Tuesday, August 14, 2007
Eye Position vs Head Position after Macular Hole Repair
Most patients are told of the importance of keeping their head down after macular hole repair, but more importantly you need to keep your eyes looking down! Remember the gas bubble is in your eye, not your head. You can have your chin tucked all the way to your chest but if you are looking at the floor five feet in front of you, or worse, trying to watch the TV, you are NOT in the right position! You can have your head at a more comfortable angle so long as your eyes are looking down at your belly button. Of course when you are laying down the the eyes should be looking straight down below you. For those who have been told you can lay on your side, try to turn your head as far in the direction your doctor has told you as you can.
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Kelly Comfort Solutions made it clear that their products were for relief from the inevitable neck and back pain. Other websites depicting people eating and drinking are insinuating that you need to spend every waking hour of the day in this equipment. The advice of eye position versus head position is key to making recovery a little more possable. When eating just keep your eyes on your food, when walking look at your feet, when showering look at the drain and forget about your head.
ReplyDeleteCertainly you don't have to be in the equipment at all times. There are folks that get by with NO equipment, either because they can't afford it or because they think they just don't need it. I am working hard on taking care of those who can't afford it by introducing items to hospitals and surgery centers that will at least offer SOMETHING for the patient to take home. As for those who don't think they need it, there are plenty of surgeons who agree with you, they just haven't been through it! Not long ago we had the priviledge of offering services to a surgeon, not just any surgeon, but the chief surgeon at his hospital. He was surprised there was nothing offered to him from the hospital let alone the surgeon who repaired HIS retina. Not long after, we were suppling his hospital with products for vitrectomy recovery. Now if one of the bigwigs at Medicare would just have one of his/her mothers have this surgery maybe they would start to cover the equipment!!!
ReplyDeleteI just had vitrectomy sutgery five days ago. I did a lot of research before hand and I, too, had a lot of questions about face-down recovery and equipment. As it turned out, ny doctor used a slower desoving gas bubble that does not require the face-down positioning. Instead, my only restriction: I cannot lay on my back.
ReplyDeleteSurgeons have been looking for ways to avoid the face down positioning for years. They know that poor compliance can lead to a reduced success rate. There are a couple of gases used for this surgery, each varying in length of duration. Some surgeons are even using an oil instead of gas to avoid the positioning factor. Most surgeons agree that maintaining the face down position does improve the chance of surgical success but there are a few who feel it isn't necessary at all. You need to do what the surgeon you have chosen and feel comfortable with recommends.
ReplyDeleteI was told to look down and bend down for at least a week and sleep side ways.. I have all the equipment. I have tried it, but I'm worried about my back and bending. the 25th is my operation so hopefully I can handle it. I will ask the Doctor if looking down without bending is sufficient.
DeleteThanks for the information you are posting here. I plan to let you know how I will do with eye down position. JW
ReplyDeleteJW:
ReplyDeleteGlad to help! Look forward to hearing from you again.
Toni
I have enjoyed reading all your info. Have not had surgery yet but go in on the 26th/may. I'm getting all the equipment necessary to help with recovery period rented at a very reasonable price/day. Hope will only be for 7 days and am very positive about recovery. Also have family members on board to help as much as needed. Will keep you posted after I can lift my head and use puter again.Thanks Judy S
ReplyDeleteHi, I'm now going into week 3 after surgery. I will say that I do not know how I would have done the face down without the equipment or my support system.It was very tiring but I got thru it........yyyyyeeeea. My Dr. is very pleased with progress but I still have a ways to go. Cannot see out of eye yet but sure that will improve slowly. Vision very blurry still, I'm off balance because of it so do not go out alone.Will keep you posted. Hope this helps. Judy S
ReplyDeleteHi
ReplyDeleteI had my operation yesterday.
I have to spend 1/2 hour of each hour in the face-down position.
Fortunately I only have to do this for 3 days.
I thought I would be able to insert the three lots of eye drops and 1 ointment that I have to have four times a day. No way can I do it myself.
I have not hired any equipment and am managing the face-down position ok. Whilst I am face-down I am planning what I need to do once in the following face-up 1/2 hour.
After the op I had a big patch over the operated eye. This meant I could not wear my glasses and so could not see very well out of my other eye.
Much better today as I have the patch off and can now wear my glasses and am able to use my computer.
Luckily I dont have to do the face-down position at night. I have been told to sleep on my left side.
I will keep in touch and let you know how I go over the next few days.
Hi again
ReplyDeleteFollowing my op on 13.3.09 and my comment on 14.3.09.
