Retina Care


 

Torn retina surgery

Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and may be performed in your ophthalmologist’s office.

Laser surgery (photocoagulation)
With laser surgery, your ophthalmologist uses a laser to make small burns around the retinal tear. The scarring that results, seals the retina to the underlying tissue, helping to prevent a retinal detachment.

Freezing treatment (cryopexy)
Your eye surgeon uses a special freezing probe to apply intense cold and freeze the retina around the retinal tear. The result is a scar that helps secure the retina to the eye wall. 

Retinal Detachment: Torn or Detached Retina Treatment
A retinal tear or a detached retina is repaired with a surgical procedure. Based on your specific condition, your ophthalmologist will discuss the type of procedure recommended and will tell you about the various risks and benefits of your treatment options.

Detached retina surgery 



Almost all patients with retinal detachments must have surgery to place the retina back in its proper position. Otherwise, the retina will lose the ability to function, possibly permanently, and blindness can result. The method for fixing retinal detachment depends on the characteristics of the detachment. In each of the following methods, your Eye M.D. will locate the retinal tears and use laser surgery or cryotherapy to seal the tear.

Scleral buckle
This treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place. The ophthalmologist often drains the fluid under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room.

 

Pneumatic retinopexy
In this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done in the ophthalmologist’s office. Your ophthalmologist will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear. 

Vitrectomy
This surgery is commonly used to fix a retinal detachment and is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble.

 

Sometimes an oil bubble is used (instead of a gas bubble) to keep the retina in place. Your body’s own fluids will gradually replace a gas bubble. An oil bubble will need to be removed from the eye at a later date with another surgical procedure. Sometimes vitrectomy is combined with a scleral buckle.

If a gas bubble was placed in your eye, your ophthalmologist may recommend that you keep your head in special positions for a time. Do not fly in an airplane or travel at high altitudes until you are told the gas bubble is gone. A rapid increase in altitude can cause a dangerous rise in eye pressure. With an oil bubble, it is safe to fly on an airplane. 

 

Most retinal detachment surgeries (80 to 90 percent) are successful, although a second operation is sometimes needed.
Some retinal detachments cannot be fixed. The development of scar tissue is the usual reason that a retina is not able to be fixed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind.

After successful surgery for retinal detachment, vision may take many months to improve and, in some cases, may never return fully. Unfortunately, some patients do not recover any vision. The more severe the detachment, the less vision may return. For this reason, it is very important to see your ophthalmologist regularly or at the first sign of any trouble with your vision.

Diabetic Retinopathy Treatment

The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won’t cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.

Laser surgery
The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema, proliferative diabetic retinopathy (PDR) and neovascular glaucoma.

Laser surgery is usually performed in an office setting. For comfort during the procedure, an anesthetic eyedrop is often all that is necessary, although an anesthetic injection is sometimes given next to the eye. The patient sits at an instrument called a slit-lamp microscope. A contact lens is temporarily placed on the eye in order to focus the laser light on the retina with pinpoint accuracy.

With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.

A few people may see laser spots near the center of their vision following treatment. They usually fade with time, but may not disappear completely.

In PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment.

Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision. 

Vitrectomy surgery
Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is often performed on an outpatient basis or with a short hospital stay. Either a local or general anesthetic may be used.

During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again.

Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.

To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist’s instructions so your eye will heal properly. 

Medication injections
In some cases, medication may be used to help treat diabetic retinopathy. Sometimes a steroid medication is used. In other cases, you may be given an anti-VEGF medication. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye which can affect your vision. An anti-VEGF drug can help reduce the growth of these abnormal blood vessels.

After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve how well you see.

Click here to read a brochure about Diabetic Retinopathy Treatment.

Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.

Macular Degeneration Treatment: How is AMD Treated?

Dry AMD and nutritional supplements
Unfortunately, at this time there is no single proven treatment for the dry form of macular degeneration. However, a large scientific study has shown that antioxidant vitamins and zinc may reduce the impact of macular degeneration in some people by slowing its progression toward more advanced stages.

The Age-Related Eye Disease Study 2 (AREDS2) showed that among people at high risk for developing late-stage, or wet, macular degeneration (such as those who have large amounts of drusen or who have significant vision loss in at least one eye), taking a dietary supplement of vitamin C, vitamin E, lutein and zeaxanthin, along with zinc, lowered the risk of macular degeneration progressing to advanced stages by at least 25 percent. The supplements did not appear to provide a benefit for people with minimal macular degeneration or people without evidence of the disease during the course of the study.

Following is the nutrient supplementation shown to be beneficial in lowering the risk of macular degeneration progressing to advanced stages:
• Vitamin C – 500 mg
• Vitamin E – 400 IU
• Lutein – 10 mg
• Zeaxanthin – 2 mg
• Zinc oxide – 80 mg
• Copper (as cupric oxide) – 2 mg (to prevent copper deficiency, which may be associated with taking high amounts of zinc)

Another large study in women showed a benefit from taking folic acid and vitamins B6 and B12. Other studies have shown that eating dark leafy greens, and yellow, orange and other colorful fruits and vegetables, rich in lutein and zeaxanthin, may reduce your risk for developing macular degeneration.

These vitamins and minerals are recommended in specific daily amounts in addition to a healthy, balanced diet. Some people may not wish to take large doses of antioxidants or zinc because of medical reasons.

