Scleral Buckle Surgery
Accounts of Personal Experiences
Gary Orndorff:
My scleral [buckle] transplant was a strip of sclera from an eye bank, and attached next to my cornea. Then the eye is turned and the strip is wrapped around the equator of the eye, with the muscles that move the eye being pulled away so the strip can go underneath them. Then the eye is rotated the other way, and the strip is wrapped around the other half of the eye in the same manner. Then the end of the strip is attached adjacent to the other side of the cornea. This is considered a very non-invasive type of surgery, since it does not disturb the vitreous or inside of the retina. If the doctor is thinking ahead, as mine was, he can use a cryogenic wand to “tack weld” the back of the retina to the eye wall by super freezing it at the corners. This will greatly reduce the likelihood of a giant retinal tear, which we myopes are prone to. In Japan, this operation is not uncommon, being done even under a local anesthetic. I, however, would want a general.
He did one eye first, then the other a week later. You will spend a week taking it easy afterwards. No heavy work, but moving around is okay. I had no significant pain after the surgeries, other than soreness of the eye muscles, since they are not used to be stretched. There are eye rotation exercises you do, and after a week, the soreness is pretty much gone. I don’t remember taking any pain meds other than a few aspirin for a day or two after each operation. The stitches that attach the strip dissolve, so there are no followup procedures, other than routine checkups.
The cost was approx $10,000 per eye, about 10 years ago, by Dr. Frank Thompson, in San Gabriel, Ca. The procedure sounds a little gross, and looks worse, but it was no big deal as long as you don’t have to watch it performed! This is not experimental surgery. The procedure has been performed for 30 years or more, in Japan, Russia, Europe, and the U.S. I worked for our local electric utility, who had excellent insurance. The administrators (Blue Cross/Blue Shield) at first said no, but my company pays the actual money, being self-insured, so they told BC/BS to pay for all of it. I ended up paying only $65 of the over $20,000. I was very fortunate to have such a compassionate benefits group.
I feel this operation has done more to preserve what eyesight I have left than anything else that could have been done for me at the time. I had laser cauterizing of leaking blood vessels in each eye previously. They were necessary, but very destructive to my sight since they were almost on top of my central vision. At least the scleral operations were virtually risk-free with little discomfort.
Posted to MDForum by “Spookyluv2”:
I had the scleral buckle by Dr. [Brian] Ward in November of 2009. I am glad I did. It was in the eye that is NOT neovascularizing, my right eye, which is 30.5 and -12.50. The only issue I have is some lingering double vision, but it is almost not noticeable anymore except when I am tired or in a strange place. I know that’s weird, but sometimes I notice more when I am in a room that I am not familiar with, especially in the evenings. My insurance covered all but $400. I did not do the left eye because I was afraid my eyes wouldn’t work together looking to the left, like they do not work together looking up and to the right, and that would be intolerable. I don’t know what the outcome has been for others. Dr. Ward says the double vision goes away for everyone over time, but for me, it has been nearly two years, and I still have a little bit.
Posted to MDForum by Lupe Nielsen:
I went to see Dr. Brian Ward on March 16, 2011.
I like this doctor. He is quite personable and he knows what he is doing. He and his staff are used to dealing with people with high myopia, so cases like ours do not come as a surprise for them. He is quite honest, and does not mince words when he describes my eyes; “they are rather dreadful”, he said. He is the only ophthalmologist that has sent me in writing a full diagnostic report of my condition.
For your reference, here is my current eye situation:
Age: 45
Gender: Female
Current eyeglass prescription: -25
Current contact lens prescription: -23
Right eye – Vision with correction 20/400. Eye length: 35.9 mm. This eye has a significant staphyloma in the back. It has amblyopia, esotropia (it tends to move inward a little bit), and has a stage 4 cataract. It has dry atrophic macular degeneration
Left eye – Vision with correction 20/40. Eye length: 34.9 mm. Eye has a staphyloma in the back as well. It has a stage 2 cataract and dry atrophic macular degeneration.
I have seen the right eye slowly degenerate and lose vision through the years. There is no doubt from all the analyses, that the left eye will continue to deteriorate. (I was diagnosed with MMD in the year 2000)
The axial scleral buckle surgery that is performed by Dr. Ward will not stop or cure the macular degeneration. The buckle is a small support for the back of the eye that holds and slows down its growth. The only benefit is that this might slow down the acceleration of the degenerative process.
I figure that at this point I have almost nothing to lose with having surgery in both eyes.
