Re: CANNOT SEE TO READ
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Re: CANNOT SEE TO READ
| ray | 27 May 2008 16:03 |
>> are simple refractive changes, cataracts, and potential retinal >> problems (diabetic retinopathy, macular degeneration, etc.) And such [quoted text clipped - 15 lines] >Ray described one LED looking like six, each in focus. He's got refractile >wedges and medicare won't pay until he degrades to 20/40. I appreciate your input, and value your opinion. I am still very confused. The polyopia came on overnight. After about a month it is not nearly as bad. Now there a bunch of images close together and seem to be more smeared than in good focus. The vision gets better and worse. The Muro drops seems to clear it up sometimes. I put up a home eye chart and my vision goes from 20/20 to about 20/50.
>I didn't think early Fuch's was such a barrier to surgery, and I suspect >another surgeon might not be so put off. The cataract surgeon measured corneal thickness of 645 and guttata of 3+. He said the Fuchs is fairly well advanced. How is it determined how far advanced it is? I am going for a cell count next month. Does that shed any more light on the subject? He said he has seen too many people with Fuchs that had bad results with cataract surgery that he does not recommend operating. John Hopkins says that it is usually OK for corneal thickness below 640. When I get motivated I will shop for a cornea surgeon. Do you have any recommendation for a good one in the pacific northwest? Or would you recommend a different cataract surgeon?
From the John Hopkins site:
http://www.hopkinsmedicine.org/wilmer/conditions/fuchs/treatment/fuchs_cataracts.html
Fuchs Endothelial Corneal Dystrophy (FECD) and Cataracts
Some people with cataracts also have Fuchs Endothelial Corneal Dystrophy (FECD). If a Fuchs patient undergoes cataract surgery, the fragile endothelial cells of the cornea may be damaged. (The endothelial cells are those cells at the very back of the cornea. The endothelial cells deteriorate in patients with FECD.) The loss of too many of these cells can lead to edema (swelling) of the cornea. This edema can then sometimes lead to painful corneal bullae (blisters), deterioration of vision, and eventually, the need for a corneal transplant.
In summary, in a patient with FECD, a cataract surgery may hasten the need for a corneal transplant. Because of this risk, the corneas of FECD patients are examined carefully before cataract surgery. Sometimes, the eye doctor will decide that the patient should have both cataract surgery and a corneal transplant at the same time. By doing this, two separate surgeries are combined into one procedure, and recovery time is greatly reduced.
Recent research has helped doctors figure out when a Fuchs patient can have simple cataract surgery and when a Fuchs patient should have a combined surgery (cataract surgery plus corneal transplant). These researchers showed that many Fuchs patients with corneas thinner than 640 microns can usually have simple cataract surgery. (A micron is a very tiny unit of measurement. Each micron is 0.00004 inches long.)
Whenever a person with FECD has cataract surgery, the surgeon uses special jelly-like material called viscoelastic gel. Viscoelastic gel is put inside the eye to protect the back of the cornea during the surgery. The viscoelastic gel is then taken out again at the end of the surgery. This gel has been shown to greatly decrease endothelial cell loss during cataract surgery.
Ophthalmologic researchers are trying to figure out if there is a minimum number of endothelial cells that everyone has to have in order to see properly. Preliminary research, however, indicates that no absolute number exists for this threshold value. Instead, it seems to vary from patient to patient.
>But waiting for 20/40 seems ill advised. > >-MT |
| Mike Tyner | 26 May 2008 21:44 |
> are simple refractive changes, cataracts, and potential retinal > problems (diabetic retinopathy, macular degeneration, etc.) And such > an examination is directly in line with the skills and scope of > practice of optometrists, as well as ophthalmologists, both groups who > have "medical" training regarding the eye. I think the first doctor (an optometrist) had it right. He described yellowing and vacuoles. He blamed the diplopia on vacuoles ("little lenses") and while that was hogwash, it was closer than anyone else got.
Our OP (ray) said, early on, that his only symptom was monocular polyopia OU. There just aren't that many things that cause monocular polyplopia OU at age 67.
Fuch's isn't on the list, short of fresh central erosions. Fuch's is a red herring, when it comes to explaining the symptoms.