It is very important to remember that vitamin supplements are not a cure for macular degeneration, nor will they give you back vision that you may have already lost from the disease. However, specific amounts of these supplements do play a key role in helping some people at high risk for developing advanced (wet) AMD to maintain their vision, or slow down the progression of the disease.

Talk with your ophthalmologist to find out if you are at risk for developing advanced macular degeneration, and to learn if supplements are recommended for you.

Wet macular degeneration treatment
Treating the wet form of macular degeneration may involve the use of anti-VEGF treatment, thermal laser treatment or photodynamic therapy (PDT). Treatment of wet macular degeneration generally reduces—but does not eliminate– the risk of severe vision loss.

Anti-VEGF medication injection treatments for wet macular degeneration
A common way to treat wet macular degeneration targets a specific chemical in your body that causes abnormal blood vessels to grow under the retina. That chemical is called vascular endothelial growth factor, or VEGF. Several new drug treatments (called anti-VEGF drugs) have been developed for wet AMD that can block the trouble-causing VEGF. Blocking VEGF reduces the growth of abnormal blood vessels, slows their leakage, helps to slow vision loss, and in some cases improves vision.

Your ophthalmologist administers the anti-VEGF drug (such as Avastin, Lucentis, and Eylea) directly to your eye in an outpatient procedure. Before the procedure, your ophthalmologist will clean your eye to prevent infection and will use an anesthetic drop or injection of anesthetic with a very fine needle to numb your eye. You may receive multiple anti-VEGF injections over the course of many months. Repeat anti-VEGF treatments are often needed for continued benefit.

In some cases, your ophthalmologist may recommend combining anti-VEGF treatment with other therapies. The treatment that’s right for you will depend on the specific condition of your macular degeneration.

Laser treatment for wet macular degeneration
Although most cases of wet AMD are treated with medication, in some instances thermal laser therapy may be used. Laser treatment is usually done as an outpatient procedure in the doctor’s office or at the hospital.
The laser beam in this procedure is a high-energy, focused beam of light that produces a small burn when it hits the area of the retina to be treated. This destroys the abnormal blood vessels, preventing further leakage, bleeding and growth.

Following laser treatment, vision may be more blurred than before treatment, but often it will stabilize within a few weeks. A scar forms where the treatment occurred, creating a permanent blind spot that might be noticeable in your field of vision.

Usually the abnormal blood vessels are destroyed by laser treatment. However, it is likely that 50 percent of patients with wet macular degeneration who receive this laser procedure will need a re-treatment within three to five years. You may be instructed to use the Amsler grid daily to monitor your vision for signs of change.

Photodynamic therapy (PDT)
In some cases, a type of treatment for wet macular degeneration called photodynamic therapy, or PDT, may be an option. This therapy uses a combination of a light-activated drug called a photosensitizer and a special low-power, or cool, laser to treat wet macular degeneration right at the center of the macula.

This procedure is done on an outpatient basis, usually in an ophthalmologist’s office. The photosensitive drug is injected into a vein in your arm, where it travels through the body, including the abnormal vessels behind the central macula. The low-power laser light is targeted directly on the abnormal vessels, activating the drug, which causes damage specifically to those unwanted blood vessels.

After PDT, the abnormal blood vessels may reopen, so multiple treatments may be required.

What happens when macular degeneration cannot be treated?

It is important to remember that only about 10 percent of all macular degeneration cases are exudative, or wet form, and about 75 percent of these cases cannot be treated. People with wet or dry macular degeneration symptoms who cannot be treated will not become blind, as they will still have peripheral, or side, vision.

If you have untreatable macular degeneration, you can make the most of your remaining vision by learning to “see again” with the vision you do have and with the help of special low-vision rehabilitation, devices and services. People with low vision can learn new strategies to accomplish daily activities. These skills, including mastering new techniques and devices, help people with advanced AMD regain their confidence and live independently despite loss of central vision.

While there is little that can be done to improve the eyesight of someone who has AMD, with early detection, the rate of vision loss can be slowed. The keys to slowing vision loss are to understand macular degeneration, monitor your symptoms and visit your ophthalmologist regularly to test your vision. Even with macular degeneration, you can still maintain an enjoyable lifestyle.

Branch Retinal Vein Occlusion (BRVO) Treatment

Because there is no cure for branch retinal vein occlusion, the main goal of treatment is to stabilize vision by sealing off leaking blood vessels. Treatments may include laser treatment and injections.

Finding out what caused the blockage is the first step in treatment. Your Eye M.D. may recommend a period of observation following your diagnosis. During the course of BRVO, many patients will have swelling in the central macular area. This swelling, called macular edema, can last more than one year.

Focal laser treatment is often used to reduce swelling of the macula. With this form of laser surgery, your Eye M.D. applies many tiny laser burns to areas of fluid leakage around the macula. The main goal of treatment is to stabilize vision by sealing off leaking blood vessels that interfere with the proper function of the macula. Treatment with injections of Eylea, Avastin, or Lucentis in the eye may also be done.

Location
Hawaii Vision Specialists
76 Kalanianaole Avenue
Hilo, HI 96720
Phone: 808-333-3233
Fax: 808-315-7663
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808-333-3233