ArcaMax

DEAR DR. ROACH: I'm a 73-year-old man who had worn glasses since the age of 12 until a successful laser surgery from 22 years ago, which resulted in near 20/20 vision. My vision has changed little since the surgery.

My eye health has always been very good, if not excellent, but after a recent two-hour airplane flight, I noticed a small "blob" in my right eye. Every time I moved my eye, it moved with my direction of vision. There were also brief flashes of light that occurred sporadically for about 24 hours. They haven't returned.

I underwent an urgent eye exam, which showed that the "blob" is associated with the vitreous gel in my eye. No retinal tear was observed. I have a follow-up appointment in a few weeks. I was wondering what can I expect in the short- and long-term future? What should I be cautious of, can I do anything to improve this situation, and are there limitations on my activities? -- M.R.

ANSWER: The vitreous body comprises most of the volume of the eye. It sits behind the lens and in front of the retina, and it is filled with a jelly-like substance called the vitreous humor. As we age, the vitreous humor can become thinner and detach from the retina. This is different from a retinal detachment where the retina, with its rods and cones to sense light, becomes detached from the back of the eye.

However, when the vitreous detaches, it can sometimes pull the retina off as well, which is why a complete ophthalmological exam is indicated. Between 10% and 20% of people with a posterior vitreous detachment will also have a retinal detachment at the time. More importantly for your question, even more people will suffer a retinal detachment in the few weeks after a vitreous detachment.

The key symptoms to be on the lookout for are the same flashes of light that you noticed when it first happened; an increase in the number of "blobs" (technically known as floaters); or any changes in your vision, with careful attention to your peripheral vision, which can only be tested one eye at a time. With any of these new symptoms, you should immediately see your ophthalmologist as it could mean a retinal detachment, which is far better when it is treated immediately.

There are no restrictions on your activities during this time. With most people, their vision returns to normal over time, although you may continue to notice the "blob."

DEAR DR. ROACH: I didn't have chicken pox as a child but did have it when I was 38 years old. I had red spots but no blisters or itching. I am now 65. My primary doctor says that I don't need the shingles vaccine because I still have immunity from almost 30 years ago. Do you agree? -- K.R.

ANSWER: No, I don't. You are certainly at risk from shingles. Thirty years is more than enough time for immunity to wane. Now that you are 65, you could get shingles, which is bad -- and its complication postherpetic neuralgia, which is worse.

Getting the two-dose shingles vaccine reduces these risks dramatically, and even more recently published evidence has stated that the vaccine also helps to protect people against dementia. The downsides (mostly a sore arm with a very small risk of serious side effects) are vastly outweighed by the benefits, in my opinion.

I recommend the shingles vaccine for everyone over the age of 50, whether they recall having chicken pox or not and even if they have already had shingles -- as long as they don't have a reason as to why they can't take it.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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