Case Study: Steven
Ask Steven about his experiences with vitrectomy surgery and he doesn’t equivocate.
“Quite literally, my life has been changed,” he says frankly. “I can read. I can do my hobbies. I can do all the things I was beginning to think I’d never be able to do again.”
“Quite literally, my life has been changed…”
Steven, 55, is no stranger to issues with his eyesight. As a child he suffered from a lazy right eye, which left him totally dependent on his left eye for vision. He wore glasses routinely, but in his early 50s began to notice that this same eye was becoming cloudy. He was subsequently diagnosed with cataracts and had an operation to remove them and implant a corrective lens.
For about eight months, everything was fine – until, quite suddenly, his corrected eye took a dramatic turn for the worse.
“It literally happened overnight,” he recalls. “I remember bending over over at one point the day before and getting a slight pain in the back of my eye. But I just thought it was a migraine or something like that.
“So I went to bed that night as normal, got up the next morning, opened my eye and – bang – it was full of ‘objects’. There was a matchstick-sized one right across the eye and a spider web of patches over the rest of the eye. I couldn’t read or anything like that. It was horrendous.”
In A&E, the doctors diagnosed Steven with posterior vitreous detachment (PVD for short), a condition where the vitreous jelly in the eye separates from the retina. Although PVD is common – and in most cases painless and harmless – it can be a red flag for retinal detachment, a much more serious, sight-threatening condition that requires immediate treatment.
With or without retinal issues, however, PVD can cause tiny opacities to appear in a person’s field of vision. These are known as floaters. They vary in kind from small dots and rings to general cloudiness or a cobweb effect. They are also more common in patients who, like Steven, have previously had a cataract operation.
Over the next few months, Steven sought advice from a number of specialists. The general feeling was that he would need to sit tight and wait for his brain to become accustomed to the changes – in effect, to get used to it. Understandably, this didn’t feel like the news he had been hoping for.
“I just thought, I’m not having this,” he laughs drily. “And after three months, nothing had changed whatsoever. So I started to do my own research.
“One of the specialists mentioned a possible operation called a vitrectomy, but said it wasn’t really recommended unless there was underlying damage to the retina. He also said it could be invasive and would require a general anaesthetic.”
In his research, however, Steven came across Andrew Luff’s work at Sapphire Eye Care. Mr Luff is a specialist in vitrectomy surgery for floaters and performs over 100 such operations every year. Encouraged by what he read, Steven plucked up the courage to make contact.
“He also said we could do the surgery under local anaesthetic, and that no stitches would be needed in my eye. So I came away very reassured.”
“I booked an appointment to see him, though it was with a bit of trepidation! But the whole thing turned out to be so enlightening. He listened to all my problems and concerns. He took detailed scans of my eyes. And then he used a model of an eye to talk me through the operation and the possible risks. He also said we could do the surgery under local anaesthetic, and that no stitches would be needed in my eye. So I came away very reassured.”
In a vitrectomy for floaters, the surgeon makes three tiny incisions in the eye, removes the vitreous jelly that has become clouded with floaters and replaces it with a transparent saline solution. If he also discovers evidence of retinal tears or weakness (which could predispose a patient to future retinal tears) while carrying out the surgery, he can then treat these areas with a laser to prevent subsequent retinal detachment.
A few weeks after the appointment, Steven came back in for his operation. He was nervous, but says the team were able to make him feel at home. “All the staff were superb, which really eased the day and any nerves I had,” he explains.
“When you get to the hospital, they describe exactly what will happen and what the anaesthetist will do. You have a couple of jabs around the outside of the eye to anaesthetise it, which I didn’t even feel. You can also have a sedative to help you relax.* That’s optional, but I decided to have it; it’s just a small jab on the back of the hand. From that point you’re aware of everything that’s going on, but you don’t feel anything.
“I think the operation took about 40 minutes, and in my case there was no damage to the retina so I didn’t need to have the gas treatment. They put a patch over your eye to protect it and I left hospital about an hour later. There was a small amount of bruising under the white of the eye, and a slight amount of discomfort for the first couple of days, but you just take a little paracetamol for that.”
When Steven removed the patch the next morning, the change was already obvious. “Immediately I took it off, I could see the floaters were completely gone. It was quite incredible. My distance vision was a bit affected by the drops that you take for the first month, but once I stopped those it came back perfectly.”
Three months on, Steven feels the decision to go ahead with the vitrectomy has been justified, to put it mildly.
“I’m absolutely delighted,” he says. “I’m staggered by the clarity of vision and the beautiful, vivid and bright colours – much better than before my PVD. As well as removing the floaters, it has also removed all the opaque jelly.
“If you have floaters and have been told you need to get used to it, there is a solution,” he adds. “I can now read again. I can do all my hobbies again. The difference has been incredible. I have no hesitation whatsoever in recommending it, or Mr Luff and his team.”
* Sapphire Eye Care offers intravenous sedation to all patients, delivered by a Consultant Anaesthetist.