Solipsism Gradient

In case you’re wondering, I’m still here and — after 4 years of balancing acts — now consider my situation stable. Here’s a brief update on my previous post.

The eye needed a second triamcinolone injection but can now, several months after that, be considered stable. I’ve worked out a regime of eyedrops that seems to keep the macular edema mostly at bay and holds dryness etc. to tolerable levels. My eyesight has stabilized at 20/50 and I can drive cautiously.

The development hiatus can now be labeled retirement, unfortunately. I can’t see (hehe) going back to writing Mac apps and the pace in Swift(UI) development is still such that I’m adopting a wait-and-see approach to iOS/iPadOS development.

The health reports are good, my weight is almost down to my optimum level of 72-73kg and my level of exercise keeps improving; not up to pre-pandemic levels yet, but good.

Hopefully I’ll have time to write more about table tennis soon. It’s a fascinating subject.

Two years have passed since my last post on the subject, and the few readers left may want to know what happened since then with my eye troubles.

There have some relatively minor complaints. The Diamox pills I was using to keep eye pressure down turned out to have noxious long-term side-effects and I had to discontinue them gradually. Some side-effects (dizziness, weakened voice and reduced coordination) I had attributed to lack of physical exercise and old age ? but they’re gone now, it’s a relief.

Fiddling around with eyedrops to find the least irritating ones is an ongoing process, complicated by two bouts with small corneal injuries — probably caused by forgetting to blink while using the computer.

The remaining problem is a macular edema that appeared over a year ago, causing blurred vision. After it proved resistant to eyedrops, a subtenonian triamcinolone injection relieved the condition for several months, but it seems to be coming back. It’s still undecided whether repeating the injection will be worthwhile.

In the meantime, the eye is still drier than usual, painful towards the end of the day, and the dilated pupil makes me avoid the sunlight; I’m still getting used to these — apparently permanent — conditions.

On the development front, I’ve decided to start writing software again in the near future; maybe not for publication, but purely as brain exercise. None of my old apps seem to be doable for the recent macOS versions; Apple has tightened restrictions on what can be done by third-party apps.

Also, I see that most of my Objective-C experience is now obsolete and Swift has progressed beyond my feeble CS skills. But it still might be fun to try to catch up! To that end, I’ve purchased a reasonably configured M1 Mac mini running macOS Monterey and have slowly been migrating my normal apps to that; tricky as I was still depending on some 32-bit utilities, so my trusty “Late 2014” iMac will still be in use in parallel for several months.

Things are more positive on the general health front. We’re both fully vaccinated with a booster shot, and have been able to start regular gym sessions again, with encouraging results. This has also been producing excellent results in our table tennis training, and we have even been twice to special training sessions in nearby Varginha. This weekend I’ll play the 10th TMB Challenge Plus tournament and have good chances to add a medal to my collection.

A lot happened since my last update, but the outcomes were too uncertain to write about; and I did not want to bore you with Too Much Information.

Still, I hope this post will be useful to people with similar conditions. So here’s a detailed graphic of the eye’s anatomy:

After the vitrectomy in late April, everything seemed to be reasonably OK. The octafluoropropane gas bubble the surgeon used to replace the vitreous humor took longer than expected to dissipate and a small part of it unexpectedly migrated into the eye’s anterior chamber, in front of the pupil, where it blocked the normal fluid flow and raised the internal pressure.

Both bubbles were almost gone on a Friday evening in late June when, once again, I noticed the shadows and sparkles of a retinal detachment. Unfortunate timing and circumstances conspired to push out the necessary surgery to the next Tuesday. Because of the detachment’s location on the lower part of the retina — past detachments were all on the sides or upper part — it was necessary to fill the posterior chamber with silicone oil and place a scleral buckle around the eyeball.

The consequences were not comfortable. The replacement fluid — this time, the silicon oil — leaked into the anterior chamber again, possibly following the duct opened by the gas used in the previous surgery. Pressure inside the eye increased dangerously and had to be controlled with several eyedrops designed to reduce fluid production inside the eye. The oil also painfully pressed on the iris muscles which contract or dilate the pupil.

It was all quite uncomfortable. The eyedrops messed up the fluid balance, the painkillers messed up the stomach — I lost 3 kg in the process — and the enforced inactivity messed up everything else. The eye pressure didn’t quite come down to normal levels and would damage the optic nerve in the long run. Accordingly, one month after the operation, it was decided to do yet another vitrectomy to remove the silicone oil: something which would normally have been necessary only several months later.

The scleral buckle, unfortunately, will be left in place indefinitely. As it encircles the eyeball in the back, around the muscles, every eye movement was initially painful and it’s still quite uncomfortable; I’m told it will take several months to get used to that.

So the last operation was in early August, two months ago now, and it mostly went well: all medications were slowly discontinued, the side-effects went mostly away and for a few weeks I’ve been able to resume normal activities. I have another evaluation coming up in late October, when I’ll have a comprehensive OCT exam of the retina, as well as new lens prescription info for that eye.

However preliminary examination revealed that eyesight has fallen to 20/50 (from 20/15 last year), grid distortion has worsened, and there are two dark scotomas — one at the lower left and one at the upper right — just at the edges of vision. Also, the iris muscles were damaged, so the eye was left somewhat dilated and (in photographical terms) with a fixed aperture, not useful at night or in direct sunlight. None of these conditions is expected to improve in the future, so I’m glad to have enough 3D-vision left for driving and table tennis…

Yes, things are getting better. The visual distortion I reported two months ago has lessened significantly; it’s still there, but much less pronounced and not as annoying. Hopefully all will be cleared up in a few more months, as promised; I’m scheduled for a new eye check-up 6 weeks from now.

There are two faint gray sickle-shaped shadows remaining around the central focus area, no doubt some retinal scarring resulting from the operation; they’re visible only when viewing uniformly coloured areas.

Otherwise, my depth perception has returned almost to normal and I’ve made progress on my table tennis training, somewhat hampered by the heat — it’s been between 30 and 34º for weeks. Stay tuned.

I know you’ve all been waiting for an update on my eye surgery…
…not really? Well, here’s one anyway.

Fast recap: here’s how things looked from my right eye —  it’s just slightly exaggerated. It’s called a macular pucker, and reading Spalding Gray‘s monologue about it wasn’t very comforting. The darkened, twisty part was unfortunately almost right in the middle, so reading with that eye was impossible, and the whole 3D experience was unreliable.

So, 3 weeks ago I had that somewhat scary vitrectomy operation and I’m happy to report that the surgeon said that, technically, everything went well — no infection, no visible scarring on the retina, no harm to other parts of the eye. Whew. In the meantime, I still have two weeks of antibiotic and steroid eyedrops every few hours; a small price to pay, of course!

Subjectively, the darkened blob is almost gone and the twisty parts are very gradually spreading apart and getting smaller; there remain two gray curved marks around the center, only noticeable when looking at a uniform background. Everything should stabilise in about a year and, with some luck, my eyeglasses should need no changing.

In another week I should be ready to resume my (relatively) new favorite activity: serious table tennis. I’ve started training regularly again two years ago, after about 40 years off the tables, and will write regularly about the topic here.