[A follow-up appeared on February 3, 2014: “Macular-hole surgery revisited”]
June 1, Wednesday: It’s 10:30, a cloudy, warm morning in Phoenix. Just two hours before I check in for out-patient surgery on a macular hole in my right eye at Barnet Dulaney Perkins Eye Center. I have mixed feelings. On one hand I’m eager to get it done, eager to put all these eye surgeries in the rearview mirror. A cataract was removed from the right eye on April 21 and from the left on May 5. On the other hand, I dread the recovery period from this operation, called a vitrectomy. Successful recovery depends on keeping my head down for four to five days. A gas bubble will be inserted into my eye, putting pressure on the hole to reattach itself to the macula and close. Gas rises, the hole is in the back of the retina. Therefore the face-down. Also there is a string of membrane and scar tissue that has broken away and must be peeled off. All of this has led to a slight distortion of vision in the eye. A wrinkle appears at the center of everything I look at. Chances are the eye won’t heal on its own, only get worse. The optometrist who last looked at the eye said, “You’re going to have very good results.” I’m hungry but I can’t eat or drink until after the surgery. Maybe that’s why my stomach is slightly upset. We’ll see how it goes. . . . 11:05 p.m. It’s 9 hours after surgery, and I’m trying with difficulty to type on my laptop, head-down in the head well of a rented massage chair. The chair costs $15 a day. I took the weekly rate of $75. I’m comfortable for only an hour or so, then must get in bed to stretch out my cramped legs. The operation went “great” according to the surgeon, Dr. Suhail Alam, a short and cocky dark-skinned man in his 30s. I entered the operating room at 1:15 and was rolled out 30 minutes later. Since there were some preliminaries, I figure the actual surgery took 15-20 minutes. I was awake the whole time, only the right side of my face anesthetized. Again, like the cataract surgeries, no pain, no discomfort. A bandage covers my right eye. I can’t see much, of course, but I do notice changes in the brightness of light. Dr. Alam said I must do the “face down” technique for four days but I can sleep on my left side if I choose. I feel a wetness on the bandage like my eye is watering. I had a mild headache which might be due to a caffeine withdrawal. I’ll know more tomorrow morning after the first post-op appointment.
June 2, Thursday: Day 1 after surgery. Kept 9:50 appointment at the Eye Center with the optometrist, Dr. Pinkert, 19 hours after surgery. Bandage was peeled off and eye tests made. Right-eye vision is poor, very foggy and distorted, due to the gas bubble. All I can see of the eye chart is its shape and black smears where the letters are supposed to be. Like a drab Jackson Pollock painting. The gas bubble is SF6, or sulphur hexafluoride, and is slowly absorbed into the bloodstream. Like day to night, my left eye tests out at 20/15, continuing to improve after cataract surgery nearly a month ago. The right eye is progressing normally, Pinkert says. Must keep head down for four days, meaning until Monday the 6th. Head down is defined as 50 minutes of every hour. Or 20 hours a day. Four days seems a short period from what I’d read on the Internet where three weeks is not unusual. But Pinkert said, “I’ve been working with retina surgeons for 15 years, and I’ve never heard of more than five days.” He said the gas bubble should go away by Week 3 and my vision return to normal in three months. I have one more exam scheduled, in two weeks. I’m back in the eye-drop mode. Three drops each day of Vigamox (infection) and Durezol (steroid healer). On the way home I buy an eye patch at Walgreen’s ala Johnny Depp. It’s only $2.79 and will allow me to keep the right eye open without distorting my overall vision. I inspect the right eye closer at home. I have a lot of bruising below the eye due to the anesthesia, I’m told. The skin at the outside of the eye is badly wrinkled. Still I’m able to recognize the beat-up face in the mirror as my own. . . . Before bed, I can now see colors better, though everything is still foggy and distorted. There is now a bit of a jiggle to the gas bubble.
June 3, Friday: Day 2 after surgery. Awoke this morning to see even more of a jiggle to the gas bubble. Turn my head left and right and the bubble keeps moving after I stop. I pass the time napping, reading a book, playing Words With Friends on Nebra’s Ipad and watching TV, keeping my head down as much as possible. I watched the Diamondbacks’ game tonight by setting the small TV in the study on end and bringing the massage chair close enough to look straight down. In the evening I went for a short walk through the neighborhood, training my eyes on the sidewalk below me and holding on to Nebra’s arm. All in all a boring day. While the surgery takes great skill, the recovery head-down technique seems primitive. And there is nothing to tell you if your’e doing it correctly. In three weeks I’ll walk in to the Eye Center and discover if the macular hole is closed. If not I suppose that means another operation, this one totally on my money with no help from insurance.
