UNIONDALE, NY — It’s not only impressive that Kyle Okposo is playing well this postseason, it’s also that he’s playing at all.
On Jan. 19, after having scored five goals in the previous three games, the 27-year-old Islanders forward became very concerned when the blurred vision he’d been experiencing in his left eye turned into pain. Okposo went to a doctor and was told that he would need surgery the next day to repair a detached retina.
(For a breakdown on that injury, how it occurs, its seriousness and treatment, see our interview with Dr. Richard Kaiser, an attending surgeon at Wills Eye Hospital in Philadelphia and team ophthalmologist for the NBA's 76ers, at the end of this story.)
While it was in the back of his mind that he might not be able to return for rest of the season, or ever play hockey again, Okposo’s thoughts immediately turned to his family. “I thought about them right away,” he told SI.com after New York’s morning skate on Tuesday. “That first night when I knew I was having surgery the next day, where I didn’t know if I could see again, that was pretty scary. Just for life in general.”
His fears left Okposo unable to imagine not being able “to do the things I want to do with my kids and my family.” He and his wife, Danielle, have a one-year-old daughter, Ellianna, and his face lights up at the mention of her. “I love hanging out with her,” he says. “She’s starting to really have a personality and interact, and it’s just fun to be around her.”
Okposo’s ordeal was made easier by the support he got from his second family, his Islanders teammates, who frequently texted him or checked in on how he was doing during his recovery.
“Anytime you’re hurt it’s tough to be away from the guys,” he says. “You miss the rink and you miss the camaraderie and everyday conversations when you’re sitting here and just chatting with the guys.”
It has now been six weeks since Okposo returned after missing 22 games. He needed time to recover his confidence and get comfortable on the ice. In 14 regular season games, beginning on March 10, he scored only four goals, with three assists (in the 46 games before his injury, he was on nearly a point-per-game pace: 14-30-44). But in the last four games of that stretch, he showed signs of being ready for the postseason, scoring twice and chipping in two assists. His line for 2014–15 (18-33-51) would have surely been better than his career highs of 27-42-69 from last season had he not been sidelined so long.
Okposo says he spent a lot of the time after his return making sure that he would be mentally prepared for the rugged, “amped up a notch” playoff battles to come. His play so far in the first round has reflected that effort. Delivering the mix of physicality and scoring punch that made him the seventh pick in the 2006 NHL draft, he scored goals in Games 2 and 3 of New York’s series with the Capitals.
In Game 3 on Sunday, he not only scored the Islanders’ lone goal in regulation, he also delivered a big hit that made an impact on the series. Less than four minutes into the first period, he checked Washington forward Eric Fehr into the glass. Fehr did not return to the ice, and did not play in Game 4. He is also expected to miss Game 5 with an upper-body injury.
“I feel good on the ice,” Okposo says. “Just feels good to be playing again. I had 14 games to try and get my feet back under me. I feel like I’ve done that. I feel pretty good out there.”
Being able to play his game again is no small blessing. In recent years Marc Staal, Manny Malhotra, and Chris Pronger have been hit in the eye by pucks or sticks and missed considerable playing time. The careers of Staal and Malhotra were jeopardized, though they were able to return. Pronger wasn’t so lucky. Neither was Hall of Fame defenseman Al MacInnis.
After taking a stick to the eye in January 2001, MacInnis suffered a permanent blind spot and was forced to wear a special lens in his glasses. By October ’03, he had to stop playing after he learned that he had a detached retina. He ended up retiring.
One of the league’s most devastating eye injuries was suffered by Maple Leafs defenseman Bryan Berard, who missed an entire season after being blinded in his right eye by a stick during a 2000 game. His retina was detached and he required seven surgeries. Though he eventually made it back to the NHL, his depth perception was affected and he was never the same.
