NFL coach of the Minnesota Vikings, Mike Zimmer, just had a retinal detachment to his right eye.
He has had several “surgeries” over the past 30 days to the same eye. While the exact details are not known, there is a lot we can learn from his recent experience.
What we do know is;
A retinal tear was discovered and treated around October 31.
A second operation was performed a week later.
Emergency surgery for a retinal detachment was performed on November 30.
Retinal Tears Cause Retinal Detachment
All retinal detachments start with a retinal tear. It has been my experience that most retinal tears simply “happen” and without trauma.
Retinal tears can happen to anyone. Retinal tears usually, but not always, are associated with sudden onset flashes and floaters, but they can be asymptomatic.
This may have happened with Coach Zimmer. Several accounts stated that his retinal tear was discovered after he scratched his cornea.
No, corneal abrasions can not cause retinal tears.
Treatment of Retinal Tears
The ideal treatment of a retinal tear is laser. If laser is not an option, due to the location of the retinal tear, cryotherapy, or freezing, is an excellent treatment.
Both work equally well in treating retinal tears in situations where there is no element of retinal detachment. Cryotherapy may be more uncomfortable.
I do not know if the second surgery was needed because additional tears were discovered or he developed a retinal detachment.
What is important to highlight is that additional retinal tears can occur and/or a retinal detachment could develop after treatment of an initial tear.
Treatment of Retinal Detachments
There are several ways to treat a retinal detachment. Depending upon the location of the retinal tear causing the detachment, intraocular gas may be injected into the eye which requires specific head positioning afterwards to keep the gas pushing on the retinal tear. This is an “in office” procedure.
Two other ways to fix a retinal detachment include a vitrectomy and/or scleral buckle. These may be used along with intraocular gas, too.
Regardless of the procedure, if intraocular gas is used to repair the retinal detachment, airplane flight or traveling to higher elevations is not possible.
Too rapid a decrease in atmospheric pressure can lead to expansion of the gas inside the eye. If this occurs too rapidly, the eye can not adjust to the increase in eye pressure caused by the expanding gas. The high pressure could prevent normal blood flow into the eye.
This explains a few remarks about his driving to Florida for the game against the Jaguars. No remarks about head positioning.
Not all retinal detachment surgery is an emergency. A retinal detachment starts off small and can spread. If the macula, the functional center of the retina is attached, but may become detached by waiting, it can be an emergency.
I wish Coach Zimmer well. I wanted to highlight his retinal detachment to emphasize a few points about retinal detachments in keeping with the headlines.
Happy Thanksgiving – wherever you might be. I wish the best to you and your family during this Thanksgiving holiday. Thanksgiving is celebrated 11/24 in the U.S.
Amy and I are looking forward to all the family that can convene at our house on Thursday. As of August we became “empty nesters” with the younger two leaving; one to college and the other to play juniors hockey.
Not all the kids will be able to make it home. We are still getting used to the empty house and it will be tough not to have everyone together, but we understand it’s a necessary evil of having them grow up.
Frying Turkey and Eating Well
As has become a tradition, we are frying a turkey. Here’s a video of how I fried a turkey, 2015. We gave up the oven roasted version a few years ago. That particular Thanksgiving we had several turkeys. No one touched the oven roasted and the fried were devoured. Message was received.
A few years ago, I wrote entitled Eat Right…See Good!: Eye Nutrients and the Thanksgiving Repast. There are just a few tidbits of information which might become useful if the conversation gets a little dry when you are eating on Thursday. It’s a lighter view of dissecting what we are eating and how it might affect your eyes.
My Apology for Laziness
I apologize in the long delay and inconsistency of my posts. I’m in the midst of trying to consistently post on RetinaEyeDoctor.com (here), YouTube and a podcast. It has taken a lot more time than I had initially thought.
