Retina Care

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What is the Retina?

The retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical events that ultimately trigger nerve impulses. These are sent to various visual centers of the brain through the fibers of the optic nerve. Certain conditions can cause the retina can become damaged, resulting in blurred or reduced vision.

Diabetic Retinopathy

Your body can be affected by diabetes in many ways. It can affect your vision by causing cataracts, glaucoma, and damage to the blood vessels in your eyes. People with untreated diabetes are said to be 25 times more at risk for blindness. The longer you have diabetes, the greater the risk of developing diabetic retinopathy.

Types of Diabetic Retinopathy

An early stage of Diabetic Retinopathy is Background Diabetic Retinopathy. In this stage, small blood vessels leak in the retina causing swelling. Deposits called “exudates” also form. Sometimes the leaking fluid can take place in the retina causing macular edema. When the macula becomes involved it can affect your vision and close work.

Proliferative Retinopathy

When new, abnormal blood vessels begin growing on the retina it is called Proliferative Retinopathy. The abnormal blood vessel growth is referred to as neovascularization. These new blood vessels are weak often causing them to break and bleed inside the eye. When bleeding occurs, it blocks the light entering the pupil towards the retina causing blurred vision. The new abnormal blood vessels may grow scar tissue that pull on the retina and can cause a retinal detachment.

Symptoms of Diabetic Retinopathy

The symptoms of background Diabetic Retinopathy usually go unnoticed until you have an eye exam or when there has been a significant loss in vision. Proliferative retinopathy usually causes hazy, spotty, painless changes in your vision that need immediate medical attention.

Chart Showing a Healthy Eye Compared to One With Diabetic Retinopathy

How Diabetic Retinopathy is Diagnosed

Frequent eye exams are extremely important in controlling any diabetic changes in the eyes. If Diabetic Retinopathy is found during an eye exam, a fluorescein angiography may be ordered to find out if treatment is needed. Fluorescein angiography is a test where dye is injected into the veins of your arm and photos are taken of your eyes minutes later to see if there is any leaking of the blood vessels.

Treatment of Diabetic Retinopathy

Laser surgery can be used to seal off the leaking blood vessels in the eye, which is called laser photocoagulation. If this type of surgery is performed at an early stage, it can slow down vision loss. Laser surgery can even help with proliferative retinopathy to help prevent severe visual impairment.

Cryotherapy is another treatment for Diabetic Retinopathy when laser surgery cannot be used. This procedure involves freezing parts of the retina to help shrink the abnormal blood vessel growth.

Diabetic Retinopahy Screening

Vitrectomy surgery can be done in advanced cases of proliferative retinopathy. This procedure involves removing the vitreous, which is the clear jelly-like substance in the center of the eye. The vitreous is removed due to a large amount of bleeding that has taken place.

In some cases of proliferative retinopathy, a retinal repair is needed. This surgery is recommended when the scar tissue has caused the retina to pull away from the back of the eye.

Responsibilities of a Diabetic Patient

It is very important for patients to take very good care of themselves to help with the prevention of Diabetic Retinopathy. Patients should try to maintain good blood sugar levels and good blood pressure, and avoid smoking.

Macular Degeneration

Macular degeneration is a breakdown of the retinal tissue in the macula of an affected eye. The macula is a small area in the back of the eye that allows a person to see fine detail. The breakdown of the macula causes decreased central vision, which can affect our distance and near vision. Many studies have revealed that the frequency of this disease increases dramatically after age 60, and there is currently no cure available.

Types of macular degeneration

There are two types of macular degeneration: “dry” (atrophic) and “wet” (exudative). Dry macular degeneration is the most common. It is caused by the degeneration of the retinal tissue within the macula as you age.

Macular Degeneration

It is commonly referred to as AMD or ARMD, which stands for Age-Related Macular Degeneration. Approximately 10% of the population will develop dry AMD. Vision loss in dry AMD is typically gradual.

Wet AMD occurs when there is new blood vessel growth behind the macula caused by the degeneration process. These new blood vessels leak in the back of the eye. Vision loss from this type of macular degeneration is often more rapid and severe.

The wet form of AMD is much less common than the dry type and occurs in approximately 10% of patients who have the disease. However, wet AMD accounts for 90% of the severe visual loss that is associated with macular degeneration.

Treatment of macular degeneration

Recently, studies have shown that a specific combination of vitamins, known as the AREDS vitamin formula, can be useful in reducing the severity of AMD. This combination of vitamins, named for the National Eye Institute’s Age-Related Eye Disease Study, can be purchased over the counter. Please check with your eye care professional for additional information on the use of these vitamins.

In the wet form of macular degeneration, blood vessels grow abnormally beneath the retina, damaging the macula and distorting the vision. Wet macular degeneration responds best when treated in its early stages. There are a number of treatments available, including thermal laser, which attempts to kill the new blood vessel with heat, and cold laser, which activates a light-sensitive drug in an attempt to kill the new blood vessel without additional damage to the retina.

