually find myself getting genuinely upset about it.  It’s a tricky one, because of course I don’t want to hassle people, and there’s only so much I can do on the encouragement front.  I thought I’d cracked it with a certain person a few weeks ago by casually presenting her with a voucher for a free eye test, which I’d been given.  This is someone who confessed to me some time ago that she hadn’t had an eye test since she was a child and when faced with my dropped jaw, she’d insisted that her sight was excellent and therefore she didn’t need a test.  I was even more dismayed the other day when I mentioned the voucher and she replied that she might not use it after all!  Horses and water sprang to mind and it was clear that there wasn’t much point in reitterating all the benefits of having regular eye tests.  Instead, I stifled a frustrated groan, sighed a huge internal sigh of disappointment, and pointed out only half-jokily, “But you’re an intelligent person!  Don’t pretend to be a stupid person – get an eye test!”  I’m not sure whether she will, but I did ask her to pass the voucher on to someone else if she doesn’t intend using it herself.

I shall end this post with a plea directly to you, dear reader.  Yes… YOU!  Now, clearly you’re pretty intelligent, wouldn’t you agree?  Have you had an eye test in the past couple of years?  If not, please go and get it sorted.  Don’t pretend to be a stupid person.

Hunt the optometrist: round 4

As the day of my annual ‘normal’ eye examination loomed, I decided to continue my quest to find a decent optometrist in Canterbury.  Now, before going any further here, let me explain that I’m talking about what most people refer to as an optician, for a standard eye test.  However, if we want to be accurate about things (and, trust me, I usually do), an optician is actually the person who makes and fits glasses and contact lenses.  An optometrist carries out eye tests, prescribes corrective lenses, and is qualified to diagnose certain eye abnormalities and diseases and prescribe medication for them or refer for further treatment.  An ophthalmologist is a medical doctor who specialises in eyes and is qualified to practice medicine and surgery.

After my first retinal detachment, I stopped going to the high street optometrists I’d been visiting for years, because I realised that they hadn’t given me the correct information about floaters.  (See ‘How it all began‘ if you’re wondering what they told me and why it was wrong.)  If they’d given me the correct advice, it’s possible that things may have been very different for me.  I then began using another popular high street optometrist, until I was informed one day upon going in for a quick eye pressure check, as I’d been doing sporadically for the past year or so, that they could no longer do this.  In my attempts to discover the reason for their abrupt policy change, I became involved in several heated discussions in which they told me that a) the hospital should be doing the pressure checks and was just ‘fobbing off’ their work; and b) as my eyes had so many problems, I might sue them if they got the pressure readings wrong.  Needless to say, my blood was boiling by this point and I vowed never to darken their door again.  In contrast to their customary advertising campaign, I think this behaviour demonstrates precisely why people shouldn’t go to this particular optometrists.

On my next visit to an optometrist, I plumped for an independent one (as detailed in ‘Post appointment panic‘).  Apart from the fact that he reminded me of John Major and had a sense of humour (or lack, thereof) to match, this grey-faced chap put me off by trying to tell me that it was possible to see enough of the retina to check it properly without using dilation drops.  I know that this simply isn’t true – not when checking for tears, anyway.

So it was after extensive research that I set off early on Saturday morning to another carefully selected independent optometrist, to put them through their paces for my eye test.  It started well, as I was greeted by a smiling receptionist and then a polite fellow who bore no resemblance to any politician I can think of.  He began the appointment by asking cheerfully, “So, is everything okay with your eyes then?”  I shifted uncomfortably in the chair as I responded almost guiltily, “Err… no, not exactly.  I’ve had multiple retinal detachments in my right eye, and I’ve got PVR.  I’ve got silicone oil in there at the moment.”  He looked slightly taken aback at this, and went on to ask about my left eye.  “It had two retinal tears which were fixed with cryotherapy and I have a cataract and lots of floaters”, I told him.  He shook his head in sympathy and told me how unlucky I was to have so many problems in both eyes, before asking with a slightly incredulous undertone, “Is there anything else?”  I completely forgot to tell him about the lattice degeneration, although that came up later, and the abnormal blood vessels, and just replied that I hoped that was enough for now, at which he nodded in agreement.

He carried on with the usual business of the eye test, and when we reached the pressure check, we had an interesting discussion about high pressure.  Much to my delight, he told me that he’d be happy to check my eye pressure if necessary, between my appointments at Moorfields.  He even told me that he’d be happy to dilate my eyes and check for tears if I wanted him to, at which point I almost toppled off the chair in shock.  Previous optometrists have been all but backing away from me by this point!  This one told me that he loves dilating because it allows the opportunity to get a proper look at the back of the eye, which he finds really interesting!  He did, however, also say that it was only necessary for him to dilate if there were symptoms suggestive of a retinal tear or detachment: i.e. showers of floaters, flashing lights, or the much-feared ‘curtain’.

