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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7820
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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hi I had CSR 13 years ago and the fluid cleared up after 8

Customer Question

hi I had CSR 13 years ago and the fluid cleared up after 8 months. 4 days ago I started to see a spot on the other eye(jan 14,2013), saw an opthal who referred me to a retina spe. based on the eye pics, which was 1/3 filled with dark grey taht he said was blood, said I may have PCV. He injected me with avastin to stop the leaks. Was thos the right treatment? I work with computers. will hi altitude and flying affect PVC ? thanks. JR, University of Chicago
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina specialist and deal with CSR issues all the time.

Dr. Rick :

Was it the general ophthalmologist who injected your eye with Avastin?

Dr. Rick :

Did the doctor who did the injection do an extended exam after dilating your eyes, perhaps by putting a large contact lens on your eye? Do you know if a OCT was done (computer test...takes a few minutes) or a fluorescein angiogram (injection of dye into your arm followed right away by lots of pictures....and afterwards you pee bright yellow)?

Dr. Rick :

We have been experiencing problems with the chat system for the last few days. Our engineers are working on it. However, I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
I see that you are offline. I will copy my chat notes here for your review:

Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : I am a retina specialist and deal with CSR issues all the time.
Dr. Rick : Was it the general ophthalmologist who injected your eye with Avastin?
Dr. Rick : Did the doctor who did the injection do an extended exam after dilating your eyes, perhaps by putting a large contact lens on your eye? Do you know if a OCT was done (computer test...takes a few minutes) or a fluorescein angiogram (injection of dye into your arm followed right away by lots of pictures....and afterwords you pee bright yellow)?


This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 1 year ago.

are you online now?

Expert:  Dr. Rick replied 1 year ago.
Yes. I am here. We can "chat" using this system....
Customer: replied 1 year ago.

where the @#@# XXXXX XXXXX chat system??? :)

Expert:  Dr. Rick replied 1 year ago.
It is right here....you are using it now!

I type, like this. You read and reply.

And then the whole process repeats.

Shall we get started?

Did you see my questions? Let me retype them here for you just in case they didn't come across:

Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : I am a retina specialist and deal with CSR issues all the time.
Dr. Rick : Was it the general ophthalmologist who injected your eye with Avastin?
Dr. Rick : Did the doctor who did the injection do an extended exam after dilating your eyes, perhaps by putting a large contact lens on your eye? Do you know if a OCT was done (computer test...takes a few minutes) or a fluorescein angiogram (injection of dye into your arm followed right away by lots of pictures....and afterwords you pee bright yellow)?

I look forward to reading your reply.
Customer: replied 1 year ago.

they did not do a dye test this time as they probably knew it was either CSR or PCV as I had CSR 13 years ago.

 

was this the right treatment? My neighbot who had diabetic retinopath

said had spots on her eye and her retina doctor lasered the leaks and

did a surgery on her eye to "drain" the fluid. This seems like an aggressive treatment, Are there downsides to this treatment?

 

Should I pursue this kind of treatment to get rid of the fluid/blood asap?

 

a day(or 2 days) after the avastin injection. the spot seems not get bigger any more. My vision seems to improve a little bit as I can see figures not and colors but it's still very bad.

 

The doctor also said I MAY not gain my vision back which alarmed me

 

 

will hi altitude affect my eye?

will flying affect my eye?

I was told to stay away from blood thinners/exercise for awhile or until this

gets resolved.

 

Is there anything I can do to hasten the blood fluid absorbtion so I can see

again?

 

 

Expert:  Dr. Rick replied 1 year ago.
If you had blood under or in your retina and, from what you have posted, this sounds like what is going on, then it is very unlikely that CSR is your issue at this point.

You most likely have a choroidal neovascular membrane. Avastin, and drugs like it (lucentis, afibrocept) is the treatment of choice for this condition, especially if the blood is directly under your macula/fovea.

