Magical Diamond Ring: Retinal Detachment II

If you don't know what the Magical Diamond Ring is, please refer to the previous post about a shadow appears in my peripheral vision after RD surgery. The shadow consists of a big ring encircling the whole peripheral vision plus a dot at 6 o'clock that looks like a diamond ring.

Unknown root cause but some guesses

People have some guesses about the root cause of this shadow and my estimation of probability in parenthesis:

(1) My doctor believes it is vision field blockage due to the buckle indentation, most people cannot see this but me because I had cataract surgery long time ago without IOL (intraocular lens) implantation. So this refractive phenomenon happens. (60%)

(2) The retina needs sometime to accommodate the pressure from the buckle and to recover its function. (35%)

(3) The pressure of the buckle malfunctions the retina. (~5%)

(4) Stroke of optical nerve. (0.01%)

The probability of (3) and (4) are slim as the dark spot can adapt to ambient lighting, i.e., the spot becomes brighter when I move to brighter environment and it becomes darker in dimmer places. This means the retina in the dark spot area should still have function. I can't eliminate (2) but I can find a sound explanation after detailing the phenomenon with an optical diagram, keep on reading for the description.

Here comes the explanation.

Scleral buckle is a silicone band encircling the eyeball to make an indentation to help squeezing the subretinal fluid out and help your retina flatten and reattached to the choroid.

My doctor used a higher buckle in my case which is more preferable when the tears are many and big. I appreciate his doing but this produces a deeper indentation as well.

Shape and size of some buckles can be found here: buckle catalog and more buckle catalog

What is the problem of higher buckle or deeper indentation?

Let me draw an optical diagram to explain this. Remember I had my IOL removed without implantation so the refractive error could only be corrected using exterior lens, i.e. spectacle or contact lens.

If you look into the diagram carefully, it is pretty self-explanatory. The bold blue line represents the deeper indentation caused by the higher buckle. When normal glasses is used, part of the object is blocked by the buckle indentation (blue color) which creates a blind spot on the retina. If I change to use contact lens (red color), I could see the same object smaller as well as seeing a wider vision field (grey color). This agrees with my experience when I wore contact lens before the buckling surgery. If we look into the effect of closer lens (contact lens in this diagram) against buckle indentation, we could see the closer lens may reduce the blind spot area, about half in this diagram.

This explains the possible visual field improvement using contact lens (better) or IOL implantation (best), and it is the counter proof of why the patient with IOL removed would be more susceptible to see the blockage of higher buckle.

I hope this expensive diamond ring disappears soon with contact lens or IOL implantation.

While for the scar development progress, I may have more update after revisiting my doctor next week, stay tuned!

Flashes and Floaters: Retinal Detachment I

It is now about 4 weeks time since my Retinal Detachment surgery, and I could virtually restore my macula vision (the central vision that helps us to read and see the details), however my peripheral vision is still having a black dot and a ring shadow which is quite disturbing. My Ophthalmologist said that it may fade out in 4 to 8 weeks so I have to see how it goes. Anyway, it is still a good luck for me the retina can be reattached because RD is not a minor problem especially if you had eye surgery or cataract before.

My RD surgery was a complicated one as the doctor marked in the insurance claim, an 1.5 hours surgery turned out to be 2 surgeries in 4 hours. Because the tears were quite a lot and the vitreous traction was big so I had been treated with Scleral Buckling, a surgery to mount a silicone band around your eyeball and make an indentation to push the retina back to the choroid; and a surgery called Vitrectomy to remove the pulling vitreous.

After overcoming the first hurdle on surgery, I have to pass more gates in 3-6 months.

- result of the reattachment (excellent)
- infection after surgery (no problem)
- scar development leads to redetachment (good so far, but need to monitor 3 months)
- fade out of shadow in peripherals (not good but it can take time or forever)

Therefore, I am now undergoing low protein diet to prevent scar development and patiently wait for the gone of the shadow. Anyway, it is already very lucky if the macula vision is excellent and the retina is holding in place firmly, others are only bonus.

Another worry begins with the another eye, which has 20% risk today.

I may write up a more detail record about my RD experience when I recovered completely. The only comment today is IF YOU FIND FLASHES OR FLOATERS IN YOUR VISION, GO SEE AN OPHTHALMOLOGIST AT ONCE, hours count for how good the vision can be recovered. My case was the surgery happened within 1 hour the RD had been confirmed by the doctor, similar to the urgency of car accident.

Thanks to my ophthalmologists, my wife, my families, and those who pray for me on this hard time. Love and joy last though the fate is tough and cold.