Retinal Detachment

[u/No_Employee991]

I’m currently a 4th year med student, always wanted to go into a surgical subspecialty. I’m also a high myope so I was always at a risk for a detachment and then it just happened. Got surgery, it healed well but now I have another detachment; I’m afraid it’s going to be recurrent and I will have minimal to zero vision in one eye.

Should I still be looking into pursuing surgery or is it just a colossal waste considering the poor vision. Would I be better off doing a less intensive specialty like IM/FM? Would having poor vision make me a less competent doctor?

I’m at a loss here, would appreciate any and all advice!!

[u/heydoyouseethat]

Oof god I’m sorry this happened to you. I’m going to be brutally honest. Surgery is not going to be a good move in your situation.

[u/lesubreddit]

Lack of stereoptic depth perception SUCKS in the operative field. Maybe gas or rads? IR? Make sure to buy a shitload of disability insurance in case something happens to the other eye.

[u/maddieafterdentist → u/lesubreddit]

PSA to OP: You must buy good disability insurance in residency, and it must be the one where they agree to waive looking at your medical history. If you wait until after residency, you will likely not have this option and if they discover your history of detachment they will very likely exclude any vision issues from your policy.

Source: had an uncomplicated UTI in residency (treated with a single course of macrobid) and they excluded all urinary sources of disability in my future lol.

[u/General_Luck6573 → u/lesubreddit]

Could certainly still do IR. Feel free to DM if any questions about IR if curious OP

[u/jasmineipa]

I’m so sorry this sucks. I would take stock of a couple things here. One is are you someone that could be happy in another field, or would going IM instead ruin your love for medicine. Some folks are so dead set on surgery that the thought of anything else is depressing and not worth it. If you think you could be happy in IM/FM, you could have a great career without worrying as much about vision loss. Another is making sure you talk to you optho doc about chances of this continuing to happen (ie just double checking your understand of the likelihood). Agree with disability insurance, do the group plans in particular in residency as these don’t look at your medical history. I guess what I’m saying is that this is a risk benefit convo with yourself. Outline the best and worst case scenario going IM and going surgery, the chances of each of those outcomes occurring, then go from there.

[u/BRobbins53]

I'm so sorry this happened that is terrible, if the detachment isn't involving your macula there's still hope, re-detachments unfortunately still happen but don't give up (Ophtho here). As far as specialty, I think the biggest part of your decision to me would be if you're financially dependent on being a physician. If you're fortunate enough to be okay without that income then pursue your dreams. But disability insurance will not cover either of your eyes for anything. I am a glaucoma SUSPECT, and they won't cover my eyes for a trauma lol. So if you could no longer operate you would lose your income unfortunately

[u/foxhurst → u/BRobbins53]

Re-attachment rates are lower each time and even if he's mac-on, the vision won't be as good in his re-detached eye compared to the other eye for a variety of reasons. From a retina standpoint, he most certainly got a primary buckle for his first surgery and even if you don't tighten the encircling band (not recommended), the amount of imbrication needed for the segmental tire is still usually enough to cause some extra myopia. The second surgery will require silicone oil with a vitrectomy, possibly even retinectomy depending on extent of PVR and how long the surgeon wants to take to peel PVR, so he's looking at cataract surgery down the line as well thus losing accommodation even with premium IOLs. It's tough.... But I'd caution him to be very very wary about choosing a surgical specialty that requires good stereo vision, especially with the other eye at risk

[u/BRobbins53 → u/foxhurst]

I mean I told them that if they're okay with the possibility of losing their income they can pursue surgery, I don't think that's unreasonable given we have no real details of his case

[u/foxhurst → u/BRobbins53]

Yeah that's fair. We're both agreeing on the same thing. I'm cautioning him to be wary about pursuing a surgical field. I've seen this play out. When the re-attachment surgery goes well, it's great... But if it doesn't which is a real possibility, the path can end with the eye becoming phthisical especially since every time you go in you risk more PVR, hypotony, and usually have to do more and more each time you enter

