It started late on a Thursday afternoon last May, when I noticed a wispy dark shadow in the lower left corner of my right eye. At first, I didn’t worry about it. But being 62 at the time — a baby boomer — I should have.
For years, I have had “floaters” in both eyes. Small moving spots that appear in a person’s field of vision, floaters typically occur when tiny pieces of the eye’s gellike vitreous humor break loose within the inner back portion of the eye. While annoying, ordinary floaters are very common and rarely are cause for alarm.
But a sudden burst of floaters can be a warning sign that a tear is starting to develop in the retina, the light-sensitive membrane in the back of the eye. An early-stage retinal tear can be treated in an eye doctor’s office with laser surgery that creates a weld around the edges of the tear and usually keeps the retina from detaching, according to Vinay Desai, an ophthalmologist with the Retina Group of Washington (RGW).
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. (It also affects more men than women, the NEI reports.)
Many spontaneous tears occur in boomers who develop posterior vitreous separation. This degenerative condition occurs in 30 percent of people older than 50, according to William L. Rich III, an ophthalmologist based in Falls Church.
“Most people think retinal detachments come from trauma, such as being hit by an air bag in an auto accident or getting hit with a racquetball or tennis ball. In fact, most happen while you’re walking down the street or even sleeping,” Rich says.
“As we age, the vitreous jelly, which holds the retina in place, begins to liquefy,” Rich says. “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, leaving an urgent message with the after-hours answering service.
Calling back within minutes, 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’s 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.”