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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I have been diagnosed for mole (like a macular hole) in my

Customer Question

I have been diagnosed for mole (like a macular hole) in my right eye causing reduced vision and things appearing in broken/wavey manner. It was initially noticed by my eye doctor last November. This hole has become more pronounced. My eye doctor referred me to a doctor who is specilaized in vitroretinal diseases and surgeon specilist. He recommened a surjury and indicated potential risk for not improving my demished eye sight in the right eye and including risk for retina dettachment.

My question is whether there is any other option available beside doing nothing? Is surjury is a recommended couse of action? Please suggest some weblinks where I could educate myself about.
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today. I am a retina surgeon.

Customer:

I have not seen your response

Dr. Rick :

We're still working on it..... :o)

Dr. Rick :

Yes, given what you have told me, surgery is your best, XXXXX XXXXX option to improve your vision due to your full thickness macular hole. Are their risks? You bet. Is the post op positioning difficult? Yup, but there is equipment you can rent to help with that. Can you do nothing? Yes, but I would expect the hole to enlarge, causing a larger blind spot/wavy area in your central vision. Will no treatment cause you to to lights-out blind? No, but you will, most likely have such limited central vision in that eye that you would be considered "legally blind"

Dr. Rick :

Let me find some good webpages for you....brb.

Dr. Rick :

http://my.clevelandclinic.org/disorders/macular_hole/hic_macular_hole.aspx

http://vitrectomyrecovery.org/MacularHole/?gclid=CL6JvOa02q4CFcsAQAodAUJGdg

http://www.youtube.com/watch?v=jA7rjIxwGHg (this is in a patient after cataract surgery)

Customer:

Please also let me know if I could go back to work after one week after the surgery and what I shouldn't do during this week to make sure I would get maximum benefit?

Dr. Rick :

that is a pretty good start. You can google macular hole treatment etc and get a bunch more pages.

Customer:

By the way I had cataract sugery on both eyes 4 years ago

Dr. Rick :

When you can go back to work depends on what type of gas is placed in your eye, C3F8 of SF6. With the longer acting gas you would have to do the face down positioning longer, of course. Your surgeon could give you an estimate of when she thinks you can go back to work depending on her surgical plan, what type of work you do, if there were any intraoperative issues etc.

Dr. Rick :

Good. That will prevent you from needing to worry about getting a catarct, which always happens after this type of surgery.

Dr. Rick :

Your surgeon will also have a handout that will go over in detail the do's and don't after surgery.....every surgeons list is slightly different so there is no need for you to have mine :o)

Dr. Rick :

I am glad that you are taking the time to learn all you can about your upcoming surgery. Post op care is very important and many times I sense that patients may not understand their very important role in the success or failure of their surgery. I don't think that will be a problem with you....

Customer:

Thank you and please let me know if anything else I may need to know or of any additional references.

Dr. Rick :

My pleasure. I will do that.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
I wish you the best of luck in your upcoming surgery. Let me know if there is anything else I can do to assist you. Take care.

If you have a chance, drop me a note after you are recovered from your surgery and let me know how things turned out.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
I also need to know differences between macular hole to Empiretinal membrane and Proferative vitreoretinopathy?
Expert:  Dr. Rick replied 2 years ago.
An epiretinal membrane is a "growth" on the top of your retina that wrinkles your retina without tearing a hole in it. It can be peeled from the retina with vitrectomy surgery. Here is a good article on this topic:

http://en.wikipedia.org/wiki/Epiretinal_membrane


There are different stages of a macular hole, as described by the Late Dr. Donald Gass. Here is an excellent article on this topic:

http://www.nei.nih.gov/health/macularhole/macularhole.asp

PVR is a very serious and difficult complication of a retinal detachment that was caused by a tear (rhegmatogenous RD). I, very much, do not like PVR, even though I frequently have to deal with it. Here is a very good article on this:

http://en.wikipedia.org/wiki/Proliferative_vitreoretinopathy

You are going to be the best informed patient in the entire waiting room :o)

Let me know if there is anything else I can help you with.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
I have a follow up question. Given that for a sugery to fix macular hole they inject air/gas in my eye, shouldn't this reduce risk of retina detachment as it should stablize retina further? I found it counterintutive that risk of retina detachment being increased either during or after the sugery for fixing macular hole. Also, I would like to seek your opinion on the amount of sight restoration after a surgery for fixing macular hole. What could possibly improve restoring maximum sight after surgery. Any articles and/or vidios in this regard would be helpful
Expert:  Dr. Rick replied 2 years ago.
That is an excellent question. The gas placed inside your eye is not being used to stabilize your retina but rather to keep the fluid away from the recently operated macular hole. The risk of a retinal detachment comes just from the physics of the vitrectomy and placement of the instruments inside your eye.

It is impossible for me to even guess at what amount of visual restoration you could expect without examining your eye in detail. Heck, even with a complete exam I don't give my patients a solid number, just a vague guess of a range. There are way too many variables in this type of surgery.

To restore maximum site after surgery, follow your post op instructions as if they were a command from your Higher Power.....

I don't know of any articles or videos, outside of the pre-op DVDs I use in my office, that go over this surgery in depth but I bet with the aid of Google you can find a bunch.

Let me know if there is anything else I do to help. Best of luck on your surgery should you decide to go ahead with it.

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