Intraocular Drug Therapy is the newest treatment available. This treatment involves injecting a drug into the eye to neutralize the conditions causing the growth of new blood vessels. Please note that most of the treatments available are therapies requiring a number of treatments to be performed over an extended period of time to achieve success.

Associated Eye Care is proud to offer Lucentis (ranibizumab), the first intraocular injectable drug approved by the FDA for the treatment of macular degeneration. Lucentis mitigates the effects of macular degeneration by inhibiting the growth of new, weak blood vessels. The drug can potentially prevent or reverse the effects of wet macular degeneration.

Defining success in treatment is also important. Every current treatment for wet AMD is used in an attempt to maintain the patient’s vision at the level at which they present when they are first seen by the doctor. Although some success has been achieved in improving patients’ vision with treatment, the true goal of treatment is to stop vision loss.

Unfortunately, there is no known treatment at this time for dry macular degeneration.

Prevention of macular degeneration

Amsler Grid

Unfortunately, macular degeneration is not wholly preventable. The use of AREDS vitamin therapy is a good start at trying to limit this disease process. Daily use of the Amsler Grid for those who have been diagnosed with AMD is a required measure to help detect early visual distortion related to wet AMD.

Individuals over 60 should receive regular eye exams and be vigilant for signs of cataracts, glaucoma, macular degeneration, and other age-related vision problems because the key to preventing vision loss is early detection and treatment.


What is AMD?

Age-related macular degeneration (AMD) is a disease of the retina. End-Stage AMD is the most advanced form of the disease and the leading cause of irreversible vision loss and legal blindness in individuals over the age of 65. In early, less advanced AMD, visual symptoms are generally mild and may or may not impact vision-related activities. However, advanced stages of AMD can result in severe loss of sight in the central part of vision. This is often referred to as a central vision “blind spot.” This blind spot is different than the visual disturbances experienced with cataracts (clouding of the eye’s lens) and is not correctable by cataract surgery or eyeglasses. Side vision, or peripheral vision, is not affected by AMD, but is too low resolution to make up for lost central vision. At this time, there is no cure for End-Stage AMD and no way to reverse its effects.


What is CentraSight™ and the Telescope Implant? The CentraSight treatment program uses a tiny telescope, an FDA-approved medical device, which is implanted inside the eye to improve vision and quality of life for individuals affected by End-Stage AMD. The telescope implant, about the size of a pea, is intended to improve distance and near vision in people who have lost central vision in both eyes because of End-Stage AMD. The device is surgically placed inside one eye. The implanted eye provides central vision; the other eye provides peripheral vision. This is not a cure for End-Stage AMD. It will not restore your vision to the level it was before you had AMD, and it will not completely correct your vision loss. Patients with this level of AMD have had to cease driving due to their vision; after the telescope procedure, although near and distance vision may improve, driving will not be possible because the implant does not restore normal vision.

Am I a Candidate?

In general, to be considered a potential candidate for the telescope implant an ophthalmologist must first confirm that you:

After the ophthalmologist confirms that you are a potential candidate, your vision will be tested using an external telescope simulator. The results of the test and visual training/rehabilitation evaluation visits will help you and your ophthalmologist decide if you are likely to benefit from the CentraSight treatment program. If so, the tests will also help you and your ophthalmologist discuss which eye should be treated and what your vision may be like after the treatment. Call us today to see if this procedure is right for you. Additional information can be found here.

The CentraSight treatment program involves four steps that start with diagnosis and continue after surgery:

Step 1: Diagnosis

Step 2: Candidate Screening

Step 3: Surgical Procedure

Step 4: Learning to Use Your New Vision

A member of your CentraSight team is involved at each step of the treatment. All CentraSight team members are highly qualified professionals, with special training in the CentraSight treatment program and the telescope implant technology. The following pages explain what you can expect at each step of the program. The telescope implant is not a cure that “sees” for you. For the telescope implant to work for you, you will need to work with low vision specialists as well as practice on your own at home.

Realistic Goals:

Unrealistic Goals:

Visual goals can be assessed with an external telescope simulation during pre-surgery screening visits. Your ophthalmologist will describe the risks and benefits of the telescope implant to you, including the risks of surgery.

Step 1: Diagnosis

To be considered as a possible candidate for the treatment, you must first be examined by a retina specialist to confirm that you have End-Stage AMD. This will involve a thorough medical eye examination and a review of your medical history, including any conditions that may make the procedure difficult for you or increase the likelihood of complications. Your retina specialist will explain the benefits and risks of the CentraSight treatment program and answer any questions you may have.

Step 2: Candidate Screening

The screening includes several appointments and a low vision evaluation performed by a low vision optometrist. The candidate screening step includes testing your vision using external telescope simulators. The results of these tests can help give you and your CentraSight Team a good idea of what your vision may be like after the telescope implantation surgery and if the effect of the magnification in one eye will be useful to you. Low vision providers will also talk to you about how your new vision status may affect your everyday life and how following a visual training/rehabilitation program after surgery will help you reach your vision goals.

