Ophthalmologist’s Answers to Retina Care FAQs
Answering your important retina care questions concerning :
- All
- Dislocated Lens
- Eye Injections
- Flashes and Floaters
- Macular Degeneration
- Macular Edema
- Macular Hole
- Macular Pucker
- Ophthalmologist
- Retina Care
- Retinal Artery Occlusion
- Retinal Detachment
- Syfovre
Geographic atrophy causes irreversible blind spots in the central vision. In the advanced stages of dry macular degeneration, retinal rods and cones responsible for vision undergo cell death also known as atrophy. Geographic atrophy makes it increasingly difficult to perform tasks such as reading and driving.
Syfovre is pronounced ‘Sigh-fove-ree’.
Syfovre works by inhibiting complement, which is a protein involved in our body’s immune system. While complement plays an important role in our immune system, overactive complement is involved in the development of geographic atrophy. By inhibiting complement in the eye, Syfovre slows the rate of progression of geographic atrophy by approximately 20% over two years.
Syfovre may delay blindness by slowing down the loss of retinal cells in advanced dry macular degeneration.
Syfovre does not reverse the changes that have already occurred due to dry macular degeneration. Syfovre slows the rate of progression of geographic atrophy in advanced dry macular degeneration by about 20% over two years.
Syfovre is FDA approved for monthly and every-other-month eye injections. The injection interval will be determined by your retina specialist.
The most common side effects of Syfovre are ocular discomfort, floaters, and bleeding on the surface of the eye. In clinical trials, wet macular degeneration occurred in 12% of monthly injection patients, 7% of every-other-month, and 3% of patient who did not receive the injections. Rarely, injection of medication in the eye causes a serious infection, known as endophthalmitis.
Syfovre is not yet indicated for early or intermediate stages of dry macular degeneration. Syfovre is currently the only FDA-approved medication to treat geographic atrophy secondary to advanced dry macular degeneration.
Syfovre injections will be available beginning in March 2023.
The cost of Syfovre is variable depending on your insurance coverage. Patient assistance programs are available for those patients who do not get full reimbursement from their insurance carrier.
Syfovre may be covered by your insurance depending on your specific plan. There are also co-pay assistance programs available that may help cover the cost of the injection. Retina specialist offices will complete a benefits investigation form to determine your eligibility.
Medicare will cover 80% of the cost of Syfovre. If you have a supplemental insurance plan, it may cover the full amount or a portion of the remaining 20%.
While most patients are comfortable driving after their dilated eye examinations, it is up to each individual to decide whether they are safe to operate a motor vehicle.
Dilation is necessary to adequately examine the eye, as many dangerous retinal conditions are hidden behind an un-dilated pupil.
Dilation can affect vision in two ways. First is that dilation allows more light into the eye, increasing sensitivity to brightness. This can usually be overcome by wearing tinted glasses. The second is that dilation temporarily paralyzes the muscle that allows the eye to focus on near objects. This blurriness up close does not resolve until dilation wears off a few hours later.
Most patients are comfortable driving while dilated. They use their own tinted lenses or those provided at check out to avoid sensitivity to bright light. Since driving requires mostly distance vision, patients feel comfortable driving despite being blurry at near.
The decision whether to drive or not is entirely up to each patient. Anyone who does not feel safe to drive while dilated, whether they meet Florida requirements or not, should arrange to have a separate driver or wait 3-4 hours for the dilation to wear off before driving. Those patients with reduced vision or other physical limitations should be particularly careful about driving after dilation.
A dilated pupil is critical to comprehensively examine, diagnose, and treat vision-threatening eye disease.
While many patients are used to eyeglass appointments that occur without dilation, it is the ophthalmologist’s responsibility to ensure the health of the entire eye. Even when the main complaint of the patient involves the surface of the eye, important findings in the back of the eye could change our diagnostic and treatment recommendations.
Furthermore, retina specialists are fellowship-trained surgeons who diagnose and treat eye conditions that are exclusively located behind the pupil. When evaluating the retina, particularly on a new patient, it is critical for the eye doctor to view the entirety of the back of the eye through a dilated pupil.
While dilation can be inconvenient, be assured that it doesn’t directly contribute to the cost of the visit. Ophthalmology billing is based on the complexity of your eye disease, not the dilation status of your pupil.
Congratulations, you are taking the first step towards protecting a lifetime of sharp vision thanks to your regular appointment with an ophthalmologist. Your visit with the eye doctor begins at check-in, where our friendly staff will collect your contact and medical information in a 5-minute process. Insurance copays are collected at this time.