First Surgery – Scheduled for May 4, 2011 – Right Eye
Pre-operative meeting with the doctor is usually on a Monday, and he performs the surgery on the following Wednesday.
He is very careful during the preoperative diagnosis, he did a detailed measurement of the length of my eye, an OCT Scan, he examined my eye retina in minute detail and determined that there were parts of it that needed a little “spot welding” due to lattice degeneration. He then proceeded to do slit laser surgery to seal or weld these areas to prevent any detachments during the main surgery.
Laser surgery was not comfortable for me. The laser is quite bright for the sensitive retinas, and it felt like it went on forever. I was glad when the procedure was over.
Wednesday morning arrived, and I was at the east entrance of the Good Samaritan Hospital in Campbell, California, at 5:30 am. The staff at the hospital was personable and extremely friendly, and they did everything to make you feel comfortable. The nurse proceeded to put eyedrops in my eyes which included the dreaded atropine (for dilation). I met the anesthesiologist, and the main operating room nurse, and off we went.
Surgery was scheduled for 7:30 am, and it lasted about 1 hour 20 minutes. I woke up at around 10:30 am and was out of the hospital by 11:15 am. The only mishap was that I was told that I started coming out of the anesthesia before the procedure was over, and that I almost punched the anesthesiologist. I figure this only kept them on their toes.
Needless to say, your eye is patched up and it is not a pretty sight. It is beet red and it feels like someone hit you on the face.
The reason I previously did not write a report for this eye is because this is my bad eye. At 20/400 with correction, it didnÕt make a difference whether the surgery went well or not. I simply do not have enough acuity in that eye to tell you how well I can see. I canÕt really tell if I see double or normally.
Upon my return home, I made a couple of appointments with an eye doctor to have my eye pressure checked. This is quite crucial, as eye pressure tends to increase with the surgery. In order to keep the pressure down, I took Iopidine eyedrops prescribed by Dr. Ward. Initially, the eye pressure was 21 mmHg in the operated eye. After two weeks it came down to 13 mmHg. So I was able to stop the drops then.
The eye healed quite well. You cannot let water in you eye for two weeks. It took about 3 weeks before I could wear a gas permeable contact lens in that eye. I also resumed my regular exercise routine after I was able to wear a contact lens. It took 3 months before I felt comfortable to even rub my eye, and for it to feel normal. There is still a little bit of pinkish hue on the white of my eye, though.
Second Surgery – Scheduled for August 31, 2011 – Left Eye
Second eye is a different story, though…It was done in my good (and only only eye) that has a vision of 20/40 corrected. If I lose that, I am up a creek without a paddle.
Again, pre-op was on a Monday. And yes, he did every single test known to man, including minor slit laser surgery. This time, however, the procedure consisted of a few spot welds and it was not as prolonged as the one done a few months ago for my other eye. However, the areas he hit must have been close to some nerve in my head, and although not very painful, I could feel the laser. I did have a minor headache after the procedure, but everything was back to normal by the following day.
Surgery was on Wednesday, August 31, 2010.
Everything was exactly the same, except that this time I warned the anesthesiologist that I have the tendency to come out of anesthesia before the surgery was over, so he was ready for me. I was later told that indeed I did try to come out of anesthesia before the procedure was finished. They must have pumped so many drugs in me that I did not wake up until 11:30 am.
It was very disturbing to wake up.
1. I was literally blind. My good eye was patched up, and all I could see was a blur with my bad eye. Needless to say, I was quite disoriented.
2. The anesthesia gave me a side effect called myalgia, where I had pain throughout my chest and abdomen. A muscular pain similar to the pain caused by a heavy 2 – 3 hour workout.
3. Extreme nausea.
It is not fun to be legally blind. and feel completely and utterly helpless. I returned to the hotel room, took the medication for nausea (which was effective within 30 minutes), and slept for the rest of the day.
Food consisted of broth and soup. The following morning I was eating a solid breakfast.
Unfortunately, I was still blind. My vision was poor. Probably at about 20/200 or worse. On Thursday morning when I went to see the doctor, i could only see fingers at a four foot distance. But according to Dr. Ward, the surgery was “very boring” which means it was quite routine and it went okay. There was no internal bleeding, sutures looked good, and everything looked fine.
On Friday, I went to see the doctor one more time. They did another OCT scan, and things looked good. The OCT scan is scary, though, my eyes are so elongated that it is only through the grace of God that I have as good vision in my one eye as I have so far. This morning I could see more fingers and the letter “E” on the chart. By the afternoon, I was able to navigate my way around the airport (with my husbandÕs assistance), and work at the computer and watch a little TV. The atropine was wearing off, so slowly my pupils were enabling me to focus better.