At the same time, I am expanding our subject matter from retinal diseases of the eye to all of general ophthalmology. Similar subject matter will posted across the different platforms. The idea is to provide patient education across what ever type of platform you prefer;
Reading a website/blog article
Watching and listening to a video
Listening to a podcast
Please Share, Subscribe, Download
I have an ambitious goal of reaching 100k readers per month. This will take some work on my end, but by expanding the content, I should be able to keep this informative, relevant and interesting.
To help me in this endeavor, please share articles, videos or podcasts which may be of interest to your friends and family.
This article is contributed by Alaina Kronenberg MD, a cataract specialist in Dearborn, Michigan. I asked her to write this article to better explain cataract surgery after a vitrectomy. I hope you enjoy the article.
A vitrectomy is an operation when a retinal specialist cleans out the jelly in the back of the eye (the vitreous). This is may need to be performed if you have a retinal detachment, bleeding into the vitreous and to sometimes obtain better access to the retina so your surgeon can fix many various problems on the retina.
If you need to have a vitrectomy, it is very likely that the surgery will cause you to develop a cataract. A cataract is when the natural lens inside the eye becomes cloudy. The cataract can sometimes develop fairly quickly after your retinal surgery.
If the cataract develops to the point that it interferes with your day to day vision, your comprehensive ophthalmologist may recommend that it is removed. The purpose of the cataract surgery is to improve your vision as much as possible.
If you have the start of a cataract before your require a vitrectomy surgery, often your comprehensive ophthalmologist and retinal surgeon may agree to remove the cataract before your retinal surgery. This is often recommended because it is safer to remove a cataract before retinal surgery.
Cataract Surgery After a Vitrectomy
Cataract surgery after a vitrectomy has a higher risk of a complication. The vitreous usually supports the capsule of the cataract. If the vitreous has been removed, it is often more floppy with a higher risk of being damaged during cataract surgery. Also, sometimes the capsule that surrounds the cataract was damaged during the vitrectomy. There is a higher chance you will need more that one surgery to completely get out the cataract if you had a prior vitrectomy.
Patients who have had cataract surgery after a vitrectomy need to have realistic expectations on the improvement in vision they may experience. If you have had a prior vitrectomy you also may not be a good candidate for some of the premium implants that help correct both distance and near vision.
To become a Retina Specialist, I had to first go to college and medical school and do an internship and then a residency and then, finally, I did training to sub-specialize. So, let’s break it down.
After High School, I went to Haverford College and I got a BA in biology; that took four years. Right after college, I went to medical school.
Specifically, I went to Jefferson Medical College, located in Philadelphia. That was a four-year program, and when I graduated from Jefferson, I was now an M.D. with no specialization.
Bryn Mawr Hospital | Internship
Right after Medical School, I went to the Bryn Mawr Hospital outside of Philadelphia. For one year, I was an intern in their Internal Medicine department; it has nothing to do with ophthalmology, but my internship served as a pre-requisite, so that I could get an ophthalmology residency.
After my internship at the Bryn Mawr Hospital, I then became an ophthalmology Resident at Georgetown University, and this was a three-year program. At the end of that Residency, I was finally a general ophthalmologist.
Fellowship for Retina Specialist
It was pretty clear to me during my ophthalmology residency that I was going to subspecialize – or, I wanted to subspecialize – in diseases of the retina. I wanted to become a retina specialist.
So, after I finished residency at Georgetown University, I then took a Fellowship. This is additional subspecialty training, and I went to Memphis, Tennessee so I could be a Retina Specialist under the tutelage of Steven Charles and Maurice Landers.
After completing my Retina Fellowship, I was now a Retina Specialist. After that, I just had one more test to take and that was to become Board Certified.
Board Certified Ophthalmologist
I am a Board Certified ophthalmologist which means I am Board Certified in General Ophthalmology, not Retina. There is no board certification for a retina specialist, at least at this time. So, after my Fellowship, I had to take a test, and passed, to test my knowledge on all general ophthalmology. Once I did pass that, that allowed me to say that I was a Board Certified Ophthalmologist.
Here are some causes of blurry vision following vitrectomy eye surgery. These are temporary causes and should resolve in a short time.