Following check-in, you will be escorted to a private room by a skilled ophthalmic technician. This person will be focused on your eye problem and gather important information such as your eye history, visual acuity, and eye pressure. The technician will apply numbing and dilating drops to complete this 15-minute work-up process.
After work-up, you are taken to receive specialized imaging of the eye, which is critical in diagnosing subtle changes that may indicate vision-threatening retinal disease. These eye photographs typically take 10 minutes.
Following retinal imaging, you are escorted to the examination room, where you will be met by the ophthalmologist. The eye doctor will use specialized equipment to examine your eye and review the retinal images. During this 10-20 minute interaction, your questions and concerns will be addressed completely, and treatment recommendations will be made.
A stop at check out and follow-up appointment scheduling complete the visit. Dilation should wear off within 3-4 hours. We hope you enjoyed your visit with the ophthalmologist and a lifetime of healthy eyes and vision!
A retina specialist is an ophthalmologist who underwent an additional two years of subspecialty training in clinical and surgical management of retinal disease.
Retina specialists’ training begins in residency, where they are exposed to each of the major sub-specialties in ophthalmology, including retinal diseases and surgery. Following residency, the graduated ophthalmologist participates in a two-year vitreoretinal fellowship, which typically involves the doctor working alongside experienced retinal surgeons in the clinics and operating rooms of a high-volume medical center.
During this training, retina fellows become experienced in the diagnosis, clinical and surgical management, and long-term course of complex retinal disease such as macular degeneration, retinal detachment, diabetic retinopathy, and macular pucker.
Upon graduation from vitreoretinal surgical fellowship, retina doctors are experienced in performing a number of complex retinal procedures, including retinal detachment repair, epiretinal membrane peel, eye injections, and retinal laser.
An ophthalmologist is a medical doctor who spent three years after medical school learning about eye disease and surgery in an accredited ophthalmology residency program.
The pathway to becoming an ophthalmologist begins in medical school, where students are first exposed to the basics of eye disease and how it relates to overall health. Students who develop a particular interest in the eye attend an ophthalmology residency after medical school, but not before they work a year on hospital inpatient wards, learning critical information about health and disease of the entire human body. This knowledge is critical in understanding how disease in the body manifests as pathology in the eye.
Following a general medical internship, ophthalmologists spend three years learning the breadth of eye anatomy, disease, clinical diagnosis, and surgical treatment. Graduates of ophthalmology residency are skilled in treating the most common eye conditions, including cataract, glaucoma, diabetic retinopathy, and macular degeneration.
Many ophthalmologists continue their education after residency with one or two years of fellowship training in an ophthalmology subspecialty. The ophthalmologists at Shane Retina graduated from accredited U.S. ophthalmology residency programs, became board-certified, and completed a two-year subspecialty fellowship in vitreoretinal surgery.
Ophthalmologists can be distinguished from optometrists, who complete a four-year program in optometry after college. While optometrists are skilled in many aspects of eye care, they generally do not perform ocular surgery or subspecialize in the major categories of ocular disease.
The risks of eye floater treatment are low but include cataract progression and retinal detachment.
Persistent eye floaters can be a significant hindrance to daily activities. Patients with these symptoms may choose to undergo surgical or laser floater removal, each with its own benefits and risks.
Laser floater removal, being non-invasive, is generally considered a lower risk procedure than surgery. The laser works by vaporizing large floaters suspended in the jelly that fills the eye. During this procedure, the retina specialist is careful not to treat too close to the retina or the lens. If laser energy is imparted to either of these structures, a patient could experience retinal damage or a cataract.
Surgical floater removal, known as vitrectomy, offers a more complete and permanent treatment for floaters. However, there is a 1% risk for retinal detachment in the weeks or months after vitrectomy. Furthermore, any patients who have not had cataract surgery by the time of their vitrectomy will experience a worsening of their cataract in the years following their surgical floater removal.
Chronic floaters that interfere with activities of daily life can be treated with laser or surgical floater removal.
It is common to experience floaters throughout life, typically worsening between the ages of 50 and 70. Most patients find that their floaters improve over time without a significant hindrance to vision.
A minority of patients, however, experience significant distraction and visual interference from their floaters. For these cases, there are two options for treatment, each with its own risk and benefit profile.