The laser therapy your friend had for diabetes, along with the surgery to "drain the fluid (vitrectomy) is a different deal completely.

This is not something you need to even think about at this time nor, hopefully, in the future. It is major eye surgery....

I am glad to hear that your vision has stabilized and even improved a bit already. That is a very good sign. I'm sure your doctor told you that you will most likely need further injections to control the bleeding, the next one in about 3 or 4 weeks, depending on how things go....

Concerning your future vision, your doctor is correct. The outcome is up in the air right now. One thing to keep in mind....before Avastin I told all my patient that we are hoping that they may not loose all their central vision.....improvement was not even an option back then.

Now, with Avastin, and drugs like it, not only am I able to prevent further vision loss, but I am able to get vision back -- sometimes to 20/20 -- in many patients.

So. What is the take home message? Do everything your retina doctor tells you to do and do not miss any appointments.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick

Please accept my apologies for the technical problems we have experienced with the chat system today.
Expert:  Dr. Rick replied 1 year ago.
Oops. I missed some of your questions:

Climb any mountain you want....well. Maybe not Everest.

You can safely fly.

There is nothing you can do to speed up the blood absorption.

Yes. Stay away from blood thinners and hard exercise.

Sorry about missing these.....
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7820
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 1 year ago.

 


http://25.media.tumblr.com/75d08decbf673a9b022a5d96d30861da/tumblr_mgycljWork1qb1v6ro1_500.jpg

Customer: replied 1 year ago.

I sent u a link of a pic. can u please let me know what u think of it.


and compare it with other patients who has this? How bad does it look?


 


 

Expert:  Dr. Rick replied 1 year ago.
Jerome,

That is a lot of blood and it is involving a very, very important part of your retina. And it is not CSR. And it is not pretty...but, after 20 years of clinical practice as a retina surgeon, I've seen a lot worse

I can see why your doctor did not do an angiogram. With that much blood it really is of no value right now...he will most likely do it as the blood clears. Depends on how you do.

Without stereoscopic views the clinical data I can get off the picture is limited but I can tell that the majority of the blood is sub retinal.

You are in good hands. Continue with the therapy.

Let me know if there is anything else I can do to help.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Customer: replied 1 year ago.

great then.


Another quick question. He mentioned 3 drugs. Avastin, visudyne and Lucentis(?). I asked what the best drug is, he said all 3 are good but insurance probably wont pay for visudyne and lucentis which cost $2000


and $1500.


 


My internet research :) seems to say that the 3 drugs are good for


sealing the leaks but avastin does nothing for the polyp/abnormal blood vessels, unlike visudyne. Is this true? what is your opinion on this. Thank you.


 

Customer: replied 1 year ago.

why do I need more than 1 injection? (it hurts a lot :) )


based on your experience and the blood that you saw,


how long do you think the spot in my center of vision will disappear?


 


Thanks

Customer: replied 1 year ago.

ur offline already. just wanted to send you another doc.


 


http://25.media.tumblr.com/a5a46b75465aa0eb2983e6c47d4fe992/tumblr_mgyf6zMYPT1qb1v6ro1_500.jpg


 


this is the progression of the spot I see on my right eye.


It started on the 14th, big spot on the upper right of the center of vision.


Worst was on the 18th when I had to rush to the retina specialist.


eye pressure was between 10-12 pts. blood pressure was normal.


as you can see on the 20th(today) the spot got a little(just a little bit smaller) and I can see colors when I watch TV. and figures too.


 


AS my last email said, based on your experience, and the blood that you saw, how long do you think will the spot clear?


 


Thanks.

Customer: replied 1 year ago.

When you said that you think the blood is in the sub retinal part.


Is that good or bad???

Expert:  Dr. Rick replied 1 year ago.
That is just consistent with the use of avastin.

It is not either good or bad....just is.

You are getting the best care possible with the retina doctor you are seeing.

Let me know if I can be of any further assistance.

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