Friday, September 07, 2007

Why subjective experience is important -- an example

There is an online community of 1,493 retinal detachment patients at I emphasize "patients" because there are no eye-care professionals in the group. If my cataract surgeon had been reading the group, he might have shown me "Catmaster's" recent post stating:
My second RD looks just like the photo (below). While the first RD stayed, the second would disappear. I was hoping it was an artifact from the cataract surgery, but it was not.
His second RD was like mine -- a sub-second black spot. Had I read it, my detachment would have been detected at least a week before it was -- before the fleeting shadow became a permanent blotch. Perhaps I could have avoided the scleral buckle. Perhaps I could have avoided the vitrectomy. Perhaps there would have been less retinal damage. Perhaps the odds of a recurrence would have been lower.

Monday, September 03, 2007

We need detailed descriptions of subjective experience

Our symptom vocabulary is very poor. We need detailed descriptions of subjective experience. I have been told to watch for "floaters," "light flashes," and "curtains" and heard about "flickers." But, since my surgeon has never had a detached retina, she is not able to elaborate on what, say, a light flash looks like, how long it lasts, how often they appear, how large they are, the feeling, if any, that accompanies them, etc. I am worried that the "dots" I mentioned in the previous post might be "flashes."

Only patients can provide us with detailed verbal and drawn descriptions of the symptoms. For example, I did a Google search for a drawing of a floater. I found many diagrams of eyes, but no artistic patient seems to have drawn a floater and posted it on the Web.

Small white dots moving at random in my field of vision

My vision continues to improve, but on August 31, I noticed what looked like a swarm of very small white dots darting about in the center of my field of vision. They moved in a pretty random fashion -- like the traces in particle accelerator photos. They were very faint, and I only noticed them when working on my laptop when the backlit screen was white.

During the last couple of days, they have increased in number, and now cover a greater area in my field of vision. I can now see them when looking around at light colored objects, but that may be due to increased attention on my part. They are still quite faint, and do not impair my vision in practical terms. However, they are worrisome since they remain in the center of my field of vision, perhaps indicating a macular problem. I've sent my surgeon a couple of emails, but have not heard back so perhaps she thinks it is unimportant.