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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
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Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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A month ago a rang the UKs 111 emergency health service complaining

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A month ago a rang the UKs 111 emergency health service complaining of flashing lights in my left eye. They advised me to attend the A&E dept of my local NHS hospital were I was examined by a doctor who came to the conclusion that because I'd not had a recent headache I wasn't to worry about it and for me to return home. I have a chronic movement disorder that I'm presently waiting for brain surgery to treat my worsening symptoms. In my concerns of how severe these involuntary movements / tics have become I asked the doctor whether there could be any correlation between the violent head tics that I have against my shoulder and the flashing lights in my eye, but again he reiterated his advice for me not to worry about it and to go home. It was only two weeks later when the flashing lights were replaced by bubbles appearing in the same eye that after being advised again by the 111 service to attend the same A&E dept that a retina specialist on the eye ward diagnosed a detached retina. Since I've had to undergo emergency keyhole surgery at an eye hospital as the usual technique of re-attaching the retina by laser wasn't possible in order to save my sight in this eye, I've been informed by the eye specialists that flashing lights within eyes are classic signs of the retina beginning to detach that should have been initially recognized by the A&E doctor previously.

On reflection I feel that advice could have been given to me by that A&E doctor that would have prevented this situation from happening ie. to bring forward the brain surgery in advance, or at least to be given a medical neck pillow / support to prevent the retina from detaching. I've now been informed that I'm likely to experience a permanent worsening of vision from this eye and to expect a prescription lens stronger than previously fitted into my glasses. Taking into account the knowledge known by the medical profession in pre assessing retina detachment, could I have a case presented for medical negligence against the NHS, and if so, what would be the likelihood of me being awarded compensation, and the amount given for a case of this type?

Many thanks,
Chris.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. My name isXXXXX and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

I am a retina surgeon.

Dr. Rick :

I see that you are offline. I will switch to Q&A format. This format 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..... :)

Customer: replied 1 year ago.
Have you received my initial message left online from last night Dr Rick?
Expert:  Dr. Rick replied 1 year ago.
Hi Chris,

I see you have a number of issues embedded in your post :)

Let me go over them in order:

1. You are correct. Your initial episode of flashing lights should have prompted the original A&E doctor to do a complete eye exam to make sure that you did not have any retinal holes/tears or retinal detachment in progress. It sounds, however, like this A&E doctor was a general practitioner and not an ophthalmologist. If this is, indeed, the case, he should have consulted with an ophthalmologist and had you examined by an eye expert.....

2. I do not believe that your retina detachment was caused by your tics/head movement. From the information in your post I believe it was caused by a posterior vitreous detachment causing retinal traction (which made you see the flashes of light...) and a secondary retinal tear, leading to a retinal detachment.

Moving up your brain surgery, using a special pillow etc would not have been of any help in preventing your detachment. The only thing that would have helped in your situation would have been a timely and complete eye examination by an ophthalmologist....which you did not get.

3. As to your chances of bringing legal action concerning your detachment, I'm not sure how things work in the UK but, here in the USA, from what you posted, you probably have a case....

The only way to know for sure would be to consult with a lawyer.

I hope your retinal detachment was caught before your macula was involved..... I wish you the very best.

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. 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.
My head smashes against my left shoulder very hard of late due to the worsening symptoms of my tic disorder; would this not have been a contributory factor by way of physical impact alone in detaching the retina, and if not, what exactly is a posterior vitreous detachment, and how would that cause my retina to break away in this instance?
Expert:  Dr. Rick replied 1 year ago.
Chris,

While having your head smash against your shoulder is not a good thing when you are having retinal issues, I do not believe that caused your retina to detach, or that a pillow etc would have prevented it.

A PVD tugs on your retina, which is very fragile...kinda like wet rice paper. When the vitreous pulls on the retina, it can rip a hole and this hole can lead to a retinal detachment.

Here is an excellent discussion of a PVD, what it is, what it can cause, etc from a very reliable source:

http://www.rnib.org.uk/eyehealth/eyeconditions/eyeconditionsoz/Pages/posterior_vitreous_detachment.aspx

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.
Could you verify that link again please as it doesn't take me to a web page?
Customer: replied 1 year ago.
Also, why does a PVD tug on the retina in the first place? Wouldn't it have been tugging on it all these years, I'm a middle aged man? Surely physical impact, especially of this kind?
Expert:  Dr. Rick replied 1 year ago.
Chris,

The vitreous only tugs on the retina when it starts to shrink with time. I had a PVD in my left eye when I was 26, so it can happen at almost any age.

The link doesn't seem to be working for me either....here is a new one:

http://my.clevelandclinic.org/disorders/ocular_health/hic_what_is_a_posterior_vitreous_detachment.aspx

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


As you know from asking questions on this site, you can press the positive feedback button at this point and, should you need to ask a few more questions, I will still be available to assist you....
Customer: replied 1 year ago.
When you say 'shrink' with time, is the other end of the vitreous (being the opposite end from the retina) that's anchored onto something else, that's lending a hand to the tugging process?

I was initially frightened of blinding myself with more tics as I was convinced that would exacerbate this problem. So I guess I can rest assure my Tourette tics won't cause a situation like this in future?

Many thanks Dr Rick.
Expert:  Dr. Rick replied 1 year ago.
Chris,

Think of the vitreous as a balloon inside a balloon, with spots of glue in some areas where the two touch.

The vitreous (inside balloon) naturally shrinks with age and pulls away from the outside balloon (your retina). The sticky spots put traction on the retina and, rarely, tear it.

You do not have to worry about your tics causing any further problems.

Did I mention how much fun it is to push the positive feedback button? The one labeled "excellent" is the most fun of all to push, by far.

You may do so now should you so choose.....
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 8474
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.
Yes do did, and with a competent and satisfied answer I'm happy to oblige...

That you.

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Dr. Rick
Dr. Rick
Ophthalmologist & Retina Specialist
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Ophthalmology since 1994 with Retina sub-specialty interest