Laser floater removal is one option. The advantages of this procedure are that it takes place in the clinic and is non-invasive. The floater laser works particularly well for large, discrete floaters that vaporize as they absorb the laser light energy. Patients who undergo the laser can expect a significant reduction, but not complete elimination of their discrete floaters. The risks of the laser are small, including rare cases of cataract or retinal hemorrhage.
Surgical removal of the floaters, called vitrectomy [link here], is another option. The advantage of surgical removal is that floaters are completely and permanently resolved after surgery. Vitrectomy surgery works particularly well for multiple, diffuse, or cloudy floaters. The downsides of surgery include the progression of cataracts and a 1% risk for retinal detachment.
The decision for how and when to treat floaters should be made in consultation with an ophthalmologist specialized in retinas and experienced with both the surgical and clinical floater removal procedures.
Laser floater removal is a 10-minute painless procedure that requires dilation and has few post-laser restrictions.
When you arrive at the retina clinic for laser floater removal, you will have your vision and eye pressure checked by an ophthalmic technician. The eye with chronic floaters will be dilated, and you will be seated in an exam room for a pre-laser exam by the retina specialist. Afterward, you will be seated in the laser room and given additional numbing and pressure drops. A contact lens is placed on your eye with a clear ‘goo’ filling the space between your eye and the lens.
The laser is then performed as you focus on a target light to keep the eye still. There is no pain during the procedure. Afterward, the eye is wiped clean with a tissue as you recover from the brightness of the light. The eye pressure is checked again and a one-week post-op visit is scheduled.
It takes an hour or two to un-dilate, eliminate the lubricant from your eye, and clear the vision. Some patients feel scratchy on the evening of their laser day, due to the contact between the laser lens and the surface of the eye. Artificial tears are usually enough to relieve the discomfort.
Retinal detachment repair typically requires one hour of operating time under local anesthesia at an outpatient surgery center.
The day of retinal detachment surgery starts much earlier though, beginning with the avoidance of all food and drink starting at midnight. The outpatient surgery center will set your arrival time approximately one hour prior to the start of surgery. It is important that you bring a driver along who can take you home after surgery and assist with immediate post-operative care.
After check-in, you will be taken to a pre-op area where your nurse and anesthesiologist take a short medical history. The correct eye is marked, an IV is started, and dilation and anti-bacterial drops are administered.
When your surgical time arrives, your retina specialist will perform a ‘time-out’ to confirm the correct patient, eye, and procedure. Next, you will receive propofol anesthesia through the IV, causing you to lose consciousness for approximately 5 minutes while the retinal surgeon injects local anesthesia around your eyeball.
Once you have woken from the propofol, you are wheeled into the operating room to have your eye cleaned with antibacterial soap prior to the procedure. Another time-out is performed and the surgeon places a drape over your face and upper body. The procedure progresses with you awake, comfortable, and breathing on your own. While many patients are nervous prior to their procedure, few actually require additional medication for anxiety during the case.
Following the 30-60 minute procedure, the surgical eye is patched and you are wheeled into post-op for a short recovery. Most patients are ready to meet with their transportation within 15 minutes of the completion of the case. The rest of the day is spent relaxing at home with minimal need for pain control. A post-operative visit will be scheduled in the retina clinic the next day, where the patch is removed and additional post-op instructions are given.
The most common restrictions following retinal detachment repair include avoiding air travel, maintaining certain head positions, and avoiding high-level visual tasks.
A retinal detachment occurs when the retina spontaneously separates from the back of the eye, most commonly between the ages of 50 and 70. This is a medical emergency requiring immediate repair by an ophthalmologist trained in retina surgery. Surgical repair of a retinal detachment typically involves the injection of a gas bubble into the eye, which temporarily stabilizes the retina while laser treatment provides long term attachment.
It is important that the gas bubble flatten the area of retinal detachment. Since a gas bubble floats towards the ceiling, patients are frequently advised to take certain head positions to move the bubble over the detachment. This positioning typically lasts for one week after retinal detachment repair.
In addition to positioning for one week, patients are restricted from flying until the gas dissipates over a period of 2-8 weeks. Altitude will cause a gas bubble to expand and pressurize the eye, leading to permanent blindness. Patients are also encouraged to avoid any activities that require high-level visual acuity or depth perception, which may include driving or manual labor.
Retinal detachments can be repaired by a wide variety of techniques, including retinal laser, gas injection in the eye, vitrectomy surgery, and scleral buckle.
