Clinical manager’s retina reattached using specialized eye surgery

A native of Puerto Rico, Johanna Trowell moved to Florida following her junior year of high school. Once she completed her senior year at West Orange High School in Winter Garden, Johanna continued her education and attended nursing school. For the past 18 years, she’s assisted two OB-GYNs in a private practice, where she now serves as clinical manager. 

“Originally, I wanted to be a pediatrician, but life goes on and things get in the way, and I decided to become a nurse instead,” recounts Johanna, 48. “It’s actually been very gratifying. It required less schooling, too. 

“Since the beginning of my career, I wanted to work in private practice. All nurses have their niche, and the hospital wasn’t mine. I actually started out in a pediatrician’s office and worked there for a couple of years. Then I had the opportunity to join the OB-GYN practice. I stayed all these years because I really enjoy women’s health and pregnancy.” 

While Johanna is thoroughly dedicated to her job, her life isn’t all work. 

“My grown children are at home with me,” she says. “I really like having them here and cooking for them. My hobby is working out, which I’ve been doing for the past six years. I really enjoy working out, being fit and staying healthy.” 

In April, Johanna received a clean bill of health from her eye doctor following a routine checkup and contact lens update. Unfortunately, that prognosis changed rapidly just a few days later. 

“My appointment was on Friday,” Johanna recalls. “Everything turned out great. I got a new prescription and new contacts to try. Then, two days later — that Sunday morning — I noticed that the corner of my peripheral vision in my right eye was pretty blurry, like a drop of water was in my eye. 

“That was in the morning; toward afternoon, that area became quite dark. On Monday, it seemed the darkness had spread. It covered a little more of my field of vision than the day before. I called my eye doctor and got another appointment for the next day.” 

During that appointment, the optometrist examined Johanna’s right eye and performed several imaging tests. The images revealed that Johanna’s retina was detaching from the back of her eye from top to bottom, like wallpaper peeling off a wall. 

 “My doctor said, I hope you don’t have any plans to travel anytime soon,” Johanna remembers. “I said, As a matter of fact, I do. I have a trip to Europe in three weeks. It’s a two-week vacation I’ve had planned for many months. My eye doctor looked at me and said, I’m not sure about that. Let me talk to my colleagues and get back to you. 

“My doctor immediately got on the phone with Florida Retina Institute and told them about my situation. They set up an appointment for me to meet with a retina specialist at the institute the next day. 

“When I got to Florida Retina Institute, we scheduled surgery to reattach my retina for the upcoming Friday. But on my way home, that Wednesday, they called me and said, Ms. Trowell, the doctor thinks you should actually have surgery sooner. He’s going to have one of his colleagues do it tomorrow. That’s when I met Dr. Cunningham.” 

Scleral Buckle 

Matthew A. Cunningham, MD, is a board-certified, fellowship-trained retina specialist at Florida Retina Institute. He explains that there are three types of retinal detachments: exudative, tractional and rhegmatogenous. 

An exudative detachment happens when fluid builds up behind the retina and pushes it away from the back of the eye. Exudative detachments are usually secondary to inflammation or a vascular abnormality. These don’t involve a retinal tear and generally resolve once the underlying cause has been addressed. 

Tractional detachments occur when scar tissue pulls or causes traction on the underlying retina. Patients may not have an associated retinal tear. 

A rhegmatogenous (pronounced reg-ma-TAH-juh-nus) detachment is the most common. These typically occur as the result of a retinal tear or break and can follow a posterior vitreous detachment (PVD). 

A PVD arises when the vitreous gel inside the eye begins to liquefy and pulls away from the retina. PVDs occur in about 60 to 70 percent of patients and are part of the normal aging process. 

“Posterior vitreous detachments typically happen in patients in their 60s and 70s,” Dr. Cunningham observes. “However, they can also occur in younger people who are extremely nearsighted. They often lead to a retinal tear and detachment.” 

Symptoms include a sudden onset of flashes of light, floaters and sudden changes in vision. People with these symptoms are urged to immediately visit an eye specialist. 

Also, people who are extremely nearsighted should pay special attention to these types of changes because they are at a higher risk for developing a retinal tear. 

“Ms. Trowell had a rhegmatogenous detachment, which required surgery to repair,” Dr. Cunningham explains. 

Johanna’s surgery was moved up because the detachment had not yet reached the macula, which is the center of the retina responsible for central and color vision. 

“In situations like that, where the detachment does not involve the macula, we like to repair the detachment pretty quickly, usually within a day or so,” Dr. Cunningham notes. “In Ms. Trowell’s case, we performed a scleral buckle procedure, during which we place a silicone band around the sclera, the white part of the eye. 

“Once it’s in the perfect position to support the retinal tear, we suture the band onto the sclera, and it acts like a suspender around the eye globe where the retinal tear is located. 

“Because we are causing an indentation in the eye with the scleral buckle, the eyeball becomes a bit elongated,” Dr. Cunningham describes. “As a result, patients typically become more nearsighted, or myopic, which can be corrected with new glasses or a new contact lens prescription. This happened with Ms. Trowell. She needed a new prescription for her contact lenses to correct the issue. 

“Other than the change in her nearsightedness, Ms. Trowell has made an excellent recovery. Her retina is completely reattached, and she’s not having any other problems with her eye at this time.” 

Johanna concurs. 

“I don’t have any dark patches, so I’m able to see my entire field of vision now,” she confirms. “Before surgery, half of my vision was very dark.” 

Johanna says this process taught her to not take early symptoms casually. 

“Exactly a week before this whole thing happened, I noticed two floaters in my right eye,” Johanna remembers. “I had floaters in the past, so I never thought anything about them being a prequel to a retinal detachment. Now, I know better.” 

“Sweetest Doctor Ever” 

Johanna was referred to Florida Retina Institute for emergency treatment of her retinal detachment, which was a crisis situation. Still, her experience at the institute was positive and encouraging. 

“Dr. Cunningham is the sweetest doctor ever,” Johanna raves. “He’s very knowledgeable and patient-oriented. He always has a smile on his face. He’s a great doctor and has the best bedside manner. And he was actually able to get me well in time to make my trip to Europe three weeks later. 

“The staff at Florida Retina Institute is amazing. They got me through a critical, emergent and very scary situation. I’m grateful that they responded to my situation so fast. I highly recommend Dr. Cunningham and Florida Retina Institute.” 

© FHCN article by Patti DiPanfilo 

Photos by Jordan Pysz