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AUTHOR'S NOTE: Please forgive typos and other errors below: I'm suffering vision problems at the time of writing. END NOTE.
Steroids. We see awful reports of their effects on abusers all the time. But what about their effects on people legally prescribed them by their doctors?
Pred Forte was my own steroid prescription, after cataract surgery.
My own awareness of steroids problems up to 2008 had been peripheral in nature. Noticing the mention of them in the media from time to time. But now I finally have first hand experience.
Apparently the awful blood vessel blowout after my previous eye surgery stemmed largely from the end of my steroids dosage then. For I seemed to experience a rebound in eye inflammation after the suppression effect of the steroids diminished below a certain point.
Or else the draw down in the drug caused my vitreous humor (the gel inside my eyeball) to get 'sticky', making it pull on my inner eye lining every time my eye moved, until my retina detached or a blood vessel burst.
I didn't realize then the exact cause of my complications. And my doctors (I ended up seeing two different ones) were careful to omit the info about the likely steroids connection (since they prescribe the stuff to lots of patients).
But they couldn't avoid giving me indirect clues to the truth, over many, many exams, and my own insistent questioning and observations.
And of course I got a second sample to go by: the post-op experience of my second operation.
In my first post-op, I blew a blood vessel at the end of the third week of steroids use. For post op I was supposed to take the steroids for four weeks, lowering the dose by one drop a day each succeeding week, beginning with four drops a day and ending with one drop a day.
So my blowout happened the first day of my final week, when I had just dropped to one drop a day in dosage.
After a frustratingly unhelpful emergency exam by my doc, I Googled my problem as best I could, and noticed some of the potential problems with the steroids. However, I also noted I might have been under dosing myself with them all along, according to the usage instructions I found online. By that I mean I had NOT kept laying down for a couple minutes after the drop to let my eye steep in it as appeared recommended, but rather blinked them away, jumped up, and returned to work immediately.
As the blood vessel blowout left a possibly permanent mark in my eye afterwards (the appearance of a thick wisp of smoke which waves madly about in my vision when my eye move about), I badly wanted to avoid a similar occurrence in my left eye post-op.
Note that I had no second blow out in my first eye afterwards, despite taking the steroid drops for another six days after that. Which eventually reinforced the idea that I might have been under-dosing myself a bit there, and maybe contributed to causing the blow out.
Yes, I asked my doctor if that might have been the case, and he said “no”. But that's always been his stock answer in regards to me being able to affect my vision status in any way at all on my own. He's always basically told me that I'm helpless to improve my vision health or outcome on my own. That, for instance, changes in diet, exercise, or lifestyle have nothing at all to do with it.
But changes in diet, exercise, and lifestyle seemed to enable me to reduce my eye pressures enough for him to stop prescribing glaucoma eye drops for me, a few years back. I guess he regards that as a fluke(?)
I spent two miserable weeks after my emergency blow out exam waiting to see a retinal specialist. They were miserable because my main eye doc had been pretty doom and gloom in my exam, talking about my vitreous humor getting sticky and pulling on my eyeball insides to cause the blood vessel rupture.
He carefully omitted any mention that the steroids drops might have played a role there.
But I also knew I'd never had problems like that before the surgery.
So I spent two weeks afraid to use my eyes for much of anything, dreading to hear what the specialist would say, after the awful prognosis from the first doc.
And there seemed little I could do about it myself, but contemplate blindness.
Remember I still had one eye blocked by cataract and therefore legally blind-- and now the 'clear' eye had blood in it obstructing my vision-- and my doc acted like things might get much worse.
I DID become much more careful about dispensing my remaining six days of steroid drops. Just in case my previous cavalier attitude towards them had played a role in my blowout.
Then the specialist gave me a clean bill of health, and I went back to work again. But delayed my second operation for a few weeks to give my first eye more recovery time.
However, I feared delaying too long-- for I needed a spare eye in case the first one blew out again or worse, I figured.
And with a possibly severe recession or worse imminent for America, I needed to get myself in better shape to handle it, too.
I did everything I could think of to make the second operation go better than the first. For instance, I completely quit coffee weeks before the event, to reduce the wild hallucinations that caffeine mixed with the op anesthesia and my possible migraine aura had brought me in the hours afterwards (I'd discussed this with my doc).
I also made sure to shield my eyes better from bright lights after the op. All that massively reduced the odd visual effects from what they'd been the first time.