A retinal detachment occurs when the retina separates from the back of the eye, typically resulting in flashes, floaters, and a sudden, painless loss of vision. A detachment of the retina is a potential surgical emergency and requires evaluation by an ophthalmologist specialized in retinal surgery.
There are several techniques for repairing a retinal detachment, and the choice depends on the unique characteristics of your eye and the preferences of your retina specialist. Some patients can have their retinal detachments repaired in the clinic through a combination of laser and/or gas bubble injection, called a pneumatic retinopexy. Other patients require outpatient retina surgery such as vitrectomy (removal of the vitreous jelly in the eye) or scleral buckle. These procedures have the highest success rates but are more invasive.
An eye injection visit starts with a check of your vision and eye pressure with our friendly and skilled ophthalmic technicians. Your eyes may be dilated, particularly if you are having new ocular symptoms. Next, you will have an image taken of your retina. Your retina specialist will then review the images and determine the need for injection and follow-up.
After a short discussion, the eye injection procedure begins with a drop of numbing and anti-bacterial solution. This is followed by a cotton-tip application of additional anesthesia to the surface of the eye. A lid speculum is used to prevent your lashes from touching the sterile needle during the procedure. The injection takes only a couple of seconds before the speculum is removed.
Following the eye injection, you are free to resume normal activities at your discretion. The entire eye injection office visit typically takes less than 45 minutes.
Patients can typically resume normal activities immediately following an eye injection.
Eye injections, also referred to as intravitreal injections, are a common procedure performed in the office of an ophthalmologist specialized in macula disease. During an eye injection, patients may be dilated and treated with topical numbing and anti-bacterial drops. Afterward, the patient may experience transient blurriness due to the medication or the irritant effects of the eyedrops administered during the procedure.
While the patient may be legally qualified to drive after the eye injection, each patient is responsible to make an independent assessment of their ability to operate a motor vehicle. Typical activities like exercise, bathing, and eating are certainly permissible.
Any discomfort following an eye injection can be treated with cool compresses, artificial tears, or over the counter pain killers. Any patient experiencing severe or worsening pain or loss of vision after an injection should call their ophthalmologist immediately.
Patients typically experience little to no pain during an eye injection.
The thought of receiving an injection in the eye can be quite intimidating to patients. However, eye injections are a mainstay in the treatment and prevention of vision loss from a number of blinding retina conditions, including wet age-related macular degeneration, diabetic macular edema, and retinal vein occlusion. Thankfully, locally administered anesthesia and tiny needles allow eye injections to be administered with little or no pain. Patients frequently comment that the anxiety over getting an injection in the eye is worse than the actual experience.
An eye injection, also known as an intravitreal injection, is a common and highly effective method for delivering vision-saving medication to the retina.
Eye injections deliver a targeted dose of medication that is much higher than can be achieved by drops. The two most common medications administered by eye injection are steroids and anti-vascular endothelial growth factor (anti-VEGF). Each medication has unique properties, geared towards the suppression of inflammation, bleeding, or swelling in the retina.
Patients typically receive eye injections from an ophthalmologist specialized in the retina. Eye injection appointments are similar to routine eye doctor visits, with dilation, retinal imaging, and a conversation with the doctor before the 5-minute injection procedure.
Prior to the widespread adoption of eye injections in 2005, many patients would go blind due to eye conditions such as diabetic retinopathy, macular degeneration, and retinal vein occlusion. The development of injectable medications for the eye has been nothing short of a medical miracle, restoring and preserving sight in millions of people each year.
The macula is the center of the retina that is responsible for the sharp vision used to read and drive. Disease in the macula, such as macular degeneration, diabetic macular edema, and retinal vein occlusion, can cause blurry or distorted vision and should be evaluated by a retina specialist.
A retinal artery occlusion occurs when the blood flow to the retina is stopped, causing a sudden loss of vision.
The retinal arteries deliver nutrients and oxygen to the eye. When a retinal artery becomes blocked, that section of the eye can no longer create vision. Common causes for a retinal artery occlusion include clots or other emboli that travel through the blood from the carotid artery or heart and get stuck in the retinal artery. Sometimes, inflammation in the retinal vessels causes the blockage. An artery occlusion will often cause sudden, painless blurry or dim vision. This diagnosis is taken very seriously as it may preclude a more serious life-threatening condition such as a stroke in the brain or permanent vision loss in both eyes.