June 4, Saturday: Day 3 after surgery. Right-eye vision still poor. It’s like what you’d see swimming at the bottom of a pool. Watery and unclear due to the gas bubble. I can see the green plastic warning band on my right wrist but of course no detail. The wristband offers instructions in case, say, I was in a car accident. “Warning: Gas bubble in eye,” it says. The fine print goes on to say I should not be administered nitrous oxide or be moved to a higher elevation without consulting my physician. Both would casue the gas to expand with the potential to blow out the eye. Blindness is not high on my wish list. Dr. Alam’s name and phone number appear on the underside of the band. I think the elevtion limit is 4,000 feet. I asked Dr. Pinkert the other day what retina patients do in high places like the mountainous city of Flagstaff two hours to the north. Barnet Dulaney Perkins has an eye center there at almost 7,000 feet. Pinkert said those patients either travel down to Phoenix (el 1,117) or have oil put in the eye rather than gas. The problem with oil, he said, is that it requires two operations. One to put it in, one to take it out. . . . This was the worst day for keeping my head down. Not to say it was a bad day. I get restless or cramped sitting still. So I walk around the house, water the plants in the driveway, usually with my head down. We went out to eat at a Mexican restaurant in the evening, head down most of the time. But I wonder if the gas is jiggly when I move will it press on the macular hole long enough to help it close?
June 5, Sunday: Day 4 after surgery. Last day of face-down spent in reading a book and the newspapers, playing Words With Friends again on Nebra’s iPad, fixing snacks, watering plants in the driveway and watching sports on TV. Didn’t nap, wasn’t sleepy. It is easy to begin to believe the gas bubble in my right eye is important. It is the most visible aspect of recovery. Like today, the bubble jiggles more than ever and I can see a “water line” forming toward the top of the eye. The outside world is still so distorted I could not function with the right eye alone. But in truth the bubble is a sideshow, a distraction to the really important stuff going on behind the scenes. That’s the closing of the macular hole deep in the retina. The bubble’s shape, size or length of duration has nothing to do with that. The bubble will go away one of these days and so what? It does not indicate success or failure. It is just a tool. The surgeon, Dr. Alam, says the success rate is 90 percent, but I will not know the outcome until final tests are made on the 15th, still 10 long days away.
June 6, Monday: Day 5 after surgery. The head-down period is over. Awoke after a good night’s sleep, feeling rested as I have every night since the June 1 surgery. I’d found a comfortable sleeping method at the end of the bed, lying on my stomach with my head bolstered by two pillows atop a trunk, my nose wedged in between the trunk and bed so I could breathe easily. I returned to most of my usual activities. Driving, walking 10,000 steps (roughly 5 miles) and reading upright for a change. For lunch I warily drove the busy I-17 out to Old Country buffet with the black patch over my healing right eye. I found the middle lane and stayed there, not hitting over 55 mph. There is a definite line in my vision now from the gas bubble. I called it the “water line” yesterday. In the small growing space above the line, there is more light and I see the world clearly. I call it the future. The larger receding bottom part, or the bubble, is darker, distorted. That part, I hope, is the past. The shiner is nearly gone. Just some bruising left around the nose. The wrinkly skin at the edge of the eye is diminished, all but gone. I’m feeling upbeat again.
June 7, Tuesday: Day 6 after surgery. The jiggly gas bubble dissipates fast. The bubble covered about 5/8 of my right-eye vision this morning and now at bedtime it is 1/2 or less. Still a top layer and a bottom. And a distinct line between them. If I were to use only the right eye, I would stumble over everything. Returned the massage chair in mid-afternoon to Bare Paws Massage Co. The firm operates out of a house on the east side. I’ll miss that chair in a way I can not explain. I spent a good part of four days with my head sunk down into it.
June 8, Wednesday: One week after surgery. The bobbying gas bubble continues to diminish and now takes up less than half of the right eye’s vision. The clearer part above the bubble is mildly streaked, just enough to distort reading letters on the spine of a book. I think the streaks come from the gas bubble reflecting light. Recovery seems to be going well. Only a few minor headaches and I can not attribute them to the surgery with certainty.