I also exerted greater care in dispensing my drops. Making sure not to stand up again until a full two minute count; stuff like that.
I also held off on returning to work for considerably longer than I had for the first op, just in case eye strain had contributed to my blow out. I wore the sunglass visor longer, too.
But unbeknownst to me, the real problem was the steroid draw down. As the daily dosage went down, the risk went up.
This time I made it all the way to the day just before the last I was supposed to take a single drop.
I was working, of course. For after both operations, while I was still on the drops, I had maybe a couple weeks where things seemed fine, and I could get a good amount of work done.
As I worked, I suddenly noticed something new in my vision. Of my latest operated eye.
An itty-bitty, utterly black speck, floating around.
For a moment or so I wasn't very perturbed by it, as it was so tiny.
But its darkness reminded me of something.
The deep black of the blood from the vessel burst weeks before.
To confirm the possibility, I closed my eyes and gently swished them from side to side-- and saw circular 360 degree arcs of light. Just as I had immediately after the first blow out.
It appeared I was in danger of another blow out! Yikes!
I immediately went into emergency mode, shutting down my computer, abandoning all work, donning my sunglasses…
…and doing my best not to move my eyes at all after that.
For the eye movement combined with the sticky inner eye gel or increased eye inflammation or both is what rips your retina or blood vessels.
But man, is it ever hard to avoid moving your eyes! Sheesh!
And I ended up having to attempt that near continuously for three solid weeks!
Let me tell you: that requires a near super-human effort-- at least for me.
But I was highly motivated by a desire to avoid blindness, another full-on vessel burst, and far bigger and more costly eye operations.
The main way you keep your eyes unmoving is to keep them closed as much as possible. For otherwise they'll track anything moving in your visual field.
In this mode it's best to take instant 'snapshots' of your surroundings as needed to get around or perform tasks. And you'll barely be able to do the simplest of tasks. OUCH!
Of course, you'll have no control at all when asleep. And REM sleep is defined by rapid eye movements. I guess that's why most people get their retinal detachments or burst blood vessels during sleep.
This meant I endured weeks of wondering if I'd be blind by morning. And often checked my vision upon chance awakenings at night.
Pretty much all you can do while awake is watch TV. Preferably from a distance, so as to further minimize related eye movements.
Even carrying on a conversation is risky, as interacting with others will distract you from controlling your eye movements, and your eyes naturally swoosh around during speech as you access your memories, or look at the expressions of those speaking to you.
Even abrupt jostling is risky. Like sitting down hard in a chair.
So I ended up forced to watch the awful, awful, AWFUL American TV of early 2008 for roughly 16 hours a day, seven days a week, for three weeks.
I had about 100 channels, and there was nothing on.
I definitely couldn't work or read or just about anything else. For eye movement is critical to almost everything of significance.
So why didn't I see my doctor? Because both he and the retina specialist had given me the overwhelming impression that they could do nothing for me unless and until my retina detached. At which time I'd need emergency surgery.
So I also tried to stay ready for emergency surgery for three weeks too.
Plus, I had an already scheduled appointment with the retinal specialist at the end of my second week of these three. I figured I'd do my best to avoid a blow out until then, and see what he said.
He gave me a clean bill of retinal health, and didn't even schedule me for another visit, ever.
I made sure to relate first to his assistant, and then to he himself, my experiences with the steroid weaning making my vitreous humor sticky and all that, and how I'd kept my eye movements to a minimum to avoid a blowout or worse.
Their response was to say they use those steroids on everybody-- and to comment not at all about my struggle to prevent another blowout.
I guess there was nothing helpful they could add. Plus, any comments might have acknowledged the risks they prefer to mention only in fine print of liability disclaimers.
Now, roughly three and a half weeks after my eye movement moratorium began, I still don't feel out of the woods yet. I'm still seeing uncomfortably frequent and bright arcs of light when I move my eyes from side to side-- and just as after the first operation, now too the effect often is present in both eyes rather than merely the last one operated upon.
It's like the steroid drops affect both eyes even when only put into one!
In the last day or so I dared do a bit of net research on the matter. The best news I could gather was that it can take months for the effects of the steroids to completely disappear. OUCH!
But hopefully I've protected my eyes long enough now to avoid the worst risks of blow outs or detached retinas.
But damn if this hasn't been an awfully worrisome and unexpectedly difficult experience so far!
There's more details about all this I may be able to add later.
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