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Dear Dr Misra, Thanks For Your Earlier Reply To My
Question: Dear Dr Misra,
Thanks for your earlier reply to my questions in the thread https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=390471
I have done another OCT recently on 8 July for both the LE and the operated RE, the OCT report is attached. The previous pre-operation OCT for RE, as well as the previous OCT report for LE (early XXXXXXX 2019) are also attached for reference.
Latest conditions:
RE vision-
vision acuity is 20/20 minus 2 (about 40 days post-operation), which is a bit worse than earlier result of 20/20 minus (two weeks post-operation).
Still see wavy lines, wavy edges of objects, blurry edges and slightly hazy vision , but slight improvement in the past two to three weeks
LE vision -
For my LE, my OCT shows increased thickness of fovea from 318 to 345 in a month’s time, seems very rapid.
My vision is still quite good with 20/20 minus but with mild symptoms of distortion (slightly wavy lines, a bit floating images) .
My questions –
1. For the RE, the fovea thickness now has improved to 345. My doctor said it may further improve may be to less than 300, but will not return to contour shape. Is it true? If true, why the contour shape cannot be resumed over a longer period of time, given that the epiretinal membrane has been removed and there should no longer be traction/pulling of the retina by the membrane?
2. If the fovea cannot return to contour shape and remain thicker than normal person, will it have adverse impact on the eye conditions /eye sight? (e.g. increased risk of macular edema or bleeding ? increase risk of macular hole and retinal detachment?
3. My RE has improved more notably in two weeks after operation, but since then seemed very little improvement. Still with way lines, especially for words or images on computer, still some double vision sometimes when seeing with both eyes. Wonder whether the improvement has stopped or can expect gradual improvement in next few months? What is the pattern of improvement in general after ERM surgery?
4. My left eyes has more symptoms of distortion now. Earlier after RE surgery, the pre-surgery unbalanced vision of both eyes has improved, but just a week ago, the unbalanced and uneasy feeling suddenly becomes more notable, just like the conditions before my RE surgery. Probably due to the worsening distortion of LE vision? Or the RE not recovering well? Or other reasons?
5. Is it rare for patient like my age (not too old) to develop ERM for both eyes and with such rapid progression for both eyes? I am worried that there are other underlying pathology or eye disease causing these conditions in both eyes. Is the OCT result conclusive of my disease (i.e. ERM)? Do I need to do any other tests to rule out other eye disceases/conditions?
6. My doctor suggest to observe and monitor the conditions of LE and do surgery if continue to be get worse. Any advice or things to note/alert according to your clinical experience?
Looking forward to your expert advice. Thanks much in advance.
Thanks for your earlier reply to my questions in the thread https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=390471
I have done another OCT recently on 8 July for both the LE and the operated RE, the OCT report is attached. The previous pre-operation OCT for RE, as well as the previous OCT report for LE (early XXXXXXX 2019) are also attached for reference.
Latest conditions:
RE vision-
vision acuity is 20/20 minus 2 (about 40 days post-operation), which is a bit worse than earlier result of 20/20 minus (two weeks post-operation).
Still see wavy lines, wavy edges of objects, blurry edges and slightly hazy vision , but slight improvement in the past two to three weeks
LE vision -
For my LE, my OCT shows increased thickness of fovea from 318 to 345 in a month’s time, seems very rapid.
My vision is still quite good with 20/20 minus but with mild symptoms of distortion (slightly wavy lines, a bit floating images) .
My questions –
1. For the RE, the fovea thickness now has improved to 345. My doctor said it may further improve may be to less than 300, but will not return to contour shape. Is it true? If true, why the contour shape cannot be resumed over a longer period of time, given that the epiretinal membrane has been removed and there should no longer be traction/pulling of the retina by the membrane?
2. If the fovea cannot return to contour shape and remain thicker than normal person, will it have adverse impact on the eye conditions /eye sight? (e.g. increased risk of macular edema or bleeding ? increase risk of macular hole and retinal detachment?
3. My RE has improved more notably in two weeks after operation, but since then seemed very little improvement. Still with way lines, especially for words or images on computer, still some double vision sometimes when seeing with both eyes. Wonder whether the improvement has stopped or can expect gradual improvement in next few months? What is the pattern of improvement in general after ERM surgery?
4. My left eyes has more symptoms of distortion now. Earlier after RE surgery, the pre-surgery unbalanced vision of both eyes has improved, but just a week ago, the unbalanced and uneasy feeling suddenly becomes more notable, just like the conditions before my RE surgery. Probably due to the worsening distortion of LE vision? Or the RE not recovering well? Or other reasons?
5. Is it rare for patient like my age (not too old) to develop ERM for both eyes and with such rapid progression for both eyes? I am worried that there are other underlying pathology or eye disease causing these conditions in both eyes. Is the OCT result conclusive of my disease (i.e. ERM)? Do I need to do any other tests to rule out other eye disceases/conditions?
6. My doctor suggest to observe and monitor the conditions of LE and do surgery if continue to be get worse. Any advice or things to note/alert according to your clinical experience?
Looking forward to your expert advice. Thanks much in advance.
Brief Answer:
ERM
Detailed Answer:
My dear,
Thanks for getting back to us.
I am glad that you had a prompt surgery with an excellent out come.Those hiccups of upper respiratory infection could be overcome before surgery.
There is gradual regression in thickness as observed by OCT.We can safely hope for this process of improvement to continue.
We very seldom encounter such rapid progression of ERM and immediately other eye being effected.What you have to basically understand that,though there are scientefic explanations about definetbpathilogical process of formation of ERM,there is an indevidual genetic makeup of person which decides these processes and their sequelae.There is not much we can predict about macular oedem and degenerations and macular hole,the only safeguard we have is regular follow up to manage if any of the issues crop up.
You seem to be in very good hands and have been adviced correctly that non operated eye will be observed closely for any progression to finalize further course of action.
The distortions in the operated eye may take longer to disappear as,even if the pull of ERM is gone,structural changes take longer to disappear.
Bottomline in your management is regular. lose follow up.
Hoping for a quick recovery.
ERM
Detailed Answer:
My dear,
Thanks for getting back to us.
I am glad that you had a prompt surgery with an excellent out come.Those hiccups of upper respiratory infection could be overcome before surgery.
There is gradual regression in thickness as observed by OCT.We can safely hope for this process of improvement to continue.
We very seldom encounter such rapid progression of ERM and immediately other eye being effected.What you have to basically understand that,though there are scientefic explanations about definetbpathilogical process of formation of ERM,there is an indevidual genetic makeup of person which decides these processes and their sequelae.There is not much we can predict about macular oedem and degenerations and macular hole,the only safeguard we have is regular follow up to manage if any of the issues crop up.
You seem to be in very good hands and have been adviced correctly that non operated eye will be observed closely for any progression to finalize further course of action.
The distortions in the operated eye may take longer to disappear as,even if the pull of ERM is gone,structural changes take longer to disappear.
Bottomline in your management is regular. lose follow up.
Hoping for a quick recovery.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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