All,

In Aug 2004, at age 61, I experienced flashers and floaters in my left
eye and consulted with my ophthalmologist. He advised that my
experience was not unusual for males over 50, a shrinking vitreous
detaching from contact with the interior of the eye, producing the
unsettling -but not visually damaging-- effects. He further advised
that the symptoms, which also included some general cloudiness,  should
subside in a month or so, but that I should be alert for the
possibility of retinal damage with any further flasher/floater events,
advising that sometimes the vitreous pulls sections of the retina away
as it detaches, producing holes or tears in the retina, causing  vision
loss. He noted that, overall, my vision remained what it was before the
vitreal detachment. The floaters were around the edges of vision; the
cloudiness went away (or I got used to it), and normalcy returned in a
couple of weeks.

I experienced a 2d flasher/floater event in September, but since it was
so much like the first, I did not go back to my eye doc and had a
similar post event pattern with floaters and cloudiness lessening with
time.

In October, however, a 3d flasher/floater event about mid-week produced
at first a slightly different sensation in the eye; by Friday afternoon
I became aware of what I'd describe as a "fuzzy curtain"
diagonally across the bottom edge of my left eye; by Saturday
afternoon, it was more like a deep purple curtain, diagonally across
the bottom third of my vision. The final realization that I had a
serious vision problem came when I gave myself this test:  with my
right eye shut, looking straight ahead with my left, gradually moving
my finger from waist level up in front of my left eye, my finger was
nearly dead center in front of my left  eye before I could see it. This
got my attention. Six p.m. on a Saturday, I called my
ophthalmologist's office and kept my fingers crossed.

The medical call system worked; an answering service responded, and an
on call ophthalmologist returned my call within 15 minutes; I described
my symptoms to him. This was 6 p.m., and I live 2 hours from the doc
and any retinal surgeon;  the doc advised that I had an "urgency"
but not an "emergency." I think he responded to my question about
what was going on by saying it could be retinal detachment, but that
only an exam could tell for sure.  He saw  me Sun morning at 10 a.m.
and diagnosed a retinal tear, upper left quadrant, "peeling down like
wallpaper," producing my visual experience of gradual growth of the
purple curtain across the bottom of vision.  He advised, that given the
location of the tear, that gravity would continue to "peel" it
downward and that I'd almost certainly lose all vision  without
surgical repair.

The examining doc referred me to a retinal specialist who repaired the
retinal tear the following morning. The short story is that the surgery
was successful; the surgeon reattached the retina (laser?), and used  a
combination of a "bubble" and "scleral buckle" to hold the
retina in place;  the dark curtain was gone when he removed the
bandages the next morning; I have vision-though it's of the barely
make out the big E on the eye chart kind. He advised a 3-6 month period
before knowing what kind of vision I'd have.

The longer story includes some surgery details, impressions. Three
cheers for medications and anasthesiology! Surgery was done in a
surgical center; I recall confirming "left eye," with the surgeon,
some placement of monitoring electrodes on my chest, some draping going
over my face, and hearing some discussion of my low pulse rate and
"it's o.k., he's a runner," and the next sensation I recall was
some tugging on my eye-which I take to have been stitching-, some
conversation between doc and nurse; I recall asking how it had gone; he
said, "fine." No real pain or discomfort other than just the
general strangeness of surgery itself.

Within an hour, around 10 a.m., I was out of the office, I think wheel
chaired to the car, but I walked with my wife's arm to lean on  from
the car to a bedroom for a pretty long 24 hour wait for bandage removal
and eye exam the next day. I had an Rx for darvocet, but I'm pretty
much a no meds  without good cause kind of guy, and I  was feeling no
pain, so I waited until the pain got pretty uncomfortable before taking
1 darvocet with no noticeable effect.

If this post does nothing else, I hope it publicizes my bad call on
meds; first my eye,  then my whole head vibrated at every heartbeat
with intense pain. Years ago I'd read Joan Didion's fine essay on
migraines, and it came to mind as I asked my wife to turn off all
lights and put dark blankets over windows; a phone ringing 3 rooms away
was excruciating; I called the doc's office and got permission to
double up on the darvocet and halve the interval-2 every 2 hours, I
think, instead of 1 every 4. Didion had written that some migraine
sufferers commit suicide after days, weeks of unrelieved, intense pain,
and I can now imagine that as an understandable response. I probably
deserve no sympathy from migraine sufferers, or anyone else, from not
following a simple pain meds regimen, but I do have much greater
sympathy for what migraine sufferers must endure. After 4 hours or so,
I was comfortable again; I can not imagine enduring that pain for days,
much less weeks.

The second part of the long 24 hours was that I had to keep my head
vertical, or within 75% of vertical because of the air bubble inserted
to apply pressure to the retinal repair, in construction terms, I
guess, to let the "glue" set. Propped up in bed on pillows, I got
through the night without too much discomfort-thanks to a doubled
darvacet dosage-tho I found myself walking the hall in the dark
several times just to have something to do. I'd add that the post-op
advice for a light, bland, semi-liquid diet was also on target; I had a
couple of waves of nausea, not uncommon with this kind of eye surgery,
my doc said.

Dec. 2, I returned for a six-weeks post-op exam, aware that I had been
seeing a rippled or wavy effect in any strong vertical or horizontal
line (windows, doors, brick patterns). The good news was that the
retinal repair was intact; the bad news was that the eye had developed
scar tissue which had spread across the macula, "puckering" or
wrinkling the retina. The NIH web site calls this condition a
"retinal pucker." The eye responds to the trauma by producing scar
tissue (tho I'm told that some retinal puckers appear with no
previous eye trauma or problem), and the scar tissue pulls the retina
out of normal position in contact with the interior of the eye, causing
"wrinkles" or bends in the retina which reduce vision overall,
causing the wavy effects I had been seeing. Recommendation: more
surgery.

Surgery No. 2: a retinal peel with vitrectomy.
Similar protocols to #1 surgery, tho this time the task was to
"peel" away the scar tissue and to remove the vitreous (rendered
cloudy, murky by the surgical intrusions). Gobbled a darvocet within an
hour of the surgery; some minor discomforts, but nothing to lose sleep
over, and no restrictions on how to lie down.

Post-op exam and bandage removal 1 p.m. the following day. Doc reported
"peeling" 6 layers of scar tissue and observing the retina
"relax" and start returning to a more normal, unpuckered state
after the last layer was removed.

I suppose I hoped to see some dramatic and instant vision improvement
-the scar tissue is gone; the retina is moving back into place, murky
vetreous removed-, but I'm still  barely guessing the shape of the
big E on the eye chart. Doc says this is normal and advises
"patience," saying I need 3-6 months to let the retina tell us what
it's able to do.  If anyone has experience and more understanding of
retinal physiology and behavior after an RP/V, I'd appreciate hearing
what's going on.  I'm also advised that within 5 mos to a year
after my RP/V that I may need cataract surgery, since the lens seems
not to like such changes.

Perhaps this narrative will be of some use to someone, and if you've
had retinal repair experiences, I'd be interested in hearing how your
experiences compare.

Lewis