Why Vision is Poor with Silicone Oil

Why your vision is poor following silicone oil for retinal detachment surgery.

There are many reasons why you may not see well after silicone oil is used for your retinal detachment eye surgery.  Remember, retinal detachments are potentially blinding conditions and silicone oil is often used for repeated detachments.

Did Your Macula Detach?

One major concern with every retinal detachment is whether or not the macula becomes detached.  The macula is the most sensitive part of your retina.  It provides central vision, reading ability, color vision, etc.

One goal of retinal detachment surgery, if possible, is to fix a retinal detachment before it spreads large enough to detach the macula.

If the macula detaches, you my lose permanent central vision and/or develop distortion regardless if the surgery is successful.  Thus, if the macula detached at any time, there may be some permanent loss of vision.

Was Your Lens/Cataract Removed?

Silicone oil is rarely used during “primary” retinal detachment surgery, meaning we usually don’t use silicone oil unless the retina repeatedly detaches.  So, too, is the necessity to remove the cataract, or your natural lens, during retinal detachment surgery.

If your lens was removed, this might impact your vision, too.

Index of Refraction

This is a fancy term referring to the ability of light to be focused in oil versus water.  Light is focused differently depending upon the medium, or liquid in the eye.  For instance, replacing the natural saline solution and the vitreous (i.e. during a vitrectomy) with oil would change the power of your glasses or contacts.

Too Much Oil

Oil and water focus light differently, therefore, your vision will change simply because the medium (water/vitreous exchanged for oil).

Filling an eye with silicone oil can be tricky.  Eyes come in all sizes and therefore require different volumes of oil.   We have to use our best judgement when filling the eye with oil.

The perfect amount of oil fills the entire back of the eye and stays behind the iris.  In patients where there is no lens, too much oil can move forward through the pupil and decrease the clarity of the cornea.

Too Many Retinal Detachments

Many times eyes lose vision due to damage to the retina or cornea simply from repeated detachments and surgery.  That is, while oil may be used to prevent complete loss of the eye (often the case), there has already been permanent damage to some of the ocular tissues and, thus, poor resulting vision.

What Does This Mean?

Retinal detachments are difficult to understand.  Communication with your doctor is essential, though I realize we doctors vary in our ability communicate effectively.

Silicone oil is often used as a last resort to prevent further operations.  As you can see from the list above, just by putting oil in the eye, the vision is reduced.  This fact, coupled with the necessity for future surgery to remove the oil, prevents most of us from using oil during the initial surgery.

There is a difference between successful surgery, i.e. getting the retina fixed, and seeing well.  They don’t always go hand in hand, especially in cases where there have been repeated retinal detachments….the most common use of oil.

In the end, ask your doctor why she thinks you are not seeing.  If the answer you are receiving does not make sense to you, seek a second opinion.  You have a right to understand.

 

 



Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***

Comments

  1. BC,

    Without a doubt a second opinion may be helpful to you. It may not change the course of your eye, but it may help you have a better understanding of what’s going on. Clearly, you and your present retina specialist need to connect.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Northern Virginia
    Fairfax, VA. 22030

  2. Hi doc why did I developed floaters after a focal laser macular edema treatment my doc said that they will eventually go away but I’m not sure now these is my left eye and the only I eye I can see good from I’m 29 years old and I’ve being diabetic for 15 years now on December 25 2013 I woke up with some blocking my right eye vision and I rushed my self to the e.r and was told I had a vitreous hemorrhage so they reffered to a retinal especialist I got injection treatment in both eyes and the laser treatment in my left eye my doc wanted to wait for my blood from my right eye to absorve it self but then on my next visit I told him that I felt that the bleeding was increasing so he did a scan and agreed there was a lot more blood so he scheduled me for a vitrectomy surgery the morning after the surgery he explained to me that he had problem removing the blood because it was really orgaanize and stuck to my retinah he said it was a rare case and ask if some one had punch me in the face my answer was no .so he said do to that he had to bring part of my retina with him and injected sillicon oil I only had to face down one day I got a follow up two weeks after and he checked and it was a good start up and wanted to see me in one month that month came yesterday with a bad news he said my retina is lifting up and most likely I will have to go for a second surgery but he wants to monitor it for one more week now I’m clue less and live day by day thinking what’s going to happend ……what’s is more likely for him to do in this new coming surgery????? Now I dont think his paying much attention to my left eye anymore I keep telling him I still have floaters its being two months since I developed them …will they ever go away or is it a sing of something else?? plz help

  3. Marco,

    I really can’t help you with your questions as I can’t examine you. The floaters could be blood or be related to a retinal detachment. I have no idea. I would ask your doctor if he/she feels your retina is detaching and is the cause for additional surgery.

    I wish I could help more!

    Randy

  4. Thanx doc Wong unlucky the next day I posted my questions I was watching tv and I started to see really foggy from my left eye we’re I have the floters and since my wife was cooking I ask her to open the doors and windows but she said it looks normal in here so I got worried and went out while her saying r ok I said i dont now something is not right so I ask her to take me to a store since they have more bright lights so I walked in n out and I told her take me to the e.r im sure something is going on so we went and I was told iwas a new hemorrhage and they made an appointment with a random optomologist the next morning so she checked and said theirs deffecnetly new blood floating in there she only suggested me to follow up with my normal optomologist doc and that he will decide what to do but that most likely I was going to get a new operation now when I notice this chance the blood seen really darker than right I will say it decrease a lol bit but im not sure I just have to wait to see my doc .I also have to say that the of my last visit with my optomologist I told him to check my left eye but it wasn’t dilated so he said lets do it on ur next visit and the next day its when this happen now I think that maybe if he would had checked ill be doing ok right now ..thx for ur reply

  5. Marco,

    A vitreous hemorrhage from diabetic retinopathy can sometimes take a while (weeks) to stop. Stay well.

    r

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