He went on to do a spot of digital retinal photography and was happy to show me the images and explain various things.  It was somewhat depressing to see the image of my right retina, which bore certain similarities to a teenager’s bedroom,  but at least the left one looked far more clean and tidy.  He also checked for dry eye.  As he asked me to look up while he put the drops in, I asked what they would do.  “They’ll make all your problems disappear”, he joked, with an air of mystery.  I imagined my future – bright and colourful, with 6/6 vision and no more worries – and told him that he’d be my hero forever if the drops did that.  He clearly decided that his pants wouldn’t look very professional worn over his trousers, as when I’d blinked the drops away, my view of the world was just the same.  Or, almost the same… for I finally seemed to have found a decent local optometrist.  Perhaps he’ll work on those magic drops ready for my next visit…

I’m not an ophthalmologist, but…

… 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

Tooth hurty!

One of my friends has an extensive repertoire of eye-rollingly bad jokes – most of them obtained from ‘The Ha Ha Bonk Book’.  That’s a children’s joke book, in case you’re wondering.  Whenever she receives the reply, “Two thirty” to her casual enquiry, “What’s the time?”, she’ll take delight in responding, “You’d better go to the dentist’s then!”.

And that is exactly what I did a couple of weeks ago, after waking up at 3am with stonking toothache, radiating from the area of a wisdom tooth which periodically flares up a bit.  This time, however, it was more than just a bit as it kept me awake for the rest of the night.  When I arose with the dawn I stomped to the bathroom and peered, blearily-eyed, into the mirror with my mouth opened wide, using a torch to illuminate the angry red mass adjacent to my tonsils.  After a few minutes of angling, peering, and yelping, I decided it would be prudent to stop in case I managed to smash the mirror with the end of the rather long torch and so sentence myself to seven years of bad luck.  I breakfasted on lukewarm tea, slurped through the opposite side of my mouth from the offending tooth, tiny bites of soft banana, and a couple of ibuprofen, and then headed off to the dentist’s.  I felt particularly disgruntled by this turn of events as it was the last day of my week of annual leave (which I’d hoped would work miracles on the relaxation front, leading to a renewed and revitalised me), and my birthday was in two days time.  No sweet treats or birthday cake for me, then… 😦

I reluctantly lay back in the dentist’s chair, fearing for my oil-filled RD eye as well as my aching wisdom tooth as I obeyed the dreaded instruction to “open wide” with an internal sigh whilst gripping the edge of the chair.  “Oh dear, yes, I can see exactly what the problem is!”, exclaimed the dentist, which did nothing to calm my frayed nerves as I proceeded to visualise my tooth hanging by a bloody thread with a puscular mass of green gunk welling up from deep inside the gum.  Fortunately, it wasn’t actually that bad: I just had a severely inflammed gum.  “It often happens when you get a bit of food stuck and if you’re a bit low and tired it can cause everything to flare up”, the dentist explained, leading me to wail, “But I’ve only just had a holiday!”.  He was all set to prescribe antibiotics as a precaution in case it got worse over the weekend, but then retreated to ‘The Drugs Bible’ when I told him that I’d had multiple retinal detachments and would need to be sure they were safe for me to take.  I was vaguely aware of recent research which had found a link between certain antibiotics and RD, and so I wasn’t prepared to take any chances.  After deliberating, he decided he didn’t want to give me antibiotics until I’d checked with Moorfields as to which ones would be okay.  When he noted that it would be good to get an updated medical history from me for the records I reacted with surprise, explaining that I’d done that at my annual check-up appointment just a couple of months previously.  “Oh!”, he said, in equal surprise, peering at the computer screen.  “All it says here is, ‘seeing doctor about her eyes'”.  Genius.

Instead of antibiotics, he gave the offending tooth a good clean-out (ouch) and advised continuing with ibuprofen and salt water mouthwashes.  When I got home, I rang the Moorfields advice line about the antibiotics query, whereupon I was put through to their pharmacy.  First, I was told that I’d need to check with my consultant; then I was told that the Canadian study which found a link between certain antibiotics and RD was flawed; and finally I was told that the antibiotics the dentist had suggested would be fine and the important thing was to take whatever was the best for my tooth.  All of this advice was given by the same person and did nothing to ease my niggling doubts on the issue.  I’ll be seeing my consultant in November and so will ask about antibiotics then, but unless I definitely need to take them, I don’t  really want to bother him in the meantime.  I’m pretty sure that the Canadian study led to warnings being included on the boxes of certain antibiotics, which suggests that there is a cause for concern regarding these specific ones.  And as for taking whatever was the best thing for the tooth… surely the whole picture needs to be considered?!  I mean, a decent medical professional wouldn’t just hand out aspirin to treat the heart condition of a haemophiliac, would they?  Okay, I admit that I know next to nothing about haemophilia or heart conditions, but you take my point.