Okposo doesn't know how his injury occurred and there's always the threat of reinjury, but New York captain John Tavares says he’s noticed his teammate’s improved confidence, calling him “all-star caliber” and “one of the top right wingers in the game.” Tavares appreciates the difficulty of coming back from the kind of injury that Okposo suffered, and says the big forward clearly has a good feel for his game once again and is finally getting his timing and rhythm back.
Now trailing three games to two in their series against Washington, New York coach Jack Capuano thinks Okposo’s play will be a key factor if his team is to win the series.
“When you got to have a chance to win a series, your best players have got to be your best players,” Capuano said. “Kyle’s stepped up to the way he’s got to continue to play. He’s got to be physical because he’s a big body. He plays his best hockey when he plays with an edge and he gets pucks to the net. That’s what he’s done in this series so far.”
With Okposo’s vision and game nearly back to where they were before his injury, he and the Islanders know that even if a trip to the second round isn’t in the cards this year, their future looks a lot brighter than it did last January.
Detached retinas and why they occur
SI.com: How does retinal detachment occur?
Dr. Kaiser: Under normal circumstances, they develop fairly regularly in the normal population. They’re more common in people who are nearsighted. There’s a gel in the center of the eye called the vitreous. When you’re born, the vitreous is adherent to the retina, which is the film of the camera in the back, like wallpaper that lines the whole inside wall of the eye. And the retina is what you use for vision. You process everything through your retina. What happens is the vitreous gel separates from the retina. When it does that, it can tear the retina. If you get a little tear … imagine if you had a room full of wallpaper and you got a little rip in it and then fluid from inside the room got behind the tear and peeled the wallpaper down. That’s a retinal detachment.
If it peels down through the center of your vision, you lose most of your ability see. Most of it actually comes from the macula, your central retinal vision. And that’s what you use to read and whatever you’re looking at now. You’re using a very small percentage of your retina. The areas off to the side would take away your peripheral vision. In the case of an athlete, if they were to have a retinal detachment they would notice that there was a defect off to the side in one of the quadrants of their eye. That’s the progression of a retinal detachment in normal aging.
In a case of an athlete, if they get hit in the eye with a puck or an elbow, we see the injuries a lot in basketball. There’s a fairly high frequency of eye injuries. Fortunately detachments don’t occur that often in this age group. But if they do, it’s because you get trauma to the eye, which causes that vitreous gel to more violently separate from the retina, so it’s under induced circumstances when the gel separates, so it can rip the retina and then you can end up with a detachment.
There are a couple of really well-known athletes who have had retinal detachments. Sugar Ray Leonard is the most notorious.
What happens to your vision immediately when your retina detaches?
Dr. Kaiser: You can’t see out of whatever portion of the retina is peeling off. But once the center vision is involved, that’s when you have a really abrupt decrease in vision. Once the retina’s been detached, just because you re-attach it, doesn’t mean you’re going to regain your sight. It depends on how early you catch it, and how successful the surgery is and you need a little bit of luck actually, with how you’re going to heal.
How do you perform the surgery?
Dr. Kaiser: There are a couple of ways. If you catch the injury before the detachment, after the retina tears but before it detaches, you can treat it with laser surgery, which is more of an office-based procedure that we do where we place laser burns around the tear where we literally solder the retina to the back wall of the eyes so it doesn’t detach.
If it does detach, there are two alternatives. There is a procedure called the scleral buckle and a procedure called the vitrectomy that we do in the operating room. Those are two surgical approaches. And the approach depends on the nature of the injury and the nuances of the detachment.
Once a retinal detachment is repaired, is a person more vulnerable to re-injury?
Dr. Kaiser: The natural success rate of a retinal detachment surgery the first go-around is usually around 90 percent. But that still means that one out of ten retinas will peel down again. Think of the retina as being about the size of a postage stamp but much, much thinner. And so you have this very friable thin tissue that once it’s already peeled down, there’s a tendency for it to re-detach in the short term. But if you get a patient through the first six to eight weeks after the initial surgery and they are successfully reattached, the rate of re-detachment actually goes way down, to probably around the three to four percent range.
