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by Sharon Siddique, PhD
Managing Director
All For Eyes Pte Ltd
Managing Director
All For Eyes Pte Ltd
From the patient’s perspective, the field of ophthalmology has made enormous strides in perfecting surgical
techniques to treat various types of degenerative eye conditions. Many of us with low vision would indeed be
blind without them. This article is about my own experience in recovering from what has become a relatively
common day surgery, called a vitrectomy.
OVERVIEW
During a vitrectomy the surgeon removes the vitreous gel (fluid inside the eye). Vitrectomy is often performed
in conjunction with other procedures such as retinal detachment repair, macular hole surgery, and macular
membrane peel. The retinal surgeon performs the procedure through a microscope and special lenses designed
to provide a clear image of the back of the eye. Several tiny incisions are made on the sclera. and microsurgical
instruments are inserted through the incisions.
After the appropriate surgical repairs have been made, a gas bubble is placed inside the eye. The bubble
puts gentle pressure on the macula and helps hold the retina in place. It is imperative that the bubble floats
against the macula (back of the retina) during the critical healing phase, generally two or three weeks. Since the
gas rises, this is only possible when the head is in a face-down position. So, although the surgery itself may take
only an hour or so under local anesthetic, the success or failure of the operation is in the patient’s hands, as
maintaining this face-down posture is critical.
MY OPERATION
All this reporting sounds terribly clinical and reality only sinks in when it happens to you. In my case,
degenerative myopia had led to severe complications that required immediate surgery. Although there was no
pain, the sight in my left eye was blurred. I failed the finger test – that is, not only could I not see the eye chart, I
couldn’t count the fingers the nurse held up to test my visual acuity. My ophthalmologist had a devastating
diagnosis: a macular hole, a central detachment of my retina, and an advanced cataract in my left eye.
The morning after the diagnosis I checked into the day surgery ward for a four-in-one operation – perform a
vitrectomy, close the macular hole, reattach the retina, and insert an artificial lens. Prognosis? Best case -
because of my retinal atrophy and macular degeneration, some uncorrectable, residual, sight loss. Chances of
successful reattachment and closure of the macular hole at the first try - 75%. I decided that I would do my best to
improve my odds by – keeping my head down, of course!
OPERATION
I still find it incredible that this complicated, two-hour operation could be done as day surgery, and under local
anesthetic. Sedated, I was relaxed, and felt no pain. That is one of the most insidious things about serious eye
disorders. Often there is absolutely no pain. Lying on the operating table, there was a curious detachment as I
listened to the surgeon and the nurses. And, more wonders, I actually saw the tiny instruments positioning my
new lens into place – from the inside of my eye!
I had entered the hospital at 9:30am, and I by 4:30pm I was ready to go home. My left eye was bandaged,
and I was determined to do whatever I could to ensure that I was one of the post-operative success stories. My
doctor had emphasized that I must keep my head down 24 hours a day. This made sense, as I realized that my
eyeball was filled with a gas bubble, and the head down position would ensure that the gas bubble kept pressing
against the retina, keeping it in position. Keeping this mental image, keeps up the resolve. Sounds simple
enough. Until you try it.
RECUPERATION
As soon as I reached home that first evening, I decide that “head down” meant that, no matter whether I was
sitting, standing, walking, or lying down, my eyes must always be facing the floor. No raising the head. If I wasn’t
staring at the floor, there should be alarm bells. Keeping your head down takes real discipline. You have to
constantly guard against the reflex to simply raise the head to its normal position.
Lucky for me, I had three supportive daughters. They bought me a massage chair. This chair allowed me to
redistribute my weight in a kneeling position, with the stomach and chest leaning against a support, and with a
padded hole as a headrest, so that my eyes faced the floor. Sitting normally in a chair was also possible, as long
as my eyes faced the floor. Eating was no problem. But drinking anything – including soup – meant always using
a straw – otherwise up would come the head.
Sleeping was a bit more challenging. Again, daughters to the rescue. They bought me a massage table. By
placing my head in the hole in the table, I could sleep with my eyes literally fixed on the floor, and I did not need to
worry about rolling over in my sleep. Also I experimented with the airline inflatable pillow/neck rests. They are
great. They need to be inflated until they are quite hard, and then fitted in a reversed position around the neck,
with the solid part of the pillow under the chin. Using this, it is possible to lie on the bed, on your stomach, with the
airline pillow keeping the head locked in an eyes-down position – again, without danger of accidentally rolling over.
