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Thursday / June 20.
HomemicontactInk in the Sky

Ink in the Sky

In the first of a series of exclusive blogs for mivision Prof. Nathan Efron takes you on his personal journey of retinopexy, cryopexy, vitrectomy and IOL surgery.

It was a warm Tuesday afternoon in October 2009 on the Gold Coast. I had just taken delivery of my new car (a Ford G6 series). I pulled up adjacent to my home, and waited at 90 degrees to my driveway while my radio-controlled garage roller-door opened. Ahead of me was a clear blue sky, and I suddenly noticed a bizarre phenomenon that was about to have a dramatic personal impact, and in many ways change my life forever: ink in the sky.

Have you ever placed a drop of black ink in a glass of water? Perhaps not … but maybe you have seen a still image or movie clip of this phenomenon in another context. The ink drop starts to slowly spread out with a slight twist or twirl. Well, that’s exactly what I noticed while looking out through the windscreen of my car. My initial reaction was that of slight bewilderment, but after a few moments, when I changed my direction of gaze slightly, the ‘ink’ continued to slowly swirl downwards in the same region of my field of view.

I closed each eye consecutively, and immediately realised that this event was occurring in my left eye. Apart from ink in the sky, I noticed nothing else. No pain or discomfort, no sparks or flashes, no shadow or spider-web appearance, no apparent commensurate loss of vision, no general discomfort or headache. I had not suffered any recent bumps or head trauma. Nothing. Just ink in the sky. The accompanying picture is a pretty good simulation of what I saw.

it occurred to me that the most likely explanation of the ink in the sky was that there was bleeding inside my eye

Anyway, a few seconds after first noticing this phenomenon, it occurred to me that the most likely explanation of the ink in the sky was that there was bleeding inside my eye. A sinking, sickly feeling developed in the pit of my stomach, as the real meaning of this began to dawn on me. This was most likely a retinal tear or detachment. The problem is… I know too much! I could feel my heart begin to pound, and I immediately began to consider what I ought to do next.

As a qualified and registered academic optometrist, the implications of this event were immediately apparent, and I took instant action, as I will explain later. But one wonders what a regular member of the public, without any ophthalmic or medical training, would have made of this observation. Some may realise that this appearance is abnormal, and might seek an opinion sooner or later. Retinal tears can of course lead to detachments, so such matters always require urgent investigation. I would presume, however, that the general public are perhaps not always aware of this, and a seemingly sensible option could be to wait until the next scheduled routine eye examination, and mention it then, or just wait to see if things get worse.

Good Fortune

At this point in time, there were two other elements of good fortune (that is, in addition to my own ophthalmic knowledge): first, my wife, Suzanne, was with me at the time of my ‘ink in the sky’ moment, and second, Suzanne is a practising clinical optometrist. She had driven home in her own car in tandem with me, having taken me to the showroom to collect my new car. We went straight inside and Suzanne fetched her direct ophthalmoscope. Without the benefit of dilating drops or a fully darkened room, all she could still see was a mass of swirly floaters largely obscuring the fundus.

We then decided to head off somewhere so that my eye could be examined properly. We hopped into Suzanne’s car and drove to a nearby optometry practice where Suzanne had previously worked, about a 10 minute drive away.

By the time we arrived, the ink in the sky had dissipated, and vision in my left eye was somewhat cloudy. After a brief exchange of pleasantries, our optometry colleague, Pete (not his real name), took me straight into his consulting room, checked my vision, instilled a mydriatic, and after a few minutes, sat me behind the slit lamp. He whipped out his Volk lens and started looking around. The silence was deafening. As anxious as I was to know what was happening in my eye, I knew I had to hold my tongue to give Pete a chance to have a look, digest what he saw, and relate that to me.

After about a minute, we both sat back, and I noticed that he seemed a little pale, which wasn’t especially comforting to me. Pete said that everything looked cloudy, and that clearly something untoward was happening in my eye, but he couldn’t be sure. Whatever it was, we all agreed that it was important that I get this checked out by an ophthalmologist as soon as possible.

As it turns out, there are a number of ophthalmologists on the Gold Coast specialising in retina, all with excellent reputations. Over the past few years, Suzanne had referred numerous patients to various ophthalmologists, but was especially impressed with the surgical outcomes and generally high levels of eye care of Bill (not his real name). We did not have time to contemplate and research the performance and reputation of Gold Coast ophthalmologists, and in any case it might not have made any difference who I chose, so we decided to call Bill’s rooms.

By this time, it was about 6pm, and Bill’s surgery was closed for the day. However, his reception staff were still there, and recognising the urgency of the situation, booked me in for the first appointment at 8am the following morning. I just knew that this was going to be the longest 14 hours of my life.

Some Background

At this point, to paint a complete picture, I need to relate to you my previous ocular and medical history. I was born on 3 September, 1954. I developed amblyopia (eye unknown) aged about five, and was treated with atropine. This was apparently successful, as I have enjoyed R&L 6/4.5 acuity, with normal binocular vision, up until now.

I have type 2, well-controlled, non-insulin-dependent diabetes (diagnosed at age 32), and for about the past 10 years, minor background diabetic retinopathy (two or three tiny microaneurysms) has been observed in both eyes.

At age 15, I attended a rock concert at the Sydney Myer Music Bowl in Melbourne with a friend, who happened to be mildly myopic. I mentioned that I couldn’t really see the stage clearly, and in jest he suggested I try his glasses. I must have had a similar amount of myopia to that of my friend, because everything suddenly became brilliantly clear through his glasses, which we fought over for the rest of the concert! The next week my mum obtained a referral from our family doctor to see an ophthalmologist. My myopia was confirmed, and I started wearing glasses, switching to contact lenses when I was about 28.

My myopia kept progressing until about 35 years of age, when my refraction more or less stabilised.

My current prescription is:

R: -6.50/-1.25 x 175

L: -5.75/-1.25 x 180

Add: +2.25

The only relevant family ocular history (and it is indeed significant) is that my mother is slightly myopic in one eye (about -1.25DS) and my maternal grandfather was highly myopic. I never found out his refraction, but I remember his very thick ‘coke-bottle-bottom’ glasses. He suffered a trauma-induced retinal detachment in his 50’s and he was in hospital for two weeks receiving treatment. My grandfather was essentially blind in the eye with the detachment, and had low vision in his other eye.

So, I have ended up a moderately high myope, and I have a family history of myopia and retinal detachment. I can just picture the ophthalmic readers of this blog nodding already…

Professor Nathan Efron is a researcher at the Institute of Health and Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology. He is the only person to have served as President of both the British Contact Lens Association and the Cornea and Contact Lens Society of Australia.