Posted by Rick on October 31, 2001, at 2:00:52
I doubt anyone really has an "answer" to this, but I'd certainly be interested in hearing any experiences or theories.
About three months after adding Serzone and Provigil (modafinil) to my Klonopin (for Social Phobia), I developed a very bothersome floater in my left eye which sometimes appeared as a thick, dark curved hair and other times as a brownish semi-opaque oval.
Briefly, floaters are usually-benign protein strands that can form in the vitreous "gel" of the eye. They are very common but usually invisible or only fleetingly, barely visible. But some can become large or start appearing dark by casting a very noticeable shadow on the retina when there's a bright background such as a computer, the blue sky, or even a well-lit book. Mine -- especially the "original," dance around and become very annoying as my eyes move, e.g looking around or looking at the speedometer-and-then-back up when driving. Sometimes when I'm reading in bight light, as I move my eyes it looks like there's a swarm of hairs and gnats and one big wingless-fly swimming around in front of my left eye. I'm told I have quite a few of these in my right eye as well, but I rarely notice them in that one.
Now, opthamologists will dismissively tell you to "just get used to" these intrusive little buggers, and they also insist that there is no way that drugs or supplements can cause or treat them.
But I really have to wonder...especially given the fact that the floaters began apearing (i.e., forming, getting larger, or becoming more noticeable to me) shortly after I started the Serzone and Provigil. For one thing, I wonder if the anti-cholinergic and drying effects of these or other meds could somehow lead to changes in the vitreous that could encourage formation of the protein strands. (No room to go into the details of my specific hypothesis on this count, or for that matter to talk about the medically-differentiated varieties of floaters here.)
What intrigues me is the thought that maybe somehow the meds are making existing floaters more *visible* to me. It IS acknowledged that many peoples find their floaters more "active" after they've gotten insufficient sleep, which might suggest that perception -- the brain -- could play a big part, beyond the characteristics of the actual floaters.
Carrying that thought further, I know that visual side-effects from Serzone are being reported more and more -- far more than for any other AD. (I saw a recent FDA report on this.) And while the reported effects involve mainly things like shimmering, trailers, and spots (not the same as floaters), I wonder if the same mechanisms that cause these perceptual effects (via the optic nerve??) could also heighten perception of the physical floaters, i.e. make them more visible and darker-looking. Serzone is largely a serotonin receptor antagonist, and apparently the eye is rife with serotonin receptors -- although I can't honestly say I understand how this could lead to increased floater awareness. As for Provigil, A) It's a fairly new drug with limited post-marketing side effect data and B) I saw one study in Medline that found two purported primary brain sites of action for Provigil, with one of those referred to as a *pre-optic* region. Does that suggest that perhaps Provigil's alertness-building effect could cause heightened sensitivity in the optic nerve, and thus perhaps make me more attuned to those floater shadows on the retina?? If it sounds like I don't know exactly what I'm talking about, that's because I really don't, but it sure "feels" as if there might be some connections here.
Meanwhile, there is esentially no research on floaters or a way to treat them since opthamologists consider them a medical non-issue. Run-of-the-mill floaters are indeed a non-issue. But for those of us plagued by nasty ones (and as bad as mine are there are people who have it nuch worse!), they're very much an issue. Funny how there are hundreds of studies on benign tinnitus -- which I have but which doesn't bother me at all -- while smug and dismissive opthamologists seem to think if someone complains that their quality of life is diminished by these "swarming eye insects" then they must be obsessive whiners or psychologicaly impaired.
I'm really tempted to stop the Serzone and or Provigil for awhile to see if these things possibly become less visible (although I'm frankly not optimistic...and if the med(s) DID have a role in the *physical* formation, I highly doubt that would be reversible). But, even though I do quite well on Klonopin alone, the combo with Serzone and Provigil serves me so well and with so few side effects that I'm really hesitant to back off even temporarily (although I wouldn't hesitate if I thought there was a STRONG chance that these were causing that daily -- though mostly daytime due to the floaters' "attraction" to light -- swirl of garbage I have to live with in my left eye.
Any thoughts? Is there anyone else out there with bothersome vitreous floaters whose presence has been verified by an eye doctor? Did they appear, or change in appearance (for better or worse) with initiation, discontinuance, or change in any meds or supplements you're taking? If so, which meds?
Rick
poster:Rick
thread:82732
URL: http://www.dr-bob.org/babble/20011025/msgs/82732.html