Solipsism Gradient

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…

An interesting phenomenon happened before my regular eye checkup in late February: the visual distortion in the right eye didn’t regress much, but subjectively my vision was almost normal. However my left eye — until now, unaffected — had developed a similar distortion in the opposite direction!

My conjecture was (and my ophthalmologist agreed) that this was a software adaption by my visual cortex. The expectation was that all these effects would continue to shrink for the next several months.

Unfortunately that was not to be. Two weeks after the checkup I noticed a persistent spot at the edge of my right-eye visual field, outlined by sparkles, even at night. I knew these were the symptoms of retinal detachment, and the ophthalmologist performed immediate surgery.

This was done by the same means as my November vitrectomy. The retina had wrinkled again, but this time at the edge; so instead of buckling it just began to tear. This was repaired by a belt-and-suspenders approach: laser “welding”, keeping the retina in place by a pressurised octafluoropropane gas bubble, and buckling the sclera mechanically. All this required paralysing the eyeball muscles and doing some tricky micro-mechanical work.

Well, after a scary and painful first week — the internal eye pressure had more than doubled and had to be relieved — I’m happy to report that recovery is underway, again. The gas bubble takes several weeks to be replaced by fluid and in the meantime there’s just a blur to be seen; but all indications are that the retina has been fixed.

More in about a month…

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.

As I’ve said yesterday:

My software development activities are (now, officially and indefinitely) on hiatus.

The dictionary says:
hiatus | h???d?s | noun (plural hiatuses) [usually in singular] a pause or gap in a sequence, series, or process…

Let me tell you about the “why” first. Thanks to all of you who immediately asked if I’m OK, by the way.

Short answer: yes, I’m OK, though not as OK as in the past — but then, that’s to be expected, with all these anniversaries streaking by. Not helped at all by miscellaneous stresses originating in Real Life™. But: see below. ?

Longer answer: in the past several years, my eyes have been getting progressively worse, to the point that reading on paper now works only with excellent illumination. OK, paper is not something I have to do on a daily basis nowadays, but reading on a screen also no longer works at the — admittedly, very small — font sizes I was used to. Jacking up the font size worked up to a point but my coding habits call for a huge amount of text visible at the same time. Stopping work altogether to wait for an improvement has, retrospectively, killed all my momentum. (I’m still waiting for that improvement, unfortunately.) Also: see below…

Medical answer: during a trip to Bhutan (highly recommended!) in 2014 I suffered a posterior vitreous detachment in my right eye; no doubt due to day-long van trips over their highways-in-progress. A couple of months later, a beginning retinal detachment was fixed by laser surgery, and everything seemed OK for a time. However, visual contrast worsened until, in 2016, I had to have cataract surgery on both eyes; this was when I stopped working altogether, waiting for my eyeglass prescriptions to stabilise. While that took longer than expected, I also found that there seemed to be no combination of monitor brightness/contrast that made working longer periods tolerable. To make things worse, the vitreous detachment seems to have left a scar on the right retina, causing a macular pucker; surgery on that (a vitrectomy, yikes!) is now scheduled to happen before the end of this year. My eye surgeon assures me that should take care of everything… digits crossed!

Needless to say, all this has been somewhat disheartening, and — as far as coding and blogging are concerned — I seem to have joined the Procrastination Monks for a few more years.

In the meantime, other things have happened, some quite positive! Stand by for more news…

Some years ago, when I needed to re-check my eyeglasses’ prescription, I found an article on the Internet about an optician – I think in Los Angeles – who was making special glasses for computer users. (I can’t find that URL anymore, unfortunately.)

Aside: my personal case is rather uncommon. I’ve always been nearsighted in the left eye (-4 to -5 diopters), while my right eye was normal. The left eye also has a slightly different color response, seeing things a little greener and darker than the right. Until my late 30s, both eyes had an overlapping range where both would focus well… starting at 30cm out and going to about 90cm (1 to 3 feet if you’re stuck in the imperial backwaters). Then, presbyopia set in and astigmatism became worse; my eyes’ focusing ranges no longer overlap at all, so I started needing different eyeglasses to work and to drive. (I still need no glasses to read with the left eye, at least.)

Anyway, having two different eyes taught me to be able to switch between them as needed and to tense and relax the eyeball voluntarily – call it manual focus. I hear this can be learned in a short time even if your eyes are equivalent.

So, the trick is to learn to relax your eyeballs, deliberately making stuff go out of focus. When you do that, you should see things at some distance between 4m and infinity in perfect focus. Next, you should measure your desired working distance to your screen; mine is exactly at arm’s length.

Now you go to the optician and do all the standard procedures, except that you’ll hold that small eyechart at arm’s length, or whatever your preferred distance is, and relax your eyeballs throughout – think of “idly gazing into the distance”. I find that the resulting diopters are about 0.25 to 0.5 stronger than they are for my driving glasses, but of course YMMV. Ideally this should also be done without any of those pesky dilating eyedrops, as you want your eyes to be as near to the normal state as possible.

If you did this correctly, you should be able to sit at your screen for hours without any eyestrain. Of course you still should get up and stretch every thirty minutes or so, unless you also have an “infinity focus” chair…

I seem to remember hearing that there are modern laser-based machines that measure your lens directly without having you read charts or whatever; I suppose that if you run into such a thing, you’d have to do the “relax” trick while this is done. Be sure to talk it over with your optician; mine needed some convincing the first time.

Update: this article about computer glasses confirms my experience. You may want to check other articles on that site for more up-to-date information about vision problems and corrections (especially if you’re based in the USA).

Halley just came out of cataract surgery (and she’s younger than I am, I hasten to add). Seems it was just marvelous:

…I am in some rapturous drug trip. I don’t even want to think of how much I WAS NOT SEEING.

I see a clock — the second hand is SCREAMING at me — hi, Halley, hi, Halley! I go into the bathroom, the chrome faucet looks like it’s on silver fire, I jump back from it to avoid getting scalded by light.

That’s the sort of thing one likes to read after all the bad news one sees elsewhere…

…hopefully doing her second eye will double the effect. I can’t wait to read about it.

I won’t need this sort of thing for some time, but hopefully by then jelly-like replacement lenses will be perfected and on the market; that would allow me to ditch my current glasses. As I have an odd combination of eye problems – 5.5 myopia in the left eye, combined with astigmatism in the right eye, and now presbyopia – I need one set of glasses for driving (or lately, doing almost anything that demands far vision) and another one optimized for working at my laptop.

The latter is optimized so as to put the screen at a virtual distance (focus-wise, that is) of 5 meters. This allows me to work long hours without tiring, as the eye stays perfectly relaxed. Still, it would be great to do without glasses altogether in all situations, but the current state of the art isn’t there yet.