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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience:  Eye Physician and Surgeon
20222826
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Im a 61 years old, female. In mid-April this year, I went

Customer Question

I'm a 61 years old, female. In mid-April this year, I went through a

vitreous speration in my right eye, suffered a retinal tear and hole that

were fixed by laser surgery. During this incident, they found a small

druse. They didn't say this could be a sign of AMD. They only said that

it was not good but not to worry for now, just keep blood sugar under

control (I'm Type 2 with a 5.7 A1C). I had a follow-up one month later.

At that point, the acuity of my right eye was 20/25 (before surgery was

20/20).

For six months, thing seemed to be back to normal except for some

sensitivity in the eye. Last Thursday I had my annual eye exam with my

regular optometrist. The acuity was back to 20/20, which was good news,

but then came the bad news: there's a small bleeding right on the macula!

The optometrist immediately started the paperwork to send me to see a

retina specialist. Because of the holidays, I did not get in right away.

And here I'm, devasted and full of questions.

I've since read a lot on the internet and I have noticed what could've

been subtle symptoms that I did not pay attention to before:

By careful testing and comparing of the two eyes, I do notice that the

right eye does not see as well in dim light as the left eye. It also seem

to retain the effect of a light longer (by this I meant the situation

when you stare into a light then close your eyes but still see the

light). When I am reading on the computer, a line may look slightly

sagging in the middle (but not much) when I see with my right eye. Also,

the right eye seems to tire more easily than the left. When I looked at a

Amsler chart, I didn't see any missing lines, the squares are even but

the lines are perhaps not absolutely ruler-straight.

I sort of self-diagnose myself with two possibilities: AMD or Macula

Hole. I suspected the Macula Hole because of my earlier experience of a

retina tear caused by the Vitreous Separation (at least that's what I was

told by my docotrs). I have no risk factors other than age and gender for

AMD (non-white, never smoke, slim, exercise regularly etc).

Do I likely have AMD or Macula Hole or something else? I know you can't

say for sure without examination. Please just give me a knowledgeable

estimate.

Which is the worse condition to have? I sort of think AMD is but I may be

wrong. They may be just as bad?

Is this highly urgent? How soon should I see the retina specialist

(immediately, a week, 10 days, please specify a time frame if you can)? I

expect there may be some delay because of the insurance paperwork and the

holidays. But if it's critical then I'll try to get to one who will see

me ASAP and pay out of pocket. My sight is too important!

When I see the specialist, what questions should I ask about my

condition? What tests that I must have (put it in another way: what tests

should I ask for even if the doctor doesn't think of giving it to me?)

Thank you very much for answering my questions.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. James replied 2 years ago.

Dr. James :

Hello.

Dr. James :

Are your eyes currently 20/20 even with the bleeding?

Customer:

Yes. And I have no symtoms other than when I mentioned in the original question

Dr. James :

The most common cause of bleeding is due to diabetes. Your hA1c is very good which means diabetes is less likely.

Dr. James :

Macula holes generally do not cause retinal bleeding.

Dr. James :

If it is a macula hole and you are 20/20, no surgery is recommended.

Dr. James :

Macula degeneration is a possibility. The AMSLER grid is good to test for the extent of the leakage. From your description of your ambler grid, it appears the distortion is very mild.

Dr. James :

Getting an appointment in the upcoming week would be good.

Customer:

Then it's even more baffling, isn't it? So, could it be the dreaded AMD?! Does bleeding mean wet AMD?

Dr. James :

bleeding means wet AMD.

Dr. James :

It's a good thing that your vision is 20/20.

Customer:

But if there's bleeding, does it mean it can turn ugly real quick? That's what I read on the internet.

Dr. James :

Yes, that is why an appointment in the next week or so is important.

Dr. James :

What did you optometrist say the bleeding was from?

Customer:

She said it was on the macula, very slight. She didn't say it's under the macula or on the surface etc. Beside bleeding below the macular (in the deeper layers of the retina), can it bleed any other way?

Dr. James :

if it is within the retina, then that''s to macula degeneration.

Dr. James :

it can bleed, under the retina, in the middle, or on top of the retina.

Dr. James :

high blood pressure or coughing can cause retinal bleeding as well.

Customer:

Coughing? How about straining to go to the bathroom? I've been having a bout of bad constipation...

Dr. James :

yes, that can do it too.

Customer:

Wow! In that case, does it mean it may not be serious at all and it may very well heal itslef?

Dr. James :

if it is due to coughing or straining, then the bleeding should clear on its own. of course the worry is for AMD which needs treatment.