There are other reasons that may blur your vision, but those reasons may be related to the particular eye disease for which we are operating.
An Eye Patch Causes Blurry Vision
After every vitrectomy, an eye patch is placed to keep the eyelids closed against the eye. There really no medicinal use of a patch other than comfort.
The pressure required to keep the eyelid closed is also enough to temporarily change the shape of your cornea. In a sense, we are artificially creating astigmatism.
Any alteration to the smoothness of the cornea or its shape can cause significant changes in your vision.
Blurriness from the patch usually resolves the same day.
Dilating Drops Cause Blurry Vision
Dilating drops are a very common cause of blurry vision. The drops dilate the pupil allowing me to see inside your eye and perform the operation.
The same drops also paralyze the muscles used to help you focus.
We usually use dilating drops which are slightly stronger than those used routinely in the office, hence, the dilation lasts longer.
Blurry vision is caused for two reasons. First, more light is allowed into the eye. Most of the this extra light needs to be focused.
Second, your eye can not focus normally because the focusing muscles (ciliary muscles) are paralyzed.
Blurry vision from the drops can take a few days to reverse.
Sometimes I elect to close the small entry wounds, called sclerotomies, with absorbable stitches (aka sutures). The wounds are adjacent to the cornea, but close enough to cause some warping or bending of the cornea if pulled too tightly.
This should all reverse when the sutures fall out by themselves.
Most vitrectomies these days are sutureless, so this has become less of an issue.
Any questions or comments? Please feel free to add them below!
Welcome! I’m Randy Wong. Thank you very much for watching this video. Today we are going to talk about retinal detachments.
We are going to talk about;
The definition of a retinal detachment
What it can cause – the signs and symptoms
Surgery to fix a retinal detachment
Timing – when is the best time for surgery?
I hope you enjoy this.
Rhegmatogenous Retinal Detachment
Today we are going to talk about 1 of 2 types of retinal detachments. We are going talk about rhegmatogenous retinal detachments and, by definition, that means the detachment is caused either by a retinal hole or retinal tear.
The hole or tear allows the fluid from the middle of the eye to communicate to a space underneath the retina. So therefore if fluid accumulates underneath the retina through this hole or tear, the retina detaches.
Keep in mind a retinal detachment is potentially blinding. So as we will talk about later, there is some urgency, or sometimes it’s an emergency, to fix a retinal detachment.
Symptoms of a Retinal Detachment
Symptoms of a retinal detachment include loss of your peripheral vision and usually the peripheral, or side vision, is involved first and the loss of vision moves centrally.
Flashes and floaters are also commonly associated with a retinal detachment because those are usually signs of a retinal tear that you may have sustained.
So, the recommendations are that new flashes and new floaters should be examined by your doctor and your doctor ought to be looking for a retinal tear because it is our job to try and prevent you from getting a retinal detachment if we can diagnose a retinal tear.
Again, symptoms of a retinal detachment include; loss of peripheral vision, especially if the vision loss is moving centrally, new flashes and new floaters.
What Do You Do? (When to call your eye doctor)
What should you do if you think you are having a retinal detachment? Maybe you’ve noticed an increase in flashes, an increase in the number of floaters or you are losing your peripheral vision.
My suggestion would be to let your own eye doctor know that you are having these new symptoms.
Once you arrive at your eye doctor’s office you need to get your pupils dilated. By dilating your pupils your doctor can directly examine your retina and if he diagnoses, or she diagnoses, you with a retinal detachment, you are going to need surgery.
Unfortunately, there are not any drops or medicines to fix a retinal detachment.
Retinal Detachment | Surgery
There are three ways or three methods to fix a retinal detachment. The first is called a pneumatic retinopexy. The second is an operation called a scleral buckle and the third is an operation called a vitrectomy.
A pneumatic retinopexy involves injection of gas into your eye. The gas is used as a tool to help reattach your retina. With a pneumatic retinopexy, depending upon the location of the tear, you may have to hold your head in a certain position.