Macular pucker occurs when a membrane forms on the surface of the retina, causing distorted or blurry vision.
The macula is another term for the center of the retina. Frequently in middle age, a membrane forms on the surface of the macula, causing wrinkles in the retina and distortion of central vision. Macular pucker is sometimes referred to as “cellophane maculopathy” or “epiretinal membrane.” These membranes can be visualized with a dilated retinal exam and specialized retinal imaging called an OCT (Optical Coherence Tomography). Visually significant membranes can be removed by a retina specialist with an outpatient surgery called a vitrectomy and membrane peel.
Macular edema is another term for swelling of the central retina, causing blurry or distorted vision.
The macula is the center of the retina that provides for sharp vision. Edema is the medical term used for swelling. Therefore, macular edema is swelling of the central vision. This can be caused by a number of diagnoses, including macular degeneration, diabetic retinopathy, retinal vein occlusion, and inflammation after cataract surgery. There are several vision-saving therapies for macular edema, including drops and eye injections. If you are experiencing blurry or distorted vision, a careful history and dilated examination by a retina specialist will determine whether you have macular edema.
Macular degeneration is a progressive retinal condition that causes painless loss of central vision in patients over the age of 60.
The macula is the center of the retina, a light-sensing structure in the back of the eye. In macular degeneration, the central retina accumulates waste products of vision, becomes inflamed, and experiences a drop in blood flow. Over time the retinal cells responsible for vision (photoreceptors) drop out, resulting in loss of central vision. In some cases, the macula may swell or bleed, resulting in a rapid loss of vision.
The causes of macular degeneration remain largely unknown, but there are several risk factors that contribute to the chances of developing macular degeneration. The largest risk factors include advanced age, family history, and tobacco use.
Treatments for macular degeneration include antioxidant vitamins and eye injections. Patients experiencing vision changes consistent with macular degeneration should consult their ophthalmologist for a dilated exam.
When referring to the eye, IOL stands for Intraocular Lens. An intraocular lens is a surgical implant that is used to replace the natural lens at the time of cataract surgery. There are many different types and strengths of IOLs. An ophthalmologist who performs cataract surgery will educate patients regarding their cataracts and the best lens options for their unique visual needs.
Diabetic macular edema is swelling in the central retina that is the most common cause of vision loss for diabetics.
Long-standing increased blood sugar causes damage to blood vessels. The blood vessels will become leaky and cause edema. Diabetic macular edema becomes more common the longer someone has diabetes—regardless of blood sugar control. Patients with diabetic macular edema usually experience progressive blurring of their central vision. Treatment options include retinal laser and eye injections. An eye doctor specializing in retinal disease will be able to evaluate the eye for diabetic retinopathy and diabetic macular edema.
An eye stroke is caused by the sudden blockage of blood flow to the retina or optic nerve, leading to a sudden loss of vision in one or both eyes.
In general, a “stroke” is when blood flow is interrupted to a part of the body causing a lack of oxygen and nutrients to the tissue. An “eye stroke” is when blood flow is interrupted to portions of the eye and encompasses various diagnoses such as retinal artery occlusion, retinal vein occlusion, and ischemic optic neuropathy. These conditions are not only vision-threatening but in some cases life-threatening. If you experience a sudden loss of vision in either eye, seek an immediate dilated exam with an ophthalmologist.
A macular hole is a gap that forms in the center of the retina, causing a blind spot in the middle of the vision.
The macula is the part of the retina responsible for central vision. Due to natural forces on the surface of the retina, a hole can form in the very center of the vision causing the patient to see a missing spot in the central vision. Most macular holes form spontaneously without any underlying risk factors. A macula hole requires timely repair by a retina specialist to prevent a permanent blind spot. Anyone experiencing a new spot of missing or blurry vision should seek a dilated exam with a retina specialist.
A detached retina occurs when fluid from inside the eye moves through a retinal tear and underneath the retina, causing rapid vision loss and the need for urgent treatment.
The retina is a thin layer of tissue that lines the inside of the back of the eye. Light that enters the eye is focused on the retina, which then sends the images to the brain.
Sometimes, tears or holes form in the retina, particularly around the ages of 50-70. These holes may allow fluid from inside the eye to move under the retina, causing it to separate (detach) from the back of the eye. In most cases, a detached retina occurs spontaneously without any previous trauma.
Symptoms of a detached retina include flashes of light, new floaters, and a grey curtain in the vision. Anyone experiencing these symptoms should seek an immediate dilated examination with an ophthalmologist.