Customer:

Usually how long does it take for that kind of bleeding to clear?

Dr. James :

4-6 weeks.

Customer:

What kind of tests can the doctor do to tell where it's bleeding from? Do I need an Flourescent Angiogram or other tests to confirm whether I have wet AMD? BTW, back in April when I had my retina tear, I had moved something very heavy. So perhaps heavy load can do it too?

Dr. James :

A fluorescein angiogram is the best test to see if there is active leakage.

Dr. James :

a retina tear is very different from bleeding in the macula.

Dr. James :

moving something heavy is unrelated to the retinal tear.

Dr. James :

macula bleeding is not related to a retinal tear either.

Customer:

I see. So, it is possible that something more innocent like coughing or straining can cause the bleeding on the macula and it's not necessary wet AMD? I know I'm grasping at straws...

Dr. James :

yes it is possible.

Dr. James :

try not to worry to much. with 20/20 vision, what ever it is, it is mild.

Customer:

Well, that gives me hope... How about the one druse I have? I understand they can be hard or soft and the doctor didn't tell me what kind. And how about the very slight distortion of the Amsler chart? Do those mean I have dry AMD? Should I be concerned at this point?

Dr. James :

Drusen are very common and hard to tell if it is related to the bleeding.

Dr. James :

distortion on the amsler grid is usually a sign of wet and.

Dr. James :

AMD

Dr. James :

dry AMD usually has no symptoms.

Dr. James :

you should be concern, but not overly concerned. call on monday or tuesday when the doctor's office is open and get an appointment this coming week.

Customer:

Thank you! XXXXX for now and will Accept your answers. However, can I reconnect with you in case I have more questions under this same thread/payment or do I have to initiate another question? I'm new at this site so I just want to know.

Dr. James :

if it is a related question, you can return to the same thread. just follow the links on the emails you get from JustAnswer.

Dr. James :

You're welcome.

Customer:

Also, if I have question in the future, can I ask for you specifically or I'll get someone in random? If I can, how?

Dr. James :

You can ask me specifically. just start your question with "Dr. James"

Dr. James :

or use this link and start your question with "Dr. James".

http://www.justanswer.com/medical/expert-dr-james/

Customer:

Thank you! Merry X'Mas!

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
Dr. James and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

Hi, Dr. James,

 

As I mentioned in my original message, I had a pin head bleeding on my retina close to or on the macula. My optometrist was concerned because it involved the macula. A couple of days ago, I went back to her office to pick up my prescription glases. She looked into my eye again (for free) and told me there's no change in my eye. The blood is still there as 10 days ago. She now said it probably was not serious though she still recommended me to see the retina specialist. In the meantime, my appointment with the retina specialist was postponed till mid February because of some scheduling problem. Since I did not feel a thing and I had used the Amsler grid to check my eyes every day and I saw no change. I thought to myself: if I can wait nearly two month to see the retina specialist, this is probably not serious?

 

Does no change in the blood spot a good indicator, like the bleeding has stopped and the blood is just waiting to be re-absorbed? Or does it mean the bleeding is still going on?

 

Thank you if you can send me a short note.

Expert:  Dr. James replied 2 years ago.
With 20/20 vision, the retina specialist may not want to treat it.

It may take a month or more for retinal bleeding to go away by itself. It is good that it has not worsened. Because there is little change, that means that it has not continued to bleed.

February should be OK if your vision continues to be 20/20 and there is not change in the AMSLER grid.
Customer: replied 2 years ago.

Hi, Dr. James,

 

I finally got to see the retina specialist last week and got a copy of her report to my doctor today. She found a "single microaneurysm noted near the FAZ. There is also 1+striae and 1+ILM changes noted in the macular region." So what I had was not bleeding but a microaneurysm that may bleed! The retina specialist said this is the very beginning of diabetic retinopathy but my condition is stable and my A1C is good so she only recommended me to have my eyes re-checked by my regular optometrist in a year. My optometrist, however, was a lot more concerned. She said the microaneurysm is close to the FAZ and if it bleeds I can go blind on that eye. On the other hand, treatment may take that eye out now because it's so close to the FAZ. So it looks like I am caught between a rock and a hard place... My optometrist had no suggestion to give; just told me to come back in 3 months (not a year, as recommended by the retina specialist). So I am more worried than ever because I got very different opinions from two doctors (the retina specialist said it was no big deal; my optometrist said it was bad but had no solution).

 

In your opinion, is there anything I can do about imy eye? Is there any treatment that is relatively safe? How likely is that microaneurysim will bleed into my fovea and if it does, is blindness inevitable?

 

Thank you for any advice you can give.

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