I saw the Specialist yesterday, 19.3.09. Everything is going good and the bubble is taking up only 40% of my right eye now. I still find it very annoying though.
The Specialist says it should be gone by the end of next week.
I initially thought I would have the gas bubble for around two months so happy to find out I have it for about two weeks. I also initially thought I would have to do the 'face-down' position for around ten days but happy when told only three days.
I was also told by the Specialist I do not have to stick to sleeping on my left side.
My sight seems to be getting a bit better each day and much better than I thought it would be at this early stage.
I am told it will be three months altogether before the sight in my right eye is settled. At that time I may or may not have to get new lenses in my glasses.
I will advise when the gas bubble has completely gone.
Hi
ReplyDeleteFollowing my op on 13.3.09 and my comments on 14.3.09 and 20.3.09.
My gas bubble is very small now (still annoying though)and I reckon it will be gone by the end of the week just as my specialist said it would.
The operation has been nothing like as bad as I expected. I was really worried, and so undecided, about having the op.
I am glad I had it done.
I would not want to have it in the other eye but if I had to I would definately not be worried about it.
Even though I was told it will be three months altogether before the sight in my operated eye is settled my vision is really good already.
I will advise when gas bubble completely gone.
I will also advise if I need to change the lenses in my glasses after the three month peiod.
xoxoxoxxoxox
Hi
ReplyDeleteFurther to my last three comments:-
Gas bubble now gone.
Sight in operated eye is good already, much better than I expected at this early stage.
As previously mentioned I am told it takes three months before the sight is settled.
I will let you know if I need to change the lenses in my glasses after the three months.
I have finished with one lot of eye drops but still using two lots of eye drops and one ointment.
xoxoxoxo
I'm schedule to have surgery 8/10 and have gotten the support system to make the 1 week initial recovery time go by much easier. What should I expect after the surgery is over? I presently have a slight central vision blind spot and remaining vision is very blurry.
ReplyDeleteI had my operation 4 days ago and have been advised to face down 50 min out of every hour...I'm 38 years old and must admit I would have gone out of my mind if it wasn't for my iPhone-been able to watch films use Internet and control my pc all from my little window to the world...mind you, it doesn't stop the agony of back and neck ache, only 10 days to go...lol peter
ReplyDeleteI am scheduled for surgery october 14 and am nervous about being able to maintain face down position. What about dressing? What about hair washing? What strategies did you do to make it easier on you and on your caregivers? (And i live alone, my family and friends all work so gatherng caregivers is a challenge but I know it's necessary) I will look forward to feedback from you who have been through this. NR
ReplyDeleteI am almost 3 weeks post surgery (9/14). My doctor is still requiring 55 minutes per hour face down until the full 3 weeks is up - it is difficult to read of other's with shorter times - mine appears to be because I am in health care system and simply cannot be seen by a doctor to ascertain if the hole is repaired. A massage table with varying equipment saved my sanity, if not my aches and pains. Helpful to hear of others' experiences.
ReplyDeletefor someone who lives alone - it would have been impossible to get the drops in my eyes for the first 2 weeks.
Hi all. For those just going into this - it is a painless operation, Iwas wide awake for the whole thing and I had no pain at all. I had my surgery on Aug 7th and I had prepared ahead of time. I live alone so I purchased meals that I could just pop in the microwave and eat quickly. I purcased a massage table on kijiji so that I could stay face down all day. I went to the library and rented "books on tape or cd" to help pass the time. It was hard to get through but after it was over, it was no big deal. Good luck to all Emily
ReplyDeleteAs for the comment about keeping your eyes down vs. your head (because the gas is in your eyes, not your head), I diagreee. Consider this visual:
ReplyDeleteAssume your eye is an inflated balloon. Draw an eye on the front facing side of the balloon. A gas bubble inside the balloon will stay at the top of the balloon because your eyes can't rotate 90 degrees. To keep the bubble at the Back of the retina, where the macula repair was done, you Must keep the balloon tipped forward (facing downward) with the eye facing the floor. The bubble will float to the top, therefore the back of the retina -- you just need to make sure the TOP is at the back of the eye.
Certainly you must have more than just eye movement. The head or even the entire upper torso will need to be bent forward in order to achieve the proper eye position. The point here is more that you must also maintain the eye position as well as the head, not just the head as many assume. Thanks for helping me reclarify that!
ReplyDeleteToni Kelly
Thanks for all of your comments. I am facing macular hole surgery in a few days and am concerned about the face down position. I do not want to jeopardize the successful outcome by not complying. You have made it sound possible to get through.....
