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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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Hi I am 50 yr old healthy fit female still getting periods. Only

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Hi I am 50 yr old healthy fit female still getting periods.
Only on Synthroid for hypothyroidism.
Weight is ok. Experience migraines 20 yrs no pain just visual disturbances .
Wear glasses since my 20's eye deteriorated.
Full health assessment done last year and optimal results.
Eyes just tested for glaucoma recently but due for full eye exam.
3 hours ago out of now where I began to see jagged black goldish lines floating across my left vision. No pain, but definitely some anxiety!!
Lasted maybe 5 minutes if that and turned to small black dots floating around mostly when eyes moved still intermittantly occurring on a very small scale.
Went to doctor right away and he thought maybe vitreous detachment.
When speaking to the office of the ophthalmologist, he felt that based on my symptoms that was not what it was ( it would not go away that fast and I would experiencing flashing lights more visual disturbances etc) and I go in for a full exam next week. Do you have any suggestions of what this could be?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.
Hi. I'm online and happy to answer your question today.

I am a retina specialist and I agree with your ophthalmologist. It does not sound like you had a vitreous detachment but rather an ocular migraine. Let me tell you a little bit about this issue:

What you are describing is consistent with ocular migraines, a condition that I not only treat in my office but that I have been dealing with personally for decades.
A typical migraine headache starts with shimmering lights, often times they surround a blurry area or have dots or jaggedly lines associated with them. They tend to progressively increase in intensity and sometimes march across the visual field causing difficulty with reading. Many times this is then accompanied by nausea, irritability, sensitivity to bright lights and/or loud noises. After the onset of the lights (called scintillating scotomas), the headache typically starts and the light show tends to progressively go away.
Many people can have this migraine phenomenon WITHOUT the headache; it is called an acephalgic migraine. Some people even start having these late in life, or may have had a few much earlier in life that behaved differently and haven't had any for decades and then begin to have them; this is not uncommon. A family history of migraines is often present as well.
This is nothing to worry about. It is not a sign of a more serious underlying condition, brain tumor or anything like that. If the episodes become so frequent that they are bothersome there are medicines that can be used to decrease their frequency or stop an episode once it has started.
I, personally, have been suffering from this condition for almost 30 years. I almost never got the headaches after the visual effects.
There was one time, I was in the middle of a very delicate retina operation, when an attack started. After a few moments I lost most of my central vision and the inferior part of my visual field. I, calmly, removed my surgical instruments from the patients eye and we all sat around in the OR for 15 minutes until my vision returned. Other than that my ocular migraines have not really caused me any significant problems :o)


Does this make sense to you?

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. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 1 year ago.
Thank you for your answer however my only reservation with this is that I have experienced migraines for so long and am so aware of the flashing jagged lights, aura, light and sound sensitivity etc and this was nothing like that.
The black lines and spots and the little spots keep recurring very slightly as the day progresses are totally different than my 'normal' flashing light episodes.
Mokie Burnham
Expert:  Dr. Rick replied 1 year ago.
Mokie,

That is very interesting. Since you have personal experience I trust that this is different.

In that case, my primary diagnosis is a PVD with retinal traction. A good dilated exam by your ophthalmologist will be able to quickly figure out what is going on. With "chat" as my only diagnostic tool, it is harder for me to pin things down...which I am sure you can understand. :)

That being said, please allow me to give you some information on this issue:

A PVD, or posterior vitreous detachment, a common event that happens in many people.

You have a thick gel material in the middle of your eyes called the vitreous. Over time as it liquefies, this gel material collapses on itself, forms little clumps that you can see as dots, lines or bugs. As these clumps form the vitreous pulls away from the wall of the eye. In the process it can stimulate the retina -- causing the flashes that you may see.

It is recommended that you see your ophthalmologist to look at the retina to make sure there are no problems such as a retinal hole or tear. In most cases, there are no problems, but this exam is precautionary and allows for preventative treatment of any lesions that are found.

If you notice a sudden increase in floaters, flashes of light (like a lightning storm), or a shadow/veil in the periphery of your vision, this can be worrisome for a retinal detachment. You would need to contact your ophthalmologist promptly in that case.

What can you do about the floaters? Well, floaters don't go away, and they don't really get worse. Over time they tend to "sink" out of your central vision and you brain "filters" them out so you don't notice them so much anymore. They almost never cause significant visual problems except, of course, if they cause a secondary retinal detachment as discussed above. The only way to decrease or remove the floaters is with a major surgery called a vitrectomy. As a retinal specialist for almost 2 decades I've only done this procedure to remove floaters in a handful of cases.

Here is a video of the actual surgery to remove floaters:
http://www.retinavitreous.com/video%20files/intro_floaters.html


In January 2013 a new drug, called Ocriplasmin, was approved by the FDA to dissolve vitreous strands in a particular eye condition called vitreomacular traction. Perhaps someday this drug could be used to also remove floaters…. Only time will tell.

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.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7906
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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