Would this increase of epinephrine/adrenaline also contribute to more frequent photopsia? Also, how long a period would this increase of epinephrine/adrenaline last and impact of these symptoms (ie, floaters, photopsia) ? In addition to the lines/floaters, I notice an increase of photopsia after more intense exercise, that continues for days after the exercise session and than gradually declines in frequency and intensity.

Btw, six weeks post laser retinopexy, my Retinal specialist indicated that I could engage in any level of exercise I wish BUT four weeks later, after informing him of the increase of floaters and photopsia after exercising and even though his examination of my retina revealed no new tears, he advised me not to “push” the exercise! Any thoughts as to why he would come to this conclusion (unfortunately he did not elucidate the reasons for his caution)?

Thanks again.

Ralph

If you agree that the vitreous is basically a closed space, that is, particles are not free to move in and out of the eye in a matter of minutes or hours, I don’t agree with exercise “stirring up” anything. Other than blood, “floaters” don’t settle out.

My explanation for the increase floaters related to exercise is a relative increase in epinephrine/adrenaline causing pupillary dilation. More light enters the eye making the floaters more apparent and obvious.

Randy

Although I am certain that you are correct regarding the impact of REM on the retina, isn’t it possible that rigorous exercise can “stir-up” the vitreous resulting in one’s perceiving more floaters of various sizes and shapes?

On another website, the Degenerative Vitreous Community, a significant number of posters note that exercise appears to exacerbate the extent and intensity of their floaters. Although anecdotal, I have experienced a similar situation.

Regards,

Ralph

Obviously, I can not examine you, but based upon your comment, the “waviness” must be considered part of the “floaters.”

I, on the other hand, do not recommend changing your exercise routine. Every evening you experience REM sleep, a normal stage of sleep where the eyes beat to and fro and cause tremendous forces inside the eye. These forces are as strong as anything you’d be doing during your exercise routine.

Randy

I have been experiencing a disturbing symptom that has occurred since I developed a PVD and retinal tears in one eye (which were repaired by laser treatment), that perhaps you can clarify. In addition to ongoing flashes of light that have been continuing for over five months and floaters, I experience intermittent “waves” of lines (for want of a better term) that scurry across my visual field in my left eye from the temporal area. According to one Specialist in Retinal Disease this is merely a sign of the shrinkage of the vitreous and these “scintillating” lines are a sign of this process and are akin to floaters. Another Specialist indicated that it was symptomatic of a ocular migraine, although there is no scotoma or any other symptoms of this condition.

A comprehensive exam of the retina this past week indicated that there was no evidence of any new tears or pathology and that the scars from the laser retinopexy healed nicely. However, I notice that the more intensely I workout the the more prevalent are these “lines” and floaters. In fact, when I ceased working out for a period of time after I had the laser repair these symptoms dissipated significantly. At the conclusion of my retinal exam this past week I was told that I should not “push” the exercise and should only walk briskly and lift moderate weights. My vision remains 20/20 and my IOP in the affected eye was 12. I have some lattice degeneration but not significant.

Dr. Wong, your impressions of these symptoms would be greatly appreciated as well as your thoughts about the extent of exercise a patient in my situation should participate in.

Thank you

Ralph

I am at a loss! I can’t come with a feasible explanation. From a statistical point of view, however, you have 2 eyes and 2 ears, thus you have a 25% chance of both having symptoms. Perhaps just a coincidence.

Randy

My Internist indicated that there may be a relationship between my prolonged period of photopsia (due to a PVD) and unilateral tinnitus. He indicated that both retinal and cochlear tissue are basically brain related structures and in some situations, such as retinal circulation problems, tinnitus may be an early symptom of important neurological problems!

Do you agree?

Thanks, kathy

I’ve never been able to classify types of distortion. By example, a telephone pole, the edge of a door and the lines on an Amsler grid are all straight. Any perturbation other than straight is distortion. The distortion should not vary, that is, it shouldn’t become better or worse with glasses/contacts. There are other causes of distortion, but it is impossible to tell without examination.

I personally don’t feel that there is a correlation between duration of flashes/floaters and developing an ERM.

All the best,

Randy

When you mention that epiretinal membrane can cause distortion in one’s vision, could you kindly be more specific regarding the kinds of visual distortion you are referring to?

Also, do you find that patients who experience significantly prolonged or unreolved periods of flashing lights and floaters due to a PVD have a greater penchant towards developing ERM?

Thanks again.

Jackie Daniels

I believe you are really asking if a patient with multiple tears, all of which were treated and never sustained a retinal detachment, at greater risk than a patient who had one tear and never detached.

I’d say, off the top of my head, that statistically both are equal if neither ever detached.

Regarding epiretinal membranes; quite common in those patients who are susceptible to forming them. While I do agree a PVD can instigate the formation of an ERM, not everyone has the potential to form them. Everyone does eventually have a PVD, though.

It is due to overproduction of a protein from cells that normally reside on the surface of the retina. Think of it as an exaggerated normal response. Somehow a PVD triggers this over production, again, in those susceptible to forming them and not tugging of the vitreous.

I would generalize and say that an ERM usually forms within 6 months of a PVD.

There are only two symptoms caused by an ERM; decreased vision and/or distortion. There are many disease that may cause these same symptoms; however, and a dilated examination is the only way to tell for sure. OCT may be helpful, too.

Vitrectomy with membrane removal is the only effective means I know to treat an epiretinal membrane. I do believe that the earlier the membrane is removed, the better the eventual vision. To state another way, the better the vision is at the time of surgery, the better the visual results. I tend to operate as soon as a patient is aware of symptoms.

The opposite is true, too. If you wait until your vision is really poor at the time of surgery, the poorer the resultant vision.

Helpful or confusing?

Stay in touch,

Randy