ReplyDeleteHi, can anyone suggest best equipment to either buy or rent? Seems like a massage table might squash face but perhaps more comfortable? I'm just reading up on the surgery and recovery and it helps to hear what you all who have gone through it have to say. I'm pretty nervous right now. Very active person and laying on my stomach for ? long seems almost impossible but my doctors hasn't told me how long he expecpets me face down at this point. Has anyone ever had their macular hole just go away by itself? I was just diagnosed two weeks ago. Vicki Sue
ReplyDeleteVicki Sue:
ReplyDeleteIt can certainly be nerve wrecking to think about, but as an active person you are in good shape to get through this! You can do it! Choosing equipment is a matter of personal preference. Some people make it through with no special equipment, others tell me they couldn't have done it without the support. Most commonly, the face down time is 7-10 days. If you would like to talk about your equipment options I would be happy to go over them with you! Kelly Comfort Solutions now has locations in PA, FL and CA. Rentals can be arranged from any of them by calling 1-800-721-8172. That's where I am too!
My eye surgeon is giving me the option of having the eye filled with silicone oil instead of gas after operating on my macular hole. He says with the oil there will be no requirement to look down for a 2 week period but there will have to be a second operation in 6 months to remove the oil. Does anyone have experience with the oil versus the gas bubble method? Recommendations? Posted 10/11/2010
ReplyDeleteThe following are the opinions of two retina surgeons. Mitchell S. Fineman, MD, is an ophthalmologist at Mid Atlantic Retina and Wills Eye Institute in Philadelphia. Eugene de Juan, MD, is an OSN Retina/Vitreous Board Member.
ReplyDeleteA limited role for silicone oil
by Dr. Fineman:
I do not think there is any question that gas is more effective than silicone oil at achieving macular hole closure. Notably, Lai and colleagues reported in Ophthalmology in 2003 a 65% macular hole closure rate after surgery with silicone oil compared with a 91% rate with gas tamponade. Gas accomplishes its intended purposes and is easily absorbed without the need for a second surgery, which is another drawback of silicone oil.
Recently, it has been suggested that silicone oil may be beneficial for patients who cannot or will not adhere to face-down positioning after surgery. Silicone oil, because it fills the entire vitreous cavity and remains the same size until it is removed, may not be as dependent on postoperative positioning as gas. Finally, silicone oil may have a role in reoperation of a macular hole when the prior surgery failed due to inadequate positioning.
However, I do not believe that silicone oil has a real role in primary repair of macular holes. It has been my experience that face-down positioning may not be necessary if the internal limiting membrane is peeled and long-acting gas is used. In patients who can position, I normally use SF6, a gas with a shorter duration. This improves the patient’s postoperative experience because once the hole is closed, visual improvement can be achieved more quickly. In patients who cannot or will not position, I use C3F8, which takes longer to absorb, but still achieves anatomical closure in more than 90% of cases.
Gas is usually preferred
by Dr. de Juan:
Although tamponade with either non-expansive SF6 (20%) or C3F8 (14%) is the standard for the repair of both traumatic and age-related macular holes, silicone oil tamponade has been suggested as a means to overcome suspected limitations of gas. Namely, use of gas requires prolonged face-down positioning by the patient in the postoperative period, and vision is reduced by the presence of the gas.
In practice, however, silicone oil has not achieved wide use because of reduced long-term results both in primary closure rates and vision. Also, it requires a secondary procedure to remove it. The reason why silicone oil is not as effective is not obvious but may relate to the reduced “drying” effect around the hole because of the buoyancy of the oil vs. gas.
Silicone oil does play a role in selected cases of macular hole. Myopic macular holes with more extensive surrounding subretinal fluid may need chronic or very long-term tamponade due to reduced healing of the posterior retinal pigment epithelium and choroidal “suction.” It can be useful in patients who are unable or unwilling to position as required with gas, such as elderly, children or those with physical limitations. But stage and size of the hole, along with surgical technique, affect the results in macular hole surgery more than the selection of the tamponade agent, making gas preferred in most cases.
It is 4 weeks since i had my vitrectomy and i have been told that the hole is now closed,I had a bubble of C3F8 placed in my eye and it is still present although it is a lot smaller now,my vision has improved things no longer look distorted through that eye,i am due my next check up in 4 weeks time.
ReplyDeleteThe surgery was no problem but having to posture face down for 10 days was a bit of a pain.
I could not find any where to hire the equipment to help with posturing where i live.
Still it is all over with now and i am very pleased with the result,although i have been told that its very likely that i will develop a cataract.
I would just like to say my vitrectomy was to repair a macula hole,i had to posture for 10 days for 50 minutes every hour,but at night i could sleep in any position as long as it wasnt on my back.