June 9, Thursday: 8th day after surgery. The good thing is that I’m now down to two eye drops a day. It was six. I take the Durezol only, a drop in early afternoon and another before bed. No more Vigamox. It’s more difficult to do the eye drops after mac hole surgery than the cataract. I’ve virtually splashed the drops all over my face because of the blurred vision. The eye patch’s elastic band is wearing out. I tied a knot in it tonight. That helped. I may not need the patch much longer. The gas bubble fills about 3/8 of my right eye, maybe even closer to a quarter. It’s hard to be precise. The worrisome thing is that I still see a “wrinkle” in the middle of a word or a wave in a straight line with the good portion of the eye. Has the hole not closed? If not, will it seal later? Questions, I guess, for the next appointment on the 15th.
June 11, Saturday: Day 10 after surgery. The annoying gas bubble changed shape. Up until this morning, it appeared as a line across my vision. Now it is a circle, a true bubble like the ones you see on a carpenter’s level.
June 12, Sunday: Day 11 after surgery. The dark oval bubble has gotten smaller. It covers about 1/10 of the right eye’s vision with my head erect, resting at the bottom. But if I bend the head over, the bubble centers itself in the eye’s middle and seems to expand. I prefer reading now using both eyes and have more or less discarded the eye patch. My vision is far from perfect but improving.
June 15, Wednesday: 14 days after surgery. Kept my 3-week post-op appointment this morning with the surgeon, Dr. Alam. All good news, the operation was successful. The macular hole is gone, he said, after looking at test results: “Everything’s terrific.” I was relieved to hear the slight “wrinkle” that distorts objects in the center of the right eye’s vision will improve. “You’re still in the early stages of recovery,” Alam said. The next, and probably last exam, is scheduled now for September 21, three months away. By then I should have a definite idea of what my vision will be. The left eye tested out at 20/15 again for distance and 20/25 for close-up. The right eye is 20/40 for both. As for the gas bubble it’s almost gone, covering only about 5% of my vision as I look straight ahead. It is dark with a big black ring and a round, clear center. Another day or two and it should disappear. A very good day all in all.
June 16, Thursday: Day 15 after surgery. For the record, the gas bubble disappeared completely about 11:30 a.m. I was on the treadmill at the gym and suddenly noticed its absence. This morning when I awoke the bubble was tiny, not quite the black dot I had read about but close. So bubble gone in 15 days. The gas bubble is such a dominant aspect of mac hole surgery that you can lose track of what’s really important. The target is closing the hole. It is not the bubble nor is it even better vision. In fact before surgery I signed a disclaimer saying I acknowledge my vision may not improve and may even get worse. That’s why I wrote yesterday the surgery was successful even though my right eye vision is not very good. If the hole does not close as mine did, then there is the chance it will get larger — often very quickly — and you can lose ALL vision in the eye. So I say to myself macular-hole surgery is all about the hole, the hole, the hole. Better vision is a bonus.
June 20, Monday: I passed the Arizona eye exam this afternoon and had the daytime-only restriction removed from my driver’s license after five months. The right eye did not pass muster at 20/40 on the eye chart, but my left eye and overall vision did. “You’re allowed to fail on one,” said the woman who gave the test. This was my goal from Day One. To regain the independence of driving at night again. Hip, hip . . . .
July 14, Thursday: The “wrinkle” in my right eye is not improving much. I’m well along into my recovery, and I’m beginning to think this is it, that it’s not going to get better by my last post-op visit in two months. I will say the distortion is smaller than before the surgery. I’m looking now through my right eye at an Obama poster on the wall six feet away. I can easily read the big print, “Be The Change,” which has 1 3/4-inch letters. But “inauguration” with letters an inch smaller is distorted so badly I can’t read it. Praise the gods for my strong left eye. It makes everything readable and clear. It seems the right eye does not affect my overall vision at all.
September 21, Wednesday: I had my 3-month checkup this morning with Dr. Alam. “As far as I’m concerned, the hole is closed,” he said after viewing the latest laser scan. He went on to say, the chances of having a hole in the other eye, the left one, is remote. Excellent news in all but I still have the impairment in the right eye. While the distortion is less than it was, the wrinkle has not gone completely away. I can now make out a word, say, though the middle letters are twisted out of shape. Dr. Alam reiterated that I would always know where the hole had been. “It’s like a broken bone,” he said, “you always know where the break occurred. It (my vision) may continue to improve.” The left eye tested out 20/40. The right was far superior at 20/20, and I was able to read a few letters on the 20/15 line. Using both eyes, I’m still very close to 20/20. I can read a newspaper and a book without aid, though low-power glasses make it easier. I hope this is the end of the eye problems, though Dr. Alam wants to see me again in a year.