This is sometimes face down, this is sometimes keeping your head straight up or to the right or to the left. Again, the positioning depends upon the location of the tear.
A pneumatic retinopexy can be done in the office and can be very effective in fixing retinal detachments.
A second way to fix a retinal detachment is with a scleral buckle. A scleral buckle involves placing a silicone band or rubber around the outside of your eye.
Don’t worry, it will be completely unnoticed once you’ve healed up. It’s intended to stay there.
A scleral buckle is a very effective way to repair a retinal detachment and has been around for several generations. It does require surgery and the most common complication of scleral buckle surgery is the increase in nearsightedness after the operation because your eye is actually made slightly longer.
A third way to fix a retinal detachment is with a vitrectomy. Remember a scleral buckle involves placing an element or a piece of rubber around the outside of your eye.
A vitrectomy involves going inside the eye to remove the vitreous and the fluid underneath the retina. Many times gas is also put into the eye at the end of the operation and just like pneumatic retinopexy you may have to hold your head in a certain position.
Vitrectomy and Scleral Buckle
So there are three ways to fix a retinal detachment: either with pneumatic a retinopexy, a scleral buckle or a vitrectomy.
Now, many times, surgeons may decide to combine both a scleral buckle and vitrectomy. This is really personal preference and all surgeons have different indications as to when to perform both.
Timing of Retinal Detachment Surgery
The timing of retinal detachment surgery is really dependant upon whether or not the macula, which is the functional center of your retina, is, what we call “threatened.”
Another way to look at it is;
“What’s the chance of you losing your central vision if we delay surgery”? If you have a retinal detachment which is not threatening your macula, therefore, it’s not threatening your central vision. Waiting a day, or longer, probably is appropriate.
Another situation is where the macula is already detached which would mean that your central vision is already lossed. Again, this is an urgent situation but not an emergent situation.
Probably the only time where retinal detachment surgery is an emergency is when you still have 20/20 vision, that is, your central vision is intact, but your doctor feels that if your retinal detachment were to enlarge your central vision might be in jeopardy.
Summary of Retinal Detachments
To summarize, we’ve talked about retinal detachments, specifically we’ve talked about rhegmatogenous retinal detachments and those are retinal detachments that involve a hole or tear in the retina.
We talked about symptoms of retinal detachments; new onset flashes, new onset floaters or loss of your peripheral vision.
We talked about surgery. The three options are pneumatic retinopexy, scleral buckle and/or vitrectomy.
We talked briefly about the timing of surgery…it’s all dependent if your central vision, or your macula is involved.
Thank you for watching!
I’m Randy Wong. I’m a retina specialist in Fairfax, Virginia. Thank you very much for watching this video. I hope you enjoyed it.
By the way, if you have any questions or comments, please leave them at the end of this video on YouTube or at the end of the article if you are reading this on one of my blogs.
If you are an existing patient of Capital Eye Consultants and you would like to remain my patient, please feel free to schedule a follow up appointment at either office.
I would suggest you authorize Capital Eye Consultants to release your records.
New Patients | Want to Make an Appointment?
If you are a new patient and would like to make an appointment, simply make a call!
My schedule is still evolving at both locations, but I am sure we should be able to accommodate you.
Woodburn Surgery Center
I will continue to operate at Woodburn Surgery Center. I have been associated with Woodburn since 2003. It is a top-shelf outpatient surgical center and is one of the best in the region.
I am particularly proud of the surgical teams we have assembled to take care of my patients including the pre-operative staff, those who assist me in the operating room, the nurses who initiate your immediate post-operative care and, of course, the anesthesia providers.
Happy New Year
I have been very inconsistent in the past year with regard to this website. My goal for this year is to produce more video content on this website. These videos will be augmented by the usual text.
I have been “practicing” with some new cameras and software over the past few months and I hope to start the new format very shortly.
Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists.
In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.
Virginia Lasik | Office of Anh Nguyen, M.D. Randall V. Wong, M.D. Contact: Layla
A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046