Step 3: Surgical Procedure

The telescope implantation surgical procedure is performed on only one eye. It involves removing the eye’s natural lens and replacing it with the tiny telescope implant. The surgical procedure is relatively short (1-1.5 hours) and is performed by a specially trained ophthalmologist. You won’t have to stay in a hospital and will return home the same day. The telescope is virtually unnoticeable to others because it is implanted totally inside the eye, and mostly covered by the colored portion of the eye (iris).

What to Expect with the Surgical Procedure

Before the surgery, your surgeon will take your medical history and check the health of both of your eyes. You should let us know if you take any medication or have any allergies. Be sure to discuss all your questions with your surgeon before scheduling your surgery. You will need to arrange for transportation to and from your surgery appointment.

Day of Surgery

The procedure is performed on an outpatient basis and generally takes 1-1.5 hours.

The surgery involves several steps:

If your surgeon is unable to implant the telescope during surgery, he or she will implant a standard intraocular lens (IOL), as in any procedure for cataract removal.

After surgery, you will have follow-up visits with your surgeon. You will have to take eye drops for several weeks. You should expect a gradual improvement in your vision of the treated eye to occur over a period of time, ranging from weeks to months. If you are found to be a candidate, your surgeon will provide you with more detailed information about the procedure and potential risks.

Step 4: Learning To Use Your New Vision

After you have recovered from surgery, specially trained low vision optometrists and occupational therapists will work with you to prescribe eyeglasses and complete your rehabilitation to help you adapt and learn how to use your new vision in daily life. They will work with you on an individualized plan over several weeks to reach your personal goals. What are the Benefits of the Telescope Implant? The effectiveness of the telescope implant has been demonstrated in FDA approved studies. In results from a survey in the FDA clinical trial, patients who received the telescope implant generally reported that they were less dependent on others, less frustrated and worried about their vision, less limited in their ability to see, and better able to visit with others and recognize facial expressions/reactions.

Overall, the survey findings showed patients had a clinically important improvement in the quality of life. An FDA study found that nine out of ten patients with the telescope implant improved vision by at least two lines on the eye chart.

What are the Risks of the Telescope Implant?

As with any medical intervention, potential risks and complications exist with the telescope implant. The most common risks of the telescope surgery include inflammatory deposits on the device and increased pressure in the eye. Significant adverse events include corneal swelling, corneal transplant, and a decrease in visual acuity. There is a risk that having the telescope implantation surgery could worsen your vision rather than improve it. Individual results may vary. You should talk to your doctor about these and other potential risks to find out if the telescope implant is right for you.
1. Hudson HL, et al. Ophthalmology. 2006.

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Retinal Detachments/Tears

Retinal laser surgery by Dr. Alan Downie is performed as a treatment for a variety of retinal problems including Diabetic Retinopathy, Age-related Macular Degeneration and tearing of the retina. Laser surgery is virtually painless and performed in our office while you remain awake and comfortable. If you or someone in your family suffers from vitreo-retinal diseases of the eye we can provide the care needed to appropriately treat this condition.

Retinal Detachment

The retina is the light-sensitive inner surface of the eye. It is responsible for gathering light that enters the eye and sending it to the brain via the optic nerve. The “red eye” effect we sometimes see in photographs is caused by bright light reflecting off the retina.

Retinal detachment is a condition in which the retina pulls away from the wall of the eye. Initially, most retinal detachments begin small, but can grow worse rapidly if left untreated. It is most common in people with high levels of nearsightedness (myopia) and the elderly.

Retinal detachment should be treated as a medical emergency and treated as soon as possible. An untreated retinal detachment can lead to significant vision loss and blindness.

Symptoms of Retinal Detachment

Symptoms include:

If you experience these symptoms, seek medical help immediately.

Causes of Retinal Detachment

Retinal detachments are frequently precipitated by injury, either directly to the eye or generally to the head. If you sustain a concussion or trauma to the eye, it is wise to watch for signs of a retinal detachment.

Individuals with severe nearsightedness (myopia) account for nearly 70% of retinal detachments. This is because most nearsighted people have longer eyes than people with normal vision, and the retina is stretched further. Other factors that increase the risk of retinal detachment include cataract surgery and diabetic retinopathy.

Retinal detachment is very often associated with a condition called posterior vitreous detachment. The vitreous humor is the transparent, gel-like fluid that fills the eye. It is attached to the retina, but generally shrinks as we age. In some cases, the level of shrinkage is great enough that the vitreous pulls away from the retina, leaving a gap. Because the vitreous no longer applies outward pressure to this portion of the retina, it is more prone to detachment.

Of the symptoms listed above, these are most commonly associated with posterior vitreous detachment:

Treatment of Retinal Detachment

It is very important to seek treatment as soon as you experience symptoms of retinal detachment. Treatment for this condition depends on the severity of the detachment, whether or not there is an associated posterior vitreous detachment, general eye health and other factors. Associated Eye Care offers a range of treatments to suit all situations, including retinal laser surgery.


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