Is it more dangerous for an athlete to return to a physical sport after they have surgery to fix a detached retina?
Dr. Kaiser: I would say it depends on the sport and the procedure that is performed, and on what other injuries the eye sustained during the initial event.
There are definitely confounding factors that enter into the equation in an eye that has undergone a trauma and ended up with a retinal detachment because more than likely there were other injuries to the eye. There are countless injuries that can occur from any sort of blunt trauma to the eye. Retinal detachment is just one. If the injury is violent enough to cause a retinal detachment, there’s a chance that something else went on with the eye as well. A lot of that will determine what the future is.
What are the other factors that go into retinal detachment, other than blunt trauma to the eye?
Dr. Kaiser: You could take ten athletes and they could all have the same blunt trauma, and there would only be one or two who would develop this type of injury because there are other factors that go into it, including if you’re nearsighted and if you have a family history.
How does being nearsighted affect this?
Dr. Kaiser: When you’re nearsighted, which is what most people who wear glasses on a daily basis are, which means that they see better up close than they do far away. What happens, is your eye is actually a little bit bigger. If you think of the eye like a camera, an image comes in through the cornea and goes through the lens, which helps focus the image. Now this image, if you have a bigger eye, is going to get focused in front of the retina. In that situation, your eye is actually larger than it should be, so the retina is stretched a little thinner around the edges in the periphery. So when you sustain an injury and that gel violently separates, you are now separating from an area where the “wallpaper” is stretched extra thin. It places you at risk. People who are nearsighted are at higher risk for retinal detachment than people who are not.
What are the lasting effects of a retinal detachment?
Dr. Kaiser: It depends on how much damage was done from the initial detachment. If it is caught early, then you can end up with no limitations and full vision. But if the detachment progresses either quickly or because of the late diagnosis, then you definitely could have significant visual limitations.
Are professional athletes likely to notice the detachment more quickly?
Dr. Kaiser: No, professional athletes actually tend not to see the symptoms. Dealing with the 76ers, these are young, healthy athletes who are used to feeling perfect and you don’t have any pain with the retinal detachment. You can have a total detachment and be totally pain-free. That doesn’t mean you’re symptom-free. But they're sort of taught not to complain. When one of the 76ers gets poked in the eye, I will insist they have a detailed exam right after the injury, and then weeks later, to repeat it, to make sure there’s not a subtle peripheral retinal detachment developing. Many times it’s subtle and slow, and it’s completely painless.
If there’s no pain, what are the symptoms of retinal detachment?
Dr. Kaiser: The key symptoms are flashes of light and floaters. So if you start seeing new floaters or flashes of light in your vision, that could be a sign that your retina is tearing.
It's very important to educate players about the symptoms and also that it can be later onset. In other words, it can be several weeks or even a month after the injury. That process when the gel separates could be about to occur, and then it finally occurs, and that’s when the new symptoms start. So a lot of times they’re separated in time.
So that’s probably why it makes sense that [Okposo] wouldn’t be sure when it happened. He probably gets punched and bumped and elbowed and sticks thrown around his face all of the time. If he thinks about it, at some point, before he developed the detachment, I would imagine he had some symptoms, like flashes or floaters. And if you catch it in that stage, we can actually prevent a retinal detachment. And that’s the easiest stage. That’s a home run, usually. If we can get to the retina before it detaches – and there’s almost always a period before it detaches – some people it’s longer, some people it’s shorter. If we can get to it at that stage, then we can help him out. It’s very rare for it to immediately detach.
It depends on when his symptoms start of flashes and floaters, and when he did he notice his vision was bad. Maybe it got to the point where he really had lost most of his vision before he got to the doctor to have surgery. When we diagnose a retinal detachment, we usually try and take the patient to the operating room within 24 hours. It all depends when did it start and he noticed it, and when did it really start. My guess is those are two separate events.
Players who take a direct, blunt trauma to the eye really need an eye exam. They certainly need to be educated.