Baby boomer sees the light, and that’s bad

I should have called my regular ophthalmologist right away, but I didn’t have health insurance at the time for financial reasons. If this is just another floater, I told myself, I can live with it.

I hadn’t been hit in the eye or experienced any other eye-related injury, so the idea that my retina might be torn never crossed my mind.

But more than 90 percent of retinal detachments occur spontaneously, according to Gordon Byrnes, an RGW surgeon. The National Eye Institute says there are a variety of risk factors for retinal detachments, including being extremely nearsighted, having a family history of the problem and aging.

“As we age, the vitreous jelly, which holds the retina in place, begins to liquefy,” says William L. Rich III, an ophthalmologist based in Falls Church, Va. “When the vitreous gets less gel-like, it can detach from the back of the eye. As the vitreous starts to detach, it may pull on the retina and cause a tear.”

The dark shadow I had dismissed Thursday was my retina starting to tear, the liquefied vitreous gel leaking through.

By Friday evening, the shadow had gotten bigger. By midnight, it was a reddish blob blotting out one-third of the field of vision. Then I started seeing flashes of light that looked like shooting stars. That’s when I called my ophthalmologist, Farhad Naseh at the Maryland Eye Institute in Gaithersburg, Md.

He said to get to the emergency room as fast as I could. The shooting stars, coupled with the reddish blob, are signs that your retina has detached, he said.

My wife and I arrived at the ER around 2:30 a.m. Saturday. Within the hour, an ER doctor had given me a preliminary exam and an ophthalmology resident was en route. By 5 a.m., the resident had examined my eye and the diagnosis was, as my ophthalmologist had feared, a detached retina. The retina had come loose from its supporting layers and the reddish blob was bleeding from blood vessels it had torn.

Even more worrisome, the macula — the part of the retina responsible for fine vision — was in the process of separating from the inside of the eye. Central vision becomes severely affected if the macula becomes detached. The resident spoke with the eye surgeon on call and relayed my diagnosis. The response was the last thing an uninsured patient like me wanted to hear: I needed a major eye operation — a vitrectomy, which removes part of the vitreous gel to get to the retina and repair it — as soon as possible. The surgery would have to be performed in a hospital operating room, under general anesthesia. The cost: more than $20,000.

I wanted to keep from going blind in that eye, but at what cost to my family? The ER charge and physicians’ fees already were estimated at around $1,000. So I called Naseh again, in hopes of finding a less-expensive option.

He urged me to call Byrnes immediately. The retinal surgeon told me to meet him at RGW’s Fairfax office right away. He would take a look and see what he could do.

When my wife and I arrived at Byrnes’ office less than an hour later, I was totally blind in my right eye. But after examining me, Byrnes said, “I think we can fix this here.”

The retina had detached from the upper portion of the eye and an adjacent area was torn. Given the location and size of the tear, Byrnes felt I was a candidate for an in-office procedure known as pneumatic retinopexy. At around $1,000, it was a fraction of the cost of the hospital vitrectomy, though Byrnes warned me that it also had a lower success rate: 75 percent compared with 95 percent. I was willing to take that risk.

After applying numbing drops and injecting local anesthesia, Byrnes placed a small probe in front of my eye directly over the tear; when activated, the probe created a localized freezing spot within the retina. The process creates an irritation that causes a scar to form, and this scar tissue holds the retina against the wall of the eye.

Byrnes then injected a gas bubble into the vitreous jelly inside my eyeball. This would push against the frozen tear in the retina and help seal it in place. The tear has to be in the upper half of the retina for the bubble to be effective. Luckily, mine was.

The procedure was over in less than 10 minutes. Success would depend on keeping the gas bubble pushed against the back of the eye, which meant I needed to go home, put my head down on a pillow on the kitchen table, and sit that way for three hours. After that, for another six hours, I would have to sit still, looking down with my head tipped at a 45-degree angle. That night, I would have to sleep sitting up with my head held erect, using pillows and duct tape across my forehead to attach my head to the wall behind the bed.

Sunday morning dawned — and I could see out of my right eye. My vision was blurry and partially blocked by what looked like several bouncing, purplish balloons, but I could see. The balloonish spots were the gas bubbles, which Byrnes said would be absorbed gradually.