ReplyDeleteI would be interested to know if anyone who has had a vitrectomy didnt go on to develop a cataract
I am scheduled to have surgery for Macular Hole on 6/16/11. I am worried more about the face down recovery time than the operation it self. These comments have been very helpful. Question I have: when you shower do you have to worry about water in the eye? How do you wash your face and your hair? I have knee problems and have concerns about laying face down. Has anyone got the same problem?
ReplyDeleteIn response...here is my story. Developed a Macular hole Feb. 2011 and had repair surgery in April, 2011. Gas Bubble and face down recovery for one week (Not pleasant). Got through it only to discover hole was not closed. So sad and depressed to hear this news. Local Doc. sent me to another Specialist in a big city area for follow up and a second surgery was scheduled for July. At this time my Dr., husband and I decided to try the oil recovery. We were thinking the gas bubble didn't work so why not try this approach. Thinking this would also be better for my life style. Required a second surgery to remove oil, but, didn't seem a problem at the time. My Dr. was all for it either way we decided. He did peel away more membranes during second surgery and the macular just settled right on down and closed about 45%during surg. At the one month scan Macular was 100% closed!! Very good news. One problem....another surgery required to remove oil. Should have been a 20 min. procedure...took one hour. It seems the Dr. didn't mention earlier on that some of the oil was hard to get out and caused him some extra work. I now have a oil floater that appears big to me and small to him. May or may not ever go away. Takes a couple of weeks for the natural vit. gel to return and the saline to absorb back into my system. The oil does not absorb it hangs around forever. The third surgery was not as easy as the first two as far as recovery. My local Dr. was quite surprised that I opted for the oil...don't think it would have been his choice. He realized the third surgery would be tuff. In closing...I do have my macular back at 100% starting my third week of recovery, vision is blurry but I can honestly say I think my sight has improved up close. According to Dr. it takes months to see the total rewards of this surgery. I will keep praying for total success. This is my story and I would not wish it on anyone. Best of Luck to you all.
ReplyDeleteI am going tomorrow, 22/12 to be examined to decide the process I need done to close my macular hole. I am very worried about the possibility of maybe 2 weeks face-down because I suffer from restless legs (Ekbom Syndrome) and cannot keep still for 10 minutes, let alone many days! I am hoping there is an alternative. I will let you know asap.
ReplyDeleteHad my surgery on Monday, Jan. 16 and it is now Thursday night. I am still face down and it is not easy... I was so sick after my surgery from the anesthesia, it took me a day to get over it. I did a lot of research and rented the massage table, the chair ,etc. The chair has been a life saver, I have used the table too. My husband put a tv under the table and I have watched a movie while face down on it. The nights are the worst, We have tried several things ,but just cannot get comfortable. I can see my gas bubble and my eye is very scratchy. I do have stitches that should dissolve in about two weeks. I have to be face down until noon Saturday. I am suppose to get up for 5-15 mins. every two hours. Can also get up to eat and take bath. I have also read about some patients not having down time, and some as much as three weeks. I guess you have to trust your Dr. I have been down most of the time,but sometimes stay up longer than my allotted time. Last night I gave it up and slept on my side for a few hours. I go back to Dr. on Tuesday and will let you know how it goes.
ReplyDeleteFlo... March 26,2012
ReplyDeletebooked for surgery April 4. I have neck and shoulder damage and have problems breathing in close places so not sure about this face down thing. Also have fibromyalgia so move almost constantly even in my sleep. How do I stay still for 45 min operation?
I had my vitrectomy March 21 st. I rented the face down chair and have a mirror that reflects the television and a platform for the bed. The surgery went smoothly and my first night down wasn't terrible because I was still numb from anesthetic! The second and third nights were uncomfortable but after figuring out how to position pillows under my arms, feet and stomach, nights have been tolerable. I do dread the nights, though. I have two more nights before my doctor's appointment (8 nights down). I can see over the top of my bubble and have tested the vision in effected eye. My vision is greatly improved but I still see a little distortion...ugh. I am praying and hoping the doc says no more face down! By the way, I was instructed to remain face down 45 minutes out of every hour. I have gone over my 15 minutes more than once, but I do stay fd all night, about 8 hours. When I walk around, it is with my face to the floor. I even sat out on our patio fd. I hope I have been a good enough patient when all is said and done! Other info that may be of interest: I am 62; I am not diabetic ; I have had 20/20 vision my whole life! Talk about LUCK! Good luck to everyone and may God bless and keep you! JLC in OK
ReplyDelete