Treatment for a detached retina is urgent and may involve laser, gas injection, or surgery. Even with treatment, a detached retina may lead to permanent vision loss or blindness.
There are different types of retinal detachments and thus different causes. However, in the “classic” retinal detachment situation, the jelly-like substance that fills an eye known as the vitreous will spontaneously peel off of the retina. Ophthalmologists call this a Posterior Vitreous Detachment (PVD). A PVD can sometimes cause a tear or hole in the retina. Water from inside the eye then travels through the tear/hole and gets underneath the retina causing a retinal detachment. A good analogy for this scenario is a room filled with water (the eyeball) with wallpaper along the walls (the retina). If there is a hole or tear in the wallpaper, water can get underneath the wallpaper and cause it to detach from the walls.
Other causes for retinal detachment, which are much less common, include diabetes, inflammation, tumors, or trauma.
Retinal artery occlusions are caused by the blockage of blood flow to the retina, causing a sudden loss of vision in one eye.
A retinal artery occlusion is essentially an “eye stroke.” This is where blood flow is blocked and oxygen cannot get to the eye. Various causes include clots, plaques, sickle cell, diabetes, and inflammation (Giant Cell Arteritis) causing the artery to no longer be open. Any retinal artery occlusion should be taken seriously as it may be a warning for a more serious systemic condition that can be life-threatening.
Macular degeneration is caused by the accumulation of damage in the central retina of individuals over the age of 60.
The retina in your eye creates vision through a metabolic process, requiring blood flow and creating waste products. In patients with macular degeneration, this process becomes less efficient, leading to an accumulation of metabolic waste products, inflammation, and decreased blood flow. These changes damage the light-sensitive cells in the retina called photoreceptors.
Macular degeneration can cause severe vision loss in two ways. The first is through the widespread drop out of retinal photoreceptors, called ‘dry’ macular degeneration. The second is through bleeding or swelling in the retina, known as ‘wet’ macular degeneration.
Patients over the age of 60 who experience blurry or distorted central vision are at risk for macular degeneration and should schedule an appointment for a dilated examination with an ophthalmologist.
Eye floaters are caused by shadows from opacities suspended in the vitreous jelly that fills the eye.
The eye is filled with a clear jelly called vitreous. The vitreous jelly is composed of 98% water trapped within a matrix of collagen fibers. The collagen fibers are thin and regularly spaced, which allows light to pass through without interference.
Over time, the collagen fibers in the vitreous jelly start to condense, becoming thick and irregular. These collagen opacities cast shadows on the retina. The shadows drift in the vision as the vitreous jelly shifts with eye movement, causing floaters.
Sometime between the age of 50-70 in most individuals, the vitreous jelly spontaneously separates from the retina. This causes a sudden increase in collagen opacities within the vitreous jelly, along with a corresponding increase in floaters.
Although collagen opacities are the most common cause for floaters, any debris within the vitreous jelly can cast a shadow on the retina. Other potential sources of debris within the vitreous jelly include infections, inflammation, bleeding, and retinal tears.
Regardless of the cause, the onset of new eye floaters may be dangerous and requires an urgent dilated examination with an ophthalmologist.
An “eye stroke” is the interruption of blood flow to the eyeball or the optic nerve. This can be caused by clotting or narrowing of the blood vessels. Underlying risk factors for an eye stroke include diabetes, high blood pressure, high cholesterol, and cardiovascular disease. These are the same causes for heart attack or stroke in the brain, and therefore an eye stroke should be taken seriously as it could a sign of a more life-threatening condition.
Eye stroke is accompanied by sudden vision loss. If you experience this symptom, contact your ophthalmologist for an urgent dilated eye exam.
A macular hole occurs when natural forces on the surface of the retina pull a gap in the center of the vision, which typically occurs spontaneously without any risk factors.
The macula is another term for the center of the retina responsible for the most detailed vision. A macular hole is a gap in the very center of the retina which causes a blind spot. These holes can form spontaneously or after the detachment of the vitreous (the jelly-like substance that fills the eye and is attached to the retina). Most macular holes remain open unless surgical repair is performed. To surgically fix a macular hole, a retina specialist removes the vitreous, peels a surface layer off the retina, and injects a gas bubble in the eye to close the hole. Surgical repair is successful in closing the hole and improving vision in more than 95% of cases.
A dislocated intraocular lens usually results in blurry vision, glare, and haloes.