Anyway… fortunately, after dosing up on ibuprofen and swilling my mouth out with the contents of the North Sea, the toothache gradually retreated and the gum seems to have returned to its normal size.  I’m still treating it cautiously and am hoping that it won’t flare up again… or at least not until after my next Moorfields appointment in November anyway.

Note:  The group of antibiotics which have been linked to RD are Fluoroquinolones.

Note 2:  ‘The Ha Ha Bonk Book’ is by Janet and Allan Ahlberg, and comes highly recommended by my hilarious friend.  If anyone can explain the joke concerning Tarzan, Jane, and colour-blindness on page 16, please do let me know.  This has been something which has puzzled my friend since the tender age of 7 and she’s now reached the ripe old age of 40 but so far, nobody has been able to explain it.

Eye-opening facts about our peepers

I’ve learnt a heck of a lot about eyes in the past three years.  The only problem is, as with many things, the more I learn the more I realise there is to learn.  But anyway, I thought it would be fun to compile a little list of some of the more fascinating facts about our eyes…

  • Only one sixth of the human eyeball is exposed.
  • The human eye weighs approximately just under an ounce (28 grams).
  • Our eyes are composed of more than two million working parts.
  • Eyes are the second most complex organ in the human body, after the brain.
  • Our eyes actually project an image onto our retina which is upside down and inverted, and our brain then flips the image.  George Stratton, an American psychologist, conducted an experiment whereby he wore an adapted lens which meant that everything he saw appeared to be inverted and upside down.  After a few days, his brain adapted and he began to see things the right way up once more.
  • The active ingredient of dilation drops is atropine, derived from Deadly Nightshade.  I told my sister this just before one of my eye appointments, and she looked at me with such horror that I felt it necessary to check with the consultant that it’s okay to keep having my eyes dilated.  Fortunately, he said it’s fine…
  • Approximately 50% of the brain is used for seeing and vision.
  • 80% of our memories are determined by what we see.
  • According to research by RNIB, 44% of UK adults said they feared losing their sight more than any long-term health condition, including Alzheimer’s, Parkinson’s, heart disease, and having to use a wheelchair.
  • People generally read text on screen 25 times more slowly than on paper.
  • On average, we blink around 28,000 times per day, and 15-20 times per minute, unless staring at a computer screen, in which case we don’t blink enough.  Now you’re making a conscious effort to blink more as you read this, aren’t you?  🙂
  • 20/20 (or 6/6) vision isn’t ‘perfect vision’ as is often assumed – it’s just normal vision.  However, in my book, there isn’t anything ‘just’ about normal vision…
  • People who were born with sight but later went blind can still see in their dreams, whereas people who were born blind don’t see images in their dreams.  (I feel I need to check this with someone who’s been blind from birth…)
  • Forget 50 shades… the human eye can distinguish 500 shades of grey.
  • Mascacra wands cause the most cosmetics-related eye injuries.  (Maybe that’s why I cringe whenever I see someone applying eye makeup.)
  • One eyelash has an approximate lifespan of five months.
  • The word ‘pupil’ is derived from the Latin ‘pupillus/pupilla’, meaning a little child or doll, as a description of the tiny reflection of your own image which you see when looking into someone’s eye.
  • Don’t share the above facts with someone who suffers from ommatophobia (fear of eyes).  I haven’t yet found a word which means ‘fear of retinal detachment’, but I know a lot of people who have this, so perhaps we should invent one?  Suggestions via the comments below, please!  😉

The curse of PVR

“PVR is from the devil!”, one of my eye buddies frequently declares with feeling, whenever the subject is broached.  She should know.  Her eight-year-old son has had five retinal detachments in his left eye and undergone over thirteen surgeries as a result of PVR.  Currently, he’s lost almost all vision in his eye and is only able to see some motion and colours.  PVR is the cause of my five re-detachments following the initial surgery to fix my first detachment back in April 2014.  PVR is a curse, and those three little letters strike fear into the heart of any RD patient, for we know the devastation and utter misery that it can cause.