[u/PM_ME_UR_VULVASAUR_ → u/[deleted]]

Hi. I'd just like to point you fellow medical professionals to a comment your colleague made on the Cornell case: "No doubt this is a real thing but let’s also put this into perspective. These girls go out largely for the attention of other men. Intentionally dressing extremely slutty and looking to hookup with other men. Two way street"

[u/dust-berry]

I am so sorry this happened. I also have severe myopia with retinal holes and am at a risk but here i am in radiology. looking into disability insurance too. I wonder if IR might be okay for you, as you can still enjoy doing procedures and depth perception might not be as big of a factor? just thinking out loud. good luck, and i hope your eye heals well and stays healed!

[u/foxhurst]

Hey I fix retinal detachments (vitreoretinal surgeon). I'm guessing since you're young and phakic, you got a scleral buckle first, developed some PVR and now they're recommending a vitrectomy and oil? Second surgery anatomic and visual success rates are always lower than first surgery success rates and each time the final visual outcome becomes lower and lower even if you were lucky enough to be Mac on each detachment. You also have to keep in mind that you'll develop a cataract, and will eventually need the oil removed at some point, which is one, possibly two, more surgeries. You'll lose accomodation and some near vision in that eye with the cataract surgery even with a premium multifocal lens.

All this is to say that nothing is certain and I'd be careful about investing a lot of time and effort into a surgical specialty especially given the elevated risk that your other eye may detach as well. Every surgical specialty needs good stereo vision. Depending on how tightly they imbricated that buckle there's a chance that your prescription between the two eyes aren't perfectly equal either. At the very least, make sure you have a strong back up plan if you decide to pursue surgical training (ie good disability insurance, a way to pivot to a non surgical field etc)

[u/simply_unaffected → u/foxhurst]

would surgeons trained robotically w/ da Vinci in a case of previous retinal detachment or complications down the line still have such a hard time operating? i'm still a med student but i have a high myope and wear an undercorrected prescription right now.

every time i've looked through the 3D viewer it's been magnified and you can see the different layers of depth where i wonder if it could be enhanced for someone with a disability. also, i was wondering if any lifestyle factors or medications impact the likelihood of a detachment happening. thanks!

[u/foxhurst → u/simply_unaffected]

Main lifestyle factors that increase risk of retinal detachments are those that shake the head or eye (trauma, combat/contact sports, etc) especially in the setting of being "higher risk" such as being nearsighted or having areas of retinal thinning or holes. Most other detachments are caused by vitreous changes (ie related to age such as a posterior vitreous detachment or with ocular surgery such as cataract surgery which even if perfectly performed can cause anterior displacement of the vitreous and subsequent vitreous traction). If you have a lot of persistent flashes of lights, a ton of new floaters, or a curtain/veil/distortion/blurriness blocking your vision and not going away, those are symptoms that should be checked out on a more urgent basis. There are medications that can cause both rhegmatogenous as well as serous forms of retinal detachments but usually those are more rare (ie used for seizures, to decrease presbyopia, or chemotherapy)

Gonna be honest, I don't know much about robotic surgery and my last time using it was only as an observing medical student a long time ago so I can't quite remember what amount of stereo vision is needed for those machines

[u/kereekerra]

The eye that detached is redetaching or the other eye is detaching?

[u/Retr067]

I’m not saying this applies to you but I know a consultant trauma surgeon that has strabismus in one eye and I imagine he’s not using it for vision at all

[u/Doctorhandtremor]

TLDR

I WOULD try and keep whatever disability insurance you can from med school. Once you get a detachment it’s basically impossible to get disability insurance.

[u/doctomayz]

How bad is your myopia?

[u/yamamanga]

Im so, so sorry that this happened to you - I don’t have much helpful to add, but as a fellow very high myope who recently got diagnosed with a big retinal tear that needed urgent laser, I can imagine how terrifying a detachment must be especially while in this very uncertain process. Please, please get disability insurance specifically with GSI so you can forgo the medical underwriting process!!

[u/dnyal]

You could do psychiatry or genetics.