Retinal Detachment Needs Quick Response

Vitrectomy, scleral buckle surgeries among reattachment repairs to prevent vision loss

“I don’t have any dark patches, so I’m able to see my entire field of vision now.” – Johanna

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 thanks to COVID,” she says. “I really like having them there and cooking for them. My hobby is working out, which I’ve been doing for the last 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 the top to the bottom, like peeling wallpaper.

“My doctor said, You have a detached retina. I hope you don’t have any plans to travel anytime soon,” Johanna remembers. “I said, Yes, I have a trip to Europe in three weeks. It’s a two-week vacation I’ve had planned for many months. She 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 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, adds
Dr. Cunningham.

A rhegmatogenous (pronounced reg-ma-TAH-juh-nus) detachment is the most common. These typically occur as the result of developing 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. However, they can also occur in younger people who are extremely nearsighted,” Dr. Cunningham observes. “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 care specialist.

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

“A rhegmatogenous detachment is what Ms. Trowell had, 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 contact lens prescription. This happened with Ms. Trowell. She will need 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.

Johanna Trowell

“I don’t have any dark patches, so I’m able to see my entire field of vision now,” Johanna 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.”

Family Operation

Boykin Construction is a family-owned and operated sitework and road building contractor in Lake County that has been in business since 1949. Jeff Boykin, 52, has been integrally involved since 1995.

“Basically, we build roads, do underground utilities and move dirt,” Jeff discloses. “We work with cities and counties as well as builders. We do private and government work.”

Jeff has no preference between private or governmental clients. He reports that they are equally desirable to work with.

“My vision is 100 percent better than it was when my retina detached.” – Jeff

“I especially like starting new projects and then finishing them,” he shares. “There’s a lot of tough work in between, but I like beginning projects and seeing them to completion.”

Jeff enjoys being part of a family business, and along with his wife, Teresa, he is all about family in his free time as well.

“I have five grandchildren I like to spend time with,” he reveals. “We go on four-wheeler rides and fish on the weekends. Spending time with my family is my entertainment.”

Like Johanna, Jeff experienced sudden symptoms of what turned out to be a retinal detachment. The first sign of trouble appeared last October, when a blood vessel broke in his right eye.

Jeff underwent a laser procedure to correct that problem, but a few months later, his vision became blurry.

“I thought my glasses were dirty, so I kept cleaning them,” Jeff recalls. “I finally realized it wasn’t my glasses. I also had some floaters develop. They were bothering me so bad that I finally had to cover my eye so I could drive. My vision was horrible. It got to the point I couldn’t see out of my right eye. You might as well say I was blind in that eye.”

Those latter symptoms began on a Friday and got progressively worse over the weekend, so Jeff went to his regular eye doctor on the following Monday.

“I could tell something was seriously wrong by the way they were dealing with things,” Jeff states. “I was told my retina was detached and torn, and the gel was leaking out of my eye. It had to be repaired within a few days or I could lose my vision. The practice’s retina specialist had just taken off, so they sent me to Florida Retina Institute.”

Three Small Incisions

“Mr. Boykin presented to us with acute flashing lights, new floaters, and peripheral and central vision loss,” Dr. Cunningham details. “I diagnosed a rhegmatogenous retinal detachment and discussed treatment options. In Mr. Boykin’s case, the macula was impacted, and the decision was made to perform vitrectomy surgery to reattach his retina.”

Jeff Boykin with his wife, Teresa

During a vitrectomy, the surgeon makes three small incisions in the sclera to gain access to the vitreous cavity within the eye. The surgeon then removes the bulk of the vitreous gel. Once the surgeon flattens the retina, the tear is sealed with laser and a tamponade, either gas or oil, is injected into the eye to hold the retina in place.

“In the majority of cases, we place a gas bubble in the eye because the gas goes away by itself,” the retina specialist informs. “We typically use oil for the more complex cases. However, when we use oil, we have to perform an additional surgery to remove the oil once the patient has recovered from the vitrectomy.

“In Mr. Boykin’s case, we were able to successfully repair his retinal detachment using a gas tamponade. We have a pretty good success rate with vitrectomy surgery for retinal detachment — approximately 90 percent reattachment after one surgery. Mr. Boykin is falling in with that 90 percent and is doing extremely well.”

Like scleral buckle surgery, vitrectomy typically results in expected side effects, which can affect the patient’s vision.

“Vitrectomy surgery hastens cataract formation,” Dr. Cunningham asserts. “Cataracts are a clouding of the lens. They cause blurry or double vision, fading of colors, halos around lights and difficulty driving at night. Cataracts must be surgically removed. We discuss this side effect in detail with patients before vitrectomy surgery and explain that cataracts can be managed with surgery.

“In addition, we always explain to our patients that we expect their vision to improve after several weeks or months following surgery. However, it may never be exactly how it was prior to developing a retinal detachment, because anytime fluid gets underneath the retina, it can affect the photoreceptors in a way that has a long-term impact on vision.”

As Dr. Cunningham warned, Jeff developed a cataract on his operative eye.

“My vision is not what it used to be because of the cataract,” Jeff confirms. “Still, my vision is 100 percent better than it was when my retina detached. I can actually see quite well out of my right eye. I don’t see floaters anymore and I don’t have any eye pain or anything.

“I’m pretty much back to normal, other than the fact that my vision in that eye isn’t as crisp as it was because of the cataract. But I can see out of the eye, and I couldn’t see out of it before surgery.”

“Nothing But the Best”

Johanna and Jeff were referred to Florida Retina Institute for emergency treatment of their retinal detachments, which were crisis situations. Still, their experiences at the institute were 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.”

Jeff agrees with Johanna’s assessment.

“Dr. Cunningham is nothing but the best,” Jeff concludes. “I highly recommend him to anyone. His staff is top-notch as well. I went to three Florida Retina Institute locations, and at all three offices everybody was extremely helpful.

“My surgery was 100 percent successful, and I’m very thankful to Florida Retina Institute and Dr. Cunningham for saving my eye.”

© FHCN article by Patti DiPanfilo. Johanna’s photos by Jordan Pysz. Jeff & Teresa’s photos courtesy of Jeff Boykin. mkb
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