“So what exactly is PVR?”, I hear you ask.  When a friend asked me this question recently, I simply answered, “Oh, it’s the thing that keeps making my retina detach – it’s like bad scar tissue, which keeps pulling the retina off again”.  That seems the simplest and quickest way of explaining it to someone who knows little about eye issues, but even the reference to scar tissue can be a bit confusing.  You see, there’s the ‘scar reaction’ which occurs after laser or cryotherapy, which basically welds the retina back together.  I think of this as ‘good scar tissue’.  In contrast, I think of PVR as ‘bad scar tissue’.  I did once have a conversation along these lines with a retinal surgeon, and he agreed, “Yes, I see what you mean”, when I explained my confusion about the difference between the scar reaction of the laser and the scar tissue of PVR.

Okay, so let’s get down to the complicated bit… PVR (or proliferative vitreoretinopathy) is a disease which is a major complication that can occur following retinal reattachment surgery.  It occurs in 5-10% of all rhegmatogenous retinal detachments (retinal detachment as a result of a tear in the retina).  Although PVR can be treated with surgery and reattachment of the retina can be achieved, the visual outcome is often extremely poor and PVR is the main cause of failure of retinal reattachment surgery.

Retinal detachment happens when a hole or tear in the retina results in vitreous fluid seeping through the hole and getting underneath the retina, pulling it away from its place at the back of the eye.  Imagine the retina as being like a wallpaper, lining most of the inside of your eye, apart from a small section at the front.  Now think about when you strip wallpaper off a wall, and how you use an instrument to create a tear in the paper and water to soak through and lift the paper off the wall.  If you think of the wallpaper as your retina and the water as the vitreous fluid inside your eye, that’s sort of what’s happening when a detachment occurs.  Of course, technically the room would be filled with water, but that’s just weird.  ANYWAY… during the process of retinal detachment, the vitreous fluid comes into contact with RPE cells (retinal pigment epithelium) just below the retina.  (In our wallpaper-stripping example, I guess this would be the brickwork, or maybe the mortar.)  As a result of the retinal tear, the RPE cells are able to migrate out into the vitreous.  The cells then proliferate and form fibrotic membranes (or scar tissue), which can then contract and pull at the retina, causing it to re-detach.

To complicate matters further, there are different types of membranes which can form, depending on which side of the retinal layers the cells settle in and which other cells are involved.  One type forms like a sheet and doesn’t necessarily affect retinal reattachment surgery; the other forms as thick membranes which cause traction, thereby pulling at the retina.  These need to be removed before the retina can be reattached.  Naturally, these are the ones which I have.  [Pauses to wail in loud misery.]  Since reading up on all this, I now understand why I’ve had three retinectomies.  A retinectomy is the procedure whereby the surgeon physically cuts away the part of the retina which won’t lie flat due to PVR.  Nothing has ever caused me to assume such a death-like pose as the moment I heard the surgeon utter the words, “Can I have the cutter, please?”, during my fourth surgery under local anaesthetic.

So why do only 5-10% of RD patients get struck down by the curse of PVR?  Although it really does often feel like some kind of terrible punishment for some unknown dreadful crime I’ve committed, I’m assured that this isn’t the case.  From what I’ve read, it seems that PVR is more likely to occur alongside any of the following circumstances: a large retinal hole or tear, a macula-off detachment, vitreous haemorrhage, aphakia (no natural lens in the eye), a long period of time between detachment and surgery, multiple surgeries, and poor surgery itself.  My initial detachment was macula-off and I waited two days for surgery, but it’s pretty normal to have a wait once the macula has detached as a delay of up to a week doesn’t affect the final visual outcome.  My current consultant (who just happens to specialise in PVR) explained to me that once someone has PVR they will always have it.  From what I can gather, the effects of PVR – particularly in the more severe cases, which mine is – can clearly be seen on the retina, but even if the surgeons are able to remove the worst of it and reattach the retina, there will still be cells floating around in places that they shouldn’t be within the eye.  A further huge problem is that PVR is a process, and inflammation can aggravate that process.  So every surgery unavoidably causes inflammation within the eye, which then risks activating the PVR once more.  It really is a vicious circle.  PVR is the enemy of the RD patient, and it needs to be beaten.  Just as Jules Gonin made a massive breakthrough in RD surgery by discovering the importance of locating the retinal tear (have a read of my earlier post, Hurrah for Jules Gonin if you’re wondering what I’m talking about here), now we need a modern day Jules to crash through the PVR barrier and bring hope to those of us who live with its curse.

Note: Please note that I am not an ophthalmologist or an expert in PVR; I have written this simply as a frightened patient afflicted with PVR.  For anyone interested in doing some further reading on the subject, you can find a selection of some of the articles which I’ve found helpful below.  If any of my eye buddies have any interesting/useful information to add, it would be great if you could share it by including it as a comment below.  🙂