This time, the eye pressure situation with the eye was much better. A few days after returning home, I had an appointment with my local retinologist. Pressure was 16 mmHg in the operated eye, which meant that I could stop taking the Iopidine drops. My next appointment with the local retinologist will be in two weeks for a final evaluation.
It has been ten days after the surgery, and my vision with glasses is probably 20/60. I have managed to drive during the day and run a few errands close to home within a 5 mile radius. I expect that my vision will improve once the stitches dissolve and I can wear contact lenses – which give me better correction. There are no noticeable side effects. I do not have any double vision or feel any difference whatsoever.
In conclusion, I wish this procedure would have been available when I was much younger. Probably if I was in my 20s and I had the buckle done around my eyes, this would have prevented them from getting so grossly elongated. I am still grateful that I can have the surgery right now. It would be shame that I get to be 60 years old and kicking myself for not trying everything that was available to me at the time. Although I don’t constantly think about it, I am aware that I can lose my vision at any moment. My only goal is to enjoy each day to the fullest, and to simplify my life. I am grateful that I still have enough health to be self-sufficient, productive and be able to work.
Other notes
After reading the above you might still have some questions left like:
Where to stay?
We stayed at a little hotel called the Bristol Hotel – located at about 1/3 mile from Dr. Ward’s office. The hotel is reasonably priced, and if you tell them you are in town for surgery (the hospital is about 2 miles away), they offer you a little discount.
Medications?
There are four drugs that are prescribed after the procedure:
Neomycyn / Steroid Combination eyedrops – An anti-inflammatory / steroid eyedrop. You will be taking these for about 3 weeks and will slowly be tapered off these.
Iopidine eyedrops – Meant to keep the eye pressure down. Once the pressure goes below 18mmHg, (The doctor likes the pressure to be even lower), then you will be off these.
Vicodin – For pain. I only used them for a day and a half. It wasnÕt too painful an experience though.
Diamox 500 mg – Sulfa drug. Helps to control the eye pressure. This is a nasty drug. If your eye pressure goes down, then you will be off this thing.
Prednisone 10 mg- For inflammation. I love prednisone. You get a 7 day supply and taper it a per instructions.
Phenegan uppositories – for nausea. I did not need these for the first time around. They did help after my second surgery when I was nauseated.
Cost?
I am self-employed and have a PPO Insurance for which I pay a premium each month. From experience, it seems that what hospitals and doctors charge depends on the various contractual agreements and the formula given to them by each insurance company. In other words, the formula is:
(A certain amount that is charged) divided by (number given by insurance co.) minus (various contractual discounts) equals (what doctor or hospital wants to get)
I have no clue how insurance companies determine their formulas. It must be a complicated algorithm full of government regulations and legal considerations. Each insurance company is different, and every company makes different arrangements with the doctors. It is my wish that one of thee days we remove the third party from the transactions one has to make with one’s chosen health providers.
After looking at the bills for my first surgery, here are the current numbers in my particular case.
Hospital charged – $46445.37 – I think this included the anesthesiologist’s fee, as we did not get any additional paperwork from his office.
Hospital received from insurance: $7126.36
Hospital received from me: $1977.42 (initial payment before surgery) + $378.58 (pending balance) = $2356.00
In summary hospital received: $9482.36
Dr. Ward’s office charged – $8926.00 – This figure included the slit laser surgery he did during the pre-op consultation, plus his fees for surgery, scleral material, etc.
He received from the insurance: $1261.12
He received from me: $330 (pre-payment) + $1415.51 (pending balance) = $1745.51
In summary doctor received: $3006.63
Total cost for right eye: $12488.99
I expect the rules of the game are different for the left eye. The reason: I have met my deductible for the year, and the second time around there were no pre-payment charges required by either the hospital or the doctor. I am also sure they will bill me later for any extra expenses.
If you do not have insurance, don’t be discouraged by these numbers. On an unrelated subject, and an unrelated pre-existing condition surgery I had around 11 years ago (being pre-existing, my insurance did not cover it), I researched how much it would cost me to pay cash to each of the entities involved in the procedure. I saved for the surgery, and when the time came I went to each of their offices with a wad of cash and paid them a fraction of what the “quoted rate” was. I paid everyone on a Tuesday, and by Thursday I had this procedure done.
Hospitals and health care providers are always willing to work with patients. I find out that if you ask nicely, they will be willing to work with you on a payment schedule or a method that will fit your needs.
And that is my report for now! If you have any comments, questions or anything else you would like to know, you are welcome to contact me.
