Tag: Eye Care

Posterior Vitreous Detachment: What It Is, and Why You Might Suddenly See Floaters or Flashes

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Hi everyone, this is Dr. Diab, board-certified ophthalmologist.

One of the most common reasons patients call me urgently is this: “I suddenly started seeing spots, or flashes of light, in one eye.”

In many cases, what is happening is called a posterior vitreous detachment.

Inside your eye is a clear gel, called the vitreous. When we are young, that gel is firm and fills the back of the eye, sitting right against the retina — the light-sensitive tissue at the back of the eye, a bit like film in a camera.

As we get older, that gel naturally starts to liquefy and shrink. At some point it pulls away from the retina. That separation is a posterior vitreous detachment.

It happens to almost everyone at some point, usually after age 50 or 60, and it is usually a normal part of aging. It does not mean your eye is falling apart, and it does not usually mean you will lose vision.

So why do you notice it? As the gel pulls away, you may see new floaters — dots, cobwebs, or shadowy shapes that drift when you move your eye. You may also see flashes of light, often in the far corner of your vision, often at night. That happens because the pulling gel tugs lightly on the retina.

Most of the time, once the gel has fully separated, the floaters settle and become less noticeable, and the flashes fade. I usually tell my patients that the brain also learns to ignore floaters over time, a bit like learning to ignore a small smudge on your glasses.

But here is the important part: we still need to check.

In a small number of people, as the gel pulls away, it can tear the retina. A tear does not always cause pain or vision loss right away, so you cannot tell from symptoms alone whether a tear is there. That is why a sudden onset of new floaters or flashes should prompt a full dilated eye exam, usually within a couple of days.

A tear, if we find one, can often be treated right away in the office with laser, to help prevent a retinal detachment. A retinal detachment is more serious and usually needs a retinal specialist and surgery.

So, in short:

  • New floaters or flashes in one eye: get a dilated exam promptly, within a couple of days.
  • Floaters and flashes together: be more urgent.
  • A new dark curtain, shadow, or black area in your vision, or a sudden drop in vision: that is an emergency, even on a weekend night. Please do not wait until Monday for that.

If you are ever unsure, it is always better to call and ask. I would much rather see you and find that everything is fine than have you wait at home worrying.

In a future post, I will talk more about what we look for during that dilated retinal exam.

If you want the short visual version, watch one of my videos on eye floaters — it covers the same warning signs in a few minutes, while this article goes a bit deeper on what is happening inside the eye.

As always, this is general information, not medical advice for your specific situation. Please do see an ophthalmologist if you have new floaters or flashes.

To LASIK or not to LASIK?

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I was very happy to be invited for an interview on the GetHealthy360 Podcast with Dr. Kris Ferguson.

Many people ask me if LASIK is a good option for them.  In this episode, I discuss laser vision correction and vision correction with lens exchange or cataract surgery.  Take a listen to get a better understanding about the pros and cons of these different treatments that can allow you to see well without glasses or contact lenses; and an explanation of how age affects our recommendation of one treatment over the other.

 

Your Success is in Who You Surround Yourself With

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There’s a smile behind this mask 🙂

While I was in the operating room today, doing my favorite dance, i.e. cataract surgery, I realized something… my success as a surgeon is in large part due to the staff assisting me in the OR.

Firstly, there is a surgical technician who sets up all the instruments and hands them to me during the case.  A good surgical tech anticipates the surgeons actions and has the next instrument ready.  When I’m working with a surgical tech that knows me well, it flows beautifully. I’ve barely reached my hand out for the next instrument and it’s already there.  I don’t have to ask for anything, she has already prepared what I’ll need next.  This wordless exchange is seamless, and we can carry on conversations about myriad topics while we do this graceful dance. It’s often a fun surprise when the patient, who is usually in a twilight sleep, chimes in on the conversation from under the drape.

In addition to the surgical tech, there is also a circulating nurse and a nurse anesthetist (or anesthesiologist) in the room with me.  The circulator does just that – circulates – almost non-stop to prepare everything between cases, bring the patient in the room, and fetch whatever is needed during the case.  An ideal circulating nurse should be efficient, while attuned to details, friendly with the patients, while maintaining professionalism, and helpful to the surgeon.  I have been lucky to work with great nurses, and it’s part of what makes my OR day the highlight of the week.  The anesthetist does the critical job of keeping the patient alive and comfortable while I operate.  It’s important to me that my patients have a pleasant and painless surgical experience, and that is achieved by good anesthesia, not too light, not too heavy.

As mentioned in my Clinic Culture post, the staff helps set the tone for friendly and compassionate patient care, and this is very true in the surgical setting, as well.  Everyone the patient meets from when they enter the surgery center to when they arrive in the recovery room post-operatively impacts their overall surgical experience.  As the surgeon, I am only one link in this chain of kindness.

Even outside of surgery and clinic, my success is related to the people I surround myself with, both actually and virtually.  Therefore, I try to surround myself by people that remind me of my purpose in life, my goals, and generally encourage and support me to the best person I can be.  This applies to family and close friends, but also to virtual friends and connections on social media.  They can promote and amplify the best side of me, or if I’ve chosen wrongly, they can really bring me down.

Look around and ask yourself, do the people I spend the most time with reflect the true me, the best me, or the person I strive to be…  If not, it may be time to reach out and make new connections.  Although it takes time and effort, it’s well worth it.  I speak from personal experience, as this past year I prioritized developing social connections that bring me joy, not only those that I feel obligated to maintain, and it has made a positive difference in my well being.

There is an Islamic saying attributed to the Prophet Muhammad ﷺ that states: Try to have as many as possible true friends, for they are the supplies in joy and the shelters in misfortunes.

 

A Medical Mission

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In the summer of 2018, I had the opportunity to travel with a non-profit organization (SAMS) to Jordan to provide eye care for refugees and other underserved populations.  I traveled with a large team of healthcare providers spanning all specialities, including a team of 6 ophthalmologists from all over the US.  Most of the people we treated were refugees who fled the war in Syria. I saw patients in the infamous Zaatari refugee camp, in a make-shift clinic in a small border town, and in a modern eye hospital in the capital, Amman.  I performed some laser and cataract surgeries, but primarily, I did exams for medical conditions of the eyes and glasses prescriptions. We worked for 6 days straight. In one day alone, I saw over 50 patients in the refugee camp.

I walked away in awe of the strength and resilience of these people.  Empowered by their will to not give in to desperation, to not curl up and cry about injustice, to push on and build a life for themselves under these awful new circumstances.  They were kind, appreciative, funny and sometimes very clearly depressed.  The children still had a sparkle in their eye and hope for the future.  One little boy (featured above in the picture at the slit lamp) was accompanying his grandfather who was one of our cataract surgery patients.  When I asked him what he wanted to do when he grew up, he said he wanted to be an ophthalmologist like me.

Much of what I did was listen to people’s concerns about their eyes, do a quick examination, and give them a bottle of artificial tears, after they had been lined up outside for hours waiting for their turn to be seen.  But their gratitude that someone took the time to fly across the world, leaving their own family and job, and peek into a slice of their life, made those moments more meaningful.  I believe that the impact we make on people in these situations (just as in my everyday medical practice) surpasses the actual medical care that we provide.  I believe that we can convey a sense of worthiness and value to each individual, a feeling of collective humanity, and a ray of hope for brighter times.

I was overcome with my own sense of gratitude.  Gratitude for my overly comfortable life, for my excellent education and training, and for having a skill to offer those in need.  The ability to help others is a privilege. It was my honor to serve in this capacity, and I hope to have similar opportunities in the future.