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Eye Problems - Retina

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I am a novice diver and I have just been diagnosed with central retinal vein occlusion with macular oedema. In short, I can't see a thing out of my left eye. I have had two injections so far and have to have another one next month. The ophthalmic surgeon I saw (well, half-saw!) advised me not to dive until my condition has improved a lot more. I was hoping you may have a different opinion, as I am due to commence my confined water dives in Stoney Cove shortly. Any advice would be greatly appreciated.

A - If it's any consolation, the visibility in Stoney isn't exactly world-shattering at the best of times... The retina is the thin membrane that lines the inner surface of the back of the eye. Its function is similar to that of the film in a camera (for those of us world-weary enough to recall the pre-digital era). Blockage of the central vein draining blood out of the eye causes blood and other fluids to leak into the retina, causing bruising and swelling ("macular oedema") as well as lack of oxygen. This interferes with the light receptor cells and reduces central vision.

Treatment of central retinal vein occlusion is controversial, as precious little evidence exists for anything. The injections you mention are of a substance called anti-VEGF, which is safe and can sometimes reduce the macular oedema. General advice is to avoid strenuous activity as the risk of bleeding into the eye is increased; in particular to avoid bending and lifting heavy weights, which can raise intraocular pressure.

Obviously diving can involve these aforementioned risk factors, so I would have to agree with your ophthalmic surgeon's advice, especially if the condition is in its early stages.

Q - My partner has just been diagnosed with a partially detached retina - apparently there are several layers at the back of the eye, and over a small area these have separated and a small bubble of liquid has got in between. The doctor he saw at Moorfields said it should heal up without problem over 6 months or so, but if it did not, then it would be treated by laser. However, the staff on duty in the casualty department on Saturday were not sure whether he would be able to go diving or not as they did not really know what the effects would be. This was not good news, as we are flying out to Sharm el Sheikh for 2 weeks diving in early July - less than a week's time.

They advised him to go back today to see a specialist, and he has just been told that they cannot envisage any problems as the space is liquid-filled and should therefore on and off-gas as does the rest of the body. This is good news - but I am not sure whether the specialist was a doctor with much experience of diving medicine, so I was wondering whether you had anything further to add to the advice from Moorfields - I am sure this must be something you have come across before and it would be reassuring to know if other people have dived with this problem without ill effect. My partner does not want to risk his eyesight for the sake of one holiday - he is 40, so hopefully has quite a few years diving left! (If he does dive, obviously it would be with additional caution in respect of depths, times and ascent rates - and if he saw any change to his vision would stop immediately).

I appreciate that you may not be able to give a definitive answer if there is not much data on this problem, but even if it's only an "if it were me...." we would be very grateful to hear from you (whether it's good news or bad).

A - Well "if it were me" I would be checking out the batfish schools on the Ras and the Camel Bar in Sharm. A liquid filled retinal detachment will not be affected by diving as the eye, its contents and this problem are incompressible during diving, so it won't worsen. The thing you have to watch out for though is any over exertion that will enlarge it.

An increase in the pressure of the eyeball can be caused by straining when exercising, such as putting on a tanked up BCD or lifting your buddy out of the water in an emergency.

So as diving is always unpredictable, your husband should wait until it is lasered back to normality or do the most basic of dives where a problem could never be encountered. So as four metre diving surrounded by three year old snorkellers on the house reef can be a bit tiring by the second day, I would stop off at the one stop laser shop to get it fixed quickly before you go.

(other dive medical questions)



   


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