I am planning to see Dr. Ward again next year for a follow up, and for a thorough check up before I tackle my next problem: Stage 4 cataract in my right eye. 😉 Until then, I will keep lurking on this forum, which is an excellent resource for everything regarding your eyes.
Take care and keep smiling!
Carol Fong:
I wanted to share my experience with Scleral Buckle Surgery. I discovered that my already bad left eye : -12.0 was deteriorating more rapidly than normal back in 2011. It had increased by 1 over one year so my optometrist referred me to Dr Brian Ward at Retinal Diagnostic Center. We did all the typical measurements and my axial length was 31 (my right eye is only slightly better but it is the dominant eye). He proposed the Scleral Buckle surgery then but I had to give it some thought before committing. It is now 2014 and I finally gathered enough courage to have it done. The procedure went pretty much like the past posts by other patients of Dr. Ward. I will try and highlight and bring out some of the details that were not discussed previously.
I am local, so it was easy to get to and from the doctor as well as the hospital.
One of the reasons for the hesitation delay is the scheduling of the surgery, you have to anticipate at least 3 months in advance. I am a teacher, so I did not want to do it during the school year and the first year, their summer was booked. I actually booked my April 9, 2014 appointment in November 2013 to coincide with our Spring Break. They will call you if someone cancels and you want to move it up…
As in any surgery, you have to do a post-op clearance with your doctor 30 days or less before day of surgery. They did not mail me the paperwork a week before the surgery, which left me 5 working days to get it done- including a blood test.
You can clear everything via phone for Good Sam prior to arriving. They were very polite and friendly.
Wednesday morning before surgery, they will fill out more paperwork and offer a 20% discount on your payment if you pay that morning.
Then, the prep room where they stick an IV into you, monitor your blood pressure and give you the dilation eye drops. This is where I came across a problem. The nurse who put in the IV catheter, I think, did something wrong. I remember the insertion is like a little painful but the pain goes away after it has been inserted, in this case, it did not- it kept nagging/pinching me. I mentioned it but the nurse thought it was nothing. Onwards…..
They wheel you into the operating room (looks nothing like TV ones) and you meet your team & Dr Ward- at least what I could recognize through fuzzy vision!. Next thing I knew, I was waking up with a patch over my left eye and Dr Ward telling me everything went well. My eye felt bruised but nothing too painful. They called my husband and told him I would be ready to go home soon. However, the IV felt really painful. I told the nurse and see looked at it and saw nothing. Ten minutes later, after she came back from break ( I was still groggy) she panicked and called another nurse. Apparently, the “nothing” was growing into a red rash that appeared to be spreading. They called Dr Ward and told them to call a Plastic Surgeon. Long story short, they think something leaked out and “burned” the area as the rash appeared to have stopped growing and was starting to heal over. I think it was a bad insertion and I told them to take it out. They gave me a Vicodin for the hand pain, not the eye pain. I was out of the hospital by Noon. The nurses were great in their concern- she said that in her 40 years, she had never seen anything like that. Oh well.
Back home, it was sleep. Apparently, not only do they put anesthesia in the IV, but also Diamox- which you have to take orally at 4pm also. Dr Ward warned of frequent urination and tingling. Well, I had the urination (that is the intent to reduce water pressure I think) but not tingling. Drink lots of water. However, the other side effects of Diamox not mentioned were nausea, constipation, loss of appetite, tiredness, dry throat/mount, slight fever- I had all of those. I am 5″ 6″ 117 pounds- I was 111 pounds by Friday. I could not eat anything but chicken soup, slept a lot – felt generally blah and lifeless. The eye pain was minimal, only soreness, so I did not take any pain killers. I was to stop the Diamox on Sunday so they could test the eye pressure on Monday to see if I still needed it. On Sunday, I felt fine and was finally up and about and most of all – hungry!
I did see Dr Ward on Thursday after the surgery, and he had me wear the eye patch for another day- lots of discharge. I have to wear the metal patch at night for 3 weeks to make sure I don’t accidentally scratch it. Generally, the pain was only annoying at the start and most of it went away by Sunday- only occasional stinging. I don’t see much double vision but my lenses are not corrected fully so it is hard to tell- I do see a bit when I try to see all the way to my left peripherally.
The visit on Monday went well. Off of the Diamox and pressure was 12. Will see him on Friday to see if I can stop the drops for that. It is now Wednesday, one week later and I ventured out to go shopping and drove- went fine though I think my eye may still be slightly dilated.
I hope this helps and good luck to all those considering the surgery. It was overall not as bad as I thought.