Ray described one LED looking like six, each in focus. He's got refractile wedges and medicare won't pay until he degrades to 20/40.
I didn't think early Fuch's was such a barrier to surgery, and I suspect another surgeon might not be so put off.
But waiting for 20/40 seems ill advised.
-MT
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| p.clarkii@gmail.com | 26 May 2008 05:10 |
> > Does Fuchs's appear to be similar to a mass of blood (or similar material) > > in that when the eye is not very active it spreads across the vision to [quoted text clipped - 33 lines] > > blob that may cover 50 percent of the field of view (sitting in the > > center)? thanks, mike, for the clarifications of a number of points that irked me when I read this thread from the start.
Fuch's is quite easy to diagnose in a simple slit-lamp evaluation. And its possible but not likely that the original poster really has this condition anyway so its mention takes the thread off a little off topic. I think the most likely conditions that need to be ruled out are simple refractive changes, cataracts, and potential retinal problems (diabetic retinopathy, macular degeneration, etc.) And such an examination is directly in line with the skills and scope of practice of optometrists, as well as ophthalmologists, both groups who have "medical" training regarding the eye.
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| Mike Tyner | 26 May 2008 03:33 |
> Does Fuchs's appear to be similar to a mass of blood (or similar material) > in that when the eye is not very active it spreads across the vision to > simulate a very thin covering and when the eye is active it coalesces into > a > blob that may cover 50 percent of the field of view (sitting in the > center)? Fuch's makes the back side of the cornea look a little like frosted glass, the texture of an orange peel.
There is no blood, and no "blob" to form any image.
The central cornea is usually worst, and the hazy vision isn't usually concentrated in any particular field or direction.
Fuch's is not rare, and it's difficult to miss if you're paying attention.
-MT, OD
>>It is a long shot but some of the symptoms you are describing are >>Fuchs's Corneal Dystrophy. Many doctors don't find it because it is [quoted text clipped - 10 lines] > blob that may cover 50 percent of the field of view (sitting in the > center)? |
| jyazelz@peoplepc.com | 26 May 2008 02:28 |
>It is a long shot but some of the symptoms you are describing are >Fuchs's Corneal Dystrophy. Many doctors don't find it because it is [quoted text clipped - 3 lines] >diagnosis. > ======================= Does Fuchs's appear to be similar to a mass of blood (or similar material) in that when the eye is not very active it spreads across the vision to simulate a very thin covering and when the eye is active it coalesces into a blob that may cover 50 percent of the field of view (sitting in the center)?
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| ray | 25 May 2008 02:54 |
It is a long shot but some of the symptoms you are describing are Fuchs's Corneal Dystrophy. Many doctors don't find it because it is rare, but it is easy to diagnose if they are looking for it. I found that I have it about 2 months ago. It only took 3 different doctors to find it, some have gone to 6 or more before they got a proper diagnosis.
>Did they check you for cataract? Your desription sounds like it, but of >course it could be something else. Only a physical examination by a [quoted text clipped - 19 lines] >> >>I am going to see an eye surgeon next week who maybe can help me. |
| MsBrainy | 25 May 2008 02:27 |
Did they check you for cataract? Your desription sounds like it, but of course it could be something else. Only a physical examination by a professional can determine your condition.
>I am 65 and my vison in the last two or so years has been getting >worse for reading. I have been buying magnafying reading glass. [quoted text clipped - 15 lines] > >I am going to see an eye surgeon next week who maybe can help me.
 Signature MsBrainy
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| Jerry | 25 May 2008 00:42 |
I am 65 and my vison in the last two or so years has been getting worse for reading. I have been buying magnafying reading glass.
Now, when I try to read, it is like looking through glasses that are smeered with vasaline. I had my vision checked and got perscription reading glasses. There is absolutely no difference and I still cannot focus to read. My distance vison is failing too.
Reading through various web sites and Usenet Groups, I have concluded that there so may different possible vision problems that I could never determine what my problem is over the Internet.
My problem is complicated by my living in Panama. I went to who I thought was an opthomologist but he was an optometrist. ( There is a language barrier since my Spanish is not perfect.) I told him that I did not think prescription glasses would solve my problem but I went ahead and had them made anyway.
I am going to see an eye surgeon next week who maybe can help me.
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