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Hi. I'm online and happy to answer your question today.
I am a retina specialist.
Are you available to chat?
I am wondering what i can expect from the exam tomorrow morning?
First of all I am glad that your family practice doctor knows that this is not anything she should mess around with.....the good news? There is no need to panic.
How is your vision in the affected eye right now?
Its ok but the spiderwebs are covering the left one almost completely- I can see through it, and about a quarter of the right eye. No light flashes today so far.
How long did these flashes of light last around the perimeter of your eyes? Also, was it in both eyes at the same time?
Last night it lasted off and on about 4 hours, it did seem like it was both eyes, but I am not sure.
So your vision in your left eye is normal then?
Maybe a little impaired, because of the spiderwebs, but otherwise I think ok.
I would like to concentrate on your right eye for a moment. Please close your left eye and, wearing your glasses if needed, answer these questions:
Can you read with your right eye.
ok, yes but blurred
If you look at an object say about 10 or more feet away, like a light switch on a wall, while you are looking at that spot, can you see everything to the left, the right, up an down?
If not, does it seem like a "piece" of your visual field is missing? What part?
you mean with just the right eye?
So. Am I correct in saying that these spiderwebs you mentioned before as "covering the left one almost completely" are NOT destroying your visual field but rather just kinda there, like dust on a camera lens -- a hassel, but not blinding.
yes. All of these question are with the left eye closed.
Except for the last one about the left eye :-)
You can repeat the same tests with the left eye only and tell me what you find.
Yes, but I just realized that my vision is more impaired than I thought, my left eye is very blurred when trying to read without my right eye, the right is more so than usual too. I do not wear corrective lenses for close up.
Ok. What about the visual field?
Testing one eye at a time, does it seem like there is a curtain coming across your vision from any direction? Like a shade being closed?
I'm sorry. The test where you use one eye to stare at a light switch etc across the room and see if you can see to the sides and up and down. This is a very crude visual field test.
no, its more like a sense of blurriness on the far right side of the right eye, and a murkiness covering the whole eye of the left.
Ok. Let me make sure I understand this correctly. The entire visual field of your left eye (all of your vision) is murky. This eye is also having more problems with near vision tasks...and this is new. The right eye can read but it is still blurry and the left side of your vision is pretty normal but the entire right half of the vision is blurry. Did I understand you correctly?
I know you really didn't ask me to figure out what is going on....you just wanted to know what the ophthalmologist is going to do....I hope you don't mind that I'm doing more then you asked for....
Ok. Well, I would very much doubt that you are experiencing retinal tearing.
Its ok, I realize that you need to figure out what you think it is before you can figure out the tests.
Do you have any other physical symptoms?
Just some tiredness in the eyes, kind of headachy.
Physical things? Weakness? Speech or thought problems? Headaches?
ok...got the headaches. I should read better :)
Also, do you have any medical problems or take any medications?
Headachy, I am sort of feeling down, but this could be because I have a history of breast cancer (5 years ago) and now am having some vaginal bleeding which my indicate another cancer/or a recurrence. This just started on sunday on top of this eye problem, see my doctor for a biopsy on friday.
Not any speech problems, nor thought problems. Some tiredness.
I'm very sorry to hear about that. I really hope that the cancer has not come back So. I can tell you what the doctor is most likely going to do tomorrow and, if you would like, I could discuss what might be going on....although after tomorrow's exam your ophthalmologist will be able to give you a pretty good idea -- especially since he will have all the test and exam results as opposed to my "educated guess" based on our chat :-)
OK, tell me about the exam and anything you may be thinking it may be so I can bring it up if I need to.
OK. Well, the first thing that will happen is that they will check your glasses, if any, and then test your vision in both eyes, both at distance and near.
Then they will do a refraction (which is better? One? Or Two?), check your pupil function, gross visual field (with their fingers), maybe check your central vision with a little piece of grid paper (amsler grid).
Then they will check your eye pressure with a yellow eye drop and a blue light thingee (a medical term ;). Then the nurse will put drops in your eye to dilated them. They take about 20 minutes to work.
Then the doctor will examine you with a slit lamp.....oops. I forgot. I'm a retina doc....The general ophthalmologists usually examine you before the dilating drops!
Then they will examine you (again) after the dilating drops, and do a retina exam with a bright light on their head (indirect exam)
You may also have a computerized visual field test. This would be before dilation and takes about 15 minutes.
The dilating drops wear off after about 5 hours; you can safely drive home with either your own sunglasses or the disposable ones the doctor will give you.
I think that about covers what I do 50 times a day!
So you think that its not a retinal tear? What else could it be?
sometimes they use a tonopen to test your eye pressure....looks like a big pencil, rather then the blue light thingee.....
this is different than the blast of air in my eye test?
I think you have had a stroke to the part of your brain that controls vision and it has affected all the vision in your left eye and half of the vision in your right eye. But, of course, I would know for sure if you were in my office and not chatting on my computer...but that would be my first guess. But, do not panic. There is nothing you can do or need to do tonight and tomorrow you will have more information based on actual clinical exam rather then some old fart on a computer in Wisconsin lol!
The blast of air test is only done by optometrists.......and this issue is way beyond their pay scale....
I figured as much, which is why I went to my doctor for the referral. Thank you for your help, should I be worried if the doctor doesn't bring this up?
No. Because her tests may show that your vision defects do not follow the anatomical lines that would indicate a brain lesion or she may find something obvious on exam that explains it all.... I
I am, however, very impressed by the speed that your FP doctor got you in to the ophthalmologist. I think that she is a keeper :-)
Please tell her that a retina surgeon thinks she is an excellent family practice physician.....
Yes she is. Again thank you this was very helpful. Unless you have more to tell me I will log off now. Oh, and I will tell her!
My pleasure. Sleep well.
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