The only time I allowed myself to raise my head was to put in the prescribed eye drops four times a day. And
to clean the eye (lid wipes are great), and retape the eye shield. I never had any pain in the eye. But I did have
several painful side effects. After a couple of days, it became apparent that keeping my head down was leading
to a collection of fluid in my face, and the sympathetic swelling and tearing of my good right eye. Gravity was at
work. But my doctor congratulated me. He said that my swollen face was proof that I was, indeed, keeping my
head down. What was very painful were the cramps in my neck and shoulder muscles. I solved this by getting my
massage lady to come every other day to give me a shoulder massage. Real bliss!
Another great challenge was keeping clean. Showering was manageable. I just removed the shower head
from the shower socket, and kept my head dry and down!. Hair washing was trickier. Before showering and
washing my hair, I would seal the left eye shield with tape all around to prevent water from entering my eye. Then
I turned the water down to a trickle, and carefully shampooed my hair. This was all done without lifting my head.
After the shower I would remove the wet eye shield and tape, put the eye drops, clean and dry the eye shield, and
replace the tape holding it over my eye. What a relief!
After a few days, boredom set in. As there is no pain, you are not really ill. And you begin to think of what
you can do other than eat, sleep, shower, and sit. Walking is restricted because it is not possible to see where
you are going without putting your head up. One life-saver for me, again thanks to quick thinking daughters, was
books on tape. There are hundreds of titles, and they come on cassettes as well as CDs. I found listening to
books a new and interesting way of assimilating information.
There is also TV without the pictures (keep the head down). And of course, the radio. And then there are
friends who visit, and time for long conversations. One more tip – it really helps to keep shifting position. A couple
of hours on the massage table listening to books on tape, or the radio. Switch to sitting on the sofa chatting with
friends. Then some time on the massage chair listening to the TV. Shower. Have a meal. A drink (through a
straw). The days pass.
My regular eye check-ups, my only outing, went from every day, to once a week. The vision in the left eye
began to slowly clear. At first, I could discern vague shapes and colours. After a couple of weeks, if I raised my
head and looked straight, I could see quite clearly out of the top 1/8 of my visual field. Colours were quite brilliant
and I realized that the cataract must have been quite advanced. The rest was blocked by the gas bubble, which
wobbled around, creating a kind of blurring and magnifying effect. I also felt brave enough to do without the eye
shield. After two weeks of practice, I had the head down sitting and sleeping well perfected.
I became much more aware of the gas bubble when I could finally raise my head, after about 3 weeks. Also
the swelling in my face rapidly cleared. As the bubble shrinks, it is like looking at the world through a bowl of
wobbly jelly. As the bubble shrunk, the visual acuity improved. There was some macular damage – a blind spot
– in my central vision. The shrinking gas bubble was like a sinking sun, and like the sun, it gave off “rays” – quite
irritating. About 8 weeks after the operation, I last vestiges of the bubble disappeared. But this setting sun has
opened a whole world of new vision.
SUMMARY
I’m one of the lucky ones. But because of my high myopia, I will always have to be vigilant. As is often the
case with degenerative eye conditions, there is no final “end” to the experience. There are four things that one
can do to try to preserve as much sight as possible, for as long as possible.
FIRST, watch for any sign of a change in your eyesight. Here the trick is to strike a balance between being too
paranoid, and not vigilant enough. In any case, don’t miss the regular eye checks.
SECOND, look after your general health: regular exercise (walking and swimming are safe), keep your blood
pressure and weight under control, don’t miss regular physicals and blood tests to test for diabetes and
cholesterol.
THIRD, I believe in vitamins, particularly anti-oxidants, and also in the many herbs which have been associated
with good eye sight, like eyebright, bilberry, and Chinese wolfberries, and of course, lots of green and yellow
fruits and vegetables.
FINALLY, I am grateful for the fact that the science of ophthalmology, and its most advanced surgical techniques,
have been used to give me back my sight. For the first time in many years, I am upbeat. I can dare to hope that
medical science will keep ahead of my deteriorating eyesight. After all, as I have learned, seeing is believing!