Cataract surgery involves the removal of a patient’s original, cloudy lens and replacement with a clear artificial lens called an intraocular lens implant. Sometimes, these lens implants can move out of position, causing a decrease in vision.
Dislocation of an intraocular lens can be complete or partial (subluxation). Restoration of vision can be achieved through surgical repositioning or replacement of the dislocated lens. In all cases of painless loss of vision, an ophthalmologist should perform a complete ocular examination to ensure that your cataract lens implant has not shifted out of position.
Floaters are mobile opacities in your vision resulting from debris within the jelly that fills your eye.
Human eyes are full of a jelly-like substance called vitreous. Mostly made of water, the vitreous achieves its jelly-like properties through the interaction of collagen fibers and other molecules that maintain the shape and clarity of the eye.
At birth, collagen fibers in the vitreous jelly are thin and regularly spaced, allowing light to pass through them without casting a shadow on the retina. With age, the collagen in the vitreous jelly starts to clump into larger opacities, causing mobile, hair-like shadows to show up in the vision. The shadows are particularly prominent when looking at a bright blue sky or white wall.
In early life, the vitreous jelly is in contact with the surface of the retina in the back of the eye. Between the age of 50-70 in most people, the vitreous jelly separates from the surface of the retina, causing a sudden onset of flashes and new, dark floaters. These new symptoms are sometimes accompanied by retinal tears or detachments, and a dilated eye exam is recommended for anyone experiencing new floaters.
Sometimes, large floaters become a chronic, aggravating symptom. While most chronic floaters can be safely observed, treatment options such as laser and surgical removal are available for those patients with significant disruption of their everyday activities.
Macular edema, or swelling in the central retina, is serious because it can cause permanent vision loss without treatment. Therefore, the cause needs to be identified and treated to prevent long term, irreversible retinal damage. The most common diagnosis associated with macular edema include macular degeneration, diabetic retinopathy, and retinal vein occlusion.
Yes, individuals can inherit a higher risk for Age-Related Macular Degeneration (AMD). There are various genes that have been associated with macular degeneration, many of which can be tested via a saliva sample.
Patients with a blood relative with macular degeneration are at higher risk for developing the condition themselves. There are several non-inherited risk factors for the condition as well, such as age, smoking, heart disease, high blood pressure, and obesity.
Individuals over the age of 60 who have a blood relative with macular degeneration should undergo annual ophthalmology examinations, including dilation and specialized retinal imaging.
A retinal detachment can be prevented by urgent dilated eye examination and treatment in patients experiencing new flashes and floaters.
Commonly between the ages of 50 and 70, individuals experience a sudden, spontaneous onset of new flashes or floaters in their vision. These symptoms may indicate the presence of a retinal tear or detachment.
Anyone who experiences new flashes and floaters should seek an urgent dilated examination with an ophthalmologist. If a retinal tear is identified, the ophthalmologist will likely treat it with laser or freezing to prevent a detachment. Oftentimes, patients will be referred to a retina specialist for further evaluation or treatment.
Occasionally, a retina specialist may treat an asymptomatic patient with laser or freezing to prevent a retinal tear or detachment.
Chronic floaters can be safely observed as they are not harmful to the eye, however, laser or surgical removal is available to individuals whose floaters significantly interfere with their daily activities.
If there is a single, discrete floater (sometimes referred to as a Weiss Ring), it can often be vaporized into smaller, non-visually significant pieces with an in-office laser procedure. For diffuse, cloudy floaters, surgical removal with a procedure known as a vitrectomy is often recommended. Vitrectomy is a common procedure performed in an outpatient setting and is used to treat many other eye conditions such as retinal detachment, macular hole, and epiretinal membrane.
An eye stroke is very serious, sometimes leading to permanent blindness or stroke in the brain.
An “eye stroke” is the interruption of blood flow to the retina or optic nerve. Causes of an eye stroke include retinal artery occlusion, retinal vein occlusion, and ischemic optic neuropathy. Depending on the cause of the “eye stroke,” this diagnosis can be vision and life-threatening. If you are experiencing sudden vision loss in one or both eyes, seek immediate evaluation with an ophthalmologist. Several treatments for eye stroke are available, including eye injections and steroid medication. In some cases, patients may be sent to the emergency room due to a high risk of stroke in the brain.
A retinal detachment may cause permanent blindness over a matter of days and should be considered an eye emergency until evaluated by a retina specialist.
