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Dear Dr Misra Thanks For Your Advice In My Earlier

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Posted on Tue, 7 Jan 2020
Question: Dear Dr Misra

Thanks for your advice in my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=395122

I have done OCT for my LE (not yet operated) early this month. The OCT and previous ones (end September and early June) are uploaded. The latest OCT showed continuous progress of ERM, though seems a slower speed. It has deteriorated with fovea thickness from 318 in early XXXXXXX to 386 in late September and 403 in early Dec.

Latest VA (3 Dec 2019) - RE 20/20 (but with shadow), LE 20/20 (but a bit opaque in central vision)

1.     My inter-ocular double vision, especially when viewing computers, is getting more serious. Is it due to my ERM progression in LE, increasing the discrepancy with my operated RE?

2.     Does the latest OCT shows that my ERM progression is getting steadier? Any other observations and advice based on the OCTs?

3.     Dr asked if I would go for surgery for my LE. While I still have some hesitation given that my VA is still good, I worry that the later I go for surgery, the poorer the surgery outcome. I heard from doctor that prime time for surgery is between half year and a year, because the longer the macular pucker, the more photoceptor cells will die. Is this true? Any prime time for surgery? My thinking is that if eventually I need to do surgery, should I go earlier for better results? Dr Misra, any advice for me?

4.     I tend to observe for a period , but how long should I observe? My VA is still quite good, but have unbalanced feeling when use both my eyes together and sometimes with double images. This is the greatest uneasiness to me at the moment, but still acceptable.     What is/are the trigger points for going for surgery?(eg. VA, fovea thickness)

Looking forward to your expert advice again. Thanks much
doctor
Answered by Dr. N K Mishra (26 hours later)
Brief Answer:
ERM

Detailed Answer:
My dear,
Thanks for sending your query to me.
There are two schools of thought regarding your situation.One is to let patient earn his surgery,let the visual acuity deteriorate enough to need surgerytwo is to go ahead early and finish the issue.
In your case I would like to have option two where we are not gaining anything by waiting.There is no treatment offered to halt the progress and it's progressing at a rapid pace.Since the vision at the moment is not effected,we need the surgery to take care of the disbalance,which is effecting your work.
I would be happy to think in terms of having the surgery in forseable future.
Any further issues please do get back to me.
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Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. N K Mishra

Ophthalmologist

Practicing since :1977

Answered : 1297 Questions

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Dear Dr Misra Thanks For Your Advice In My Earlier

Brief Answer: ERM Detailed Answer: My dear, Thanks for sending your query to me. There are two schools of thought regarding your situation.One is to let patient earn his surgery,let the visual acuity deteriorate enough to need surgerytwo is to go ahead early and finish the issue. In your case I would like to have option two where we are not gaining anything by waiting.There is no treatment offered to halt the progress and it's progressing at a rapid pace.Since the vision at the moment is not effected,we need the surgery to take care of the disbalance,which is effecting your work. I would be happy to think in terms of having the surgery in forseable future. Any further issues please do get back to me.