Most retinal detachments occur suddenly and can threaten the central vision within hours or days. Anyone experiencing a new onset of flashes, floaters, or loss of peripheral vision should seek an urgent dilated exam with an ophthalmologist.
After a retinal detachment is diagnosed, the timing of surgical repair depends largely on the location of the detachment in relation to the central vision. If the central vision is still attached, a retina specialist may proceed with treatment within 24-48 hours to repair the detachment before it progresses through the central vision. If the central vision is detached at the time of diagnosis, the surgeon may schedule treatment within the next 7-10 days.
Even with timely diagnosis and treatment, retinal detachment may result in permanent visual loss or blindness.
Macular pucker is very common, occurring in anywhere between 5-15% of the population. Retina specialists frequently diagnose and treat macular pucker with surgical removal of the offending epiretinal membrane.
Despite multiple treatment options for retinal artery occlusion, none have been proven to cure the condition.
The retinal arteries are critical for delivering oxygen and nutrients to the retina to create vision. When a retinal artery becomes blocked, all the downstream tissue stops working, causing a sudden loss of vision. Multiple modalities to reverse a retinal artery occlusion have been attempted (e.g. hyperbaric oxygen, laser, surgery, breathing into a paper bag, eye drops, clot-busting medicine, etc.), but nothing has been proven to work reliably. Most importantly, retinal artery occlusions can be the precursor to a stroke in the brain and warrant an urgent medical workup to determine the cause of the “eye stroke.”
It is unusual for a macular hole to close without surgery.
Macular holes form when surface tension on the retina causes the center of the retina to pull apart. In most cases, the surface tension will not allow the macular hole to close on its own. Instead, a retina specialist will perform surgery to close the hole. The procedure consists of a vitrectomy (removing the vitreous from the eye), peeling of the elastic membrane on the surface of the retina (Internal Limiting Membrane), and closure of the hole using the surface tension of a gas bubble. Patients may have to position themselves face down for a short period of time after a macular hole repair.
While macular edema can resolve on its own, most symptomatic cases of swelling in the retina benefit from treatments prescribed by an ophthalmologist specialized in retina care.
The macula is another term for the center of the retina. There are many causes for swelling (edema) of the macula, including due to vascular abnormalities such as those found in Age-Related Macular Degeneration, Diabetic Retinopathy, and Uveitis. Sometimes recent cataract surgery or infection can cause macular edema as well. While mild cases of macular edema can resolve without treatment, most symptomatic patients benefit from treatments prescribed by retina specialists, including eye drops, eye injections, retinal laser, or retina surgery.
Macular edema can be reversed with treatment by an ophthalmologist specialized in retinal diseases.
Macular edema is another term for swelling of the central retina, which can occur in macular degeneration, diabetic retinopathy, retinal vein occlusion, and after cataract removal. Depending on the cause, macular edema can be treated with observation, eye drops, eye injections, retinal laser, or retinal surgery. An eye doctor specializing in retinal conditions will take a careful history and perform a detailed examination to determine the cause and recommend the appropriate treatment regimen.
Cataract surgery can be redone, most commonly after a problem occurs with the lens implant from the original procedure.
Cataract surgery entails removing the natural lens material and replacing it with an artificial lens implant designed to match the patient’s approximate prescription. If there is a problem with the implant, such as damage, dislocation, or patient dissatisfaction, the surgeon can replace or reposition the implant. Patients may also develop a ‘secondary cataract’ in the months or years following cataract surgery, which is a condition remedied with a painless, non-invasive laser procedure called a YAG capsulotomy.
It is unusual for a macular pucker to improve without surgical removal.
Macular pucker is caused by a membrane on the surface of the center of the retina. The membrane is a form of “scar tissue” that contracts and causes the macula (center of the retina) to pucker or wrinkle. This causes blurry or distorted vision. It is rare for a membrane to get better on its own. The best way to correct this condition is to have retina surgery to peel the membrane off the surface of the retina to relieve the wrinkling.
There are numerous causes for new floaters in the vision, many of them concerning for permanent vision loss or blindness. Among the dangerous causes for new eye floaters are retinal tears, retinal detachment, bleeding in the eye, eye infection, and inflammation. Individuals experiencing floaters in the eye should seek an immediate dilated retinal examination with an ophthalmologist.
Unlike new floaters, chronic floaters (>6 months) are generally not a sign of danger and can be evaluated by an ophthalmologist on a non-urgent basis.