Tag Archives: Tampa

Retinal Detachment

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is the retina?

The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.

What is retinal detachment?

When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture.  Similarly, when the retina detaches the eye loses vision.

Retinal break
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image for enlargement)

What causes retinal detachment?

Retinal breaks (holes and tears in the retina) cause retinal detachment. These retinal breaks are usually caused by a degeneration of the vitreous (the clear gel that fills the eye and normally helps to hold the retina in place). Vitreous degeneration is common in aging and near-sightedness, but may also follow a direct blow to the eye, hemorrhage, infection, or inflammation inside the eye. When the vitreous degenerates and condenses, it pulls on the retina and may cause retinal tears, which often lead to retinal detachment.

What are the symptoms of retinal detachment?

Prior to retinal detachment, most people notice warning signs such as new floating spots or “cobwebs” in the vision. Sometimes, brief lightning-like flashes of light are seen in the side vision. These are the symptoms of vitreous degeneration and retinal breaks. The retinal detachment that follows usually causes a dark “curtain” or “shadow” to form in the side-vision. The “shadow” often comes from below and on the side near the nose.  If it is not treated, the shadow gradually covers all of the vision resulting in blindness. There is generally no pain with retinal detachment.

How is retinal detachment treated?

The treatment of most retinal detachments requires surgery. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination. Surgery is not usually aimed at eliminating flashes and floaters. Flashes usually disappear in a few weeks or months. The floaters gradually fade over many months, but rarely disappear completely.  Some retinal detachments that do not cause symptoms may be observed without initial surgery.

Laser/Cryopexy demarcation:  Small areas of the retinal detachment (especially before any side vision has been lost) can sometimes be treated with laser or cryopexy to “seal down” the retinal along the edges of the detachment in an effort to prevent it from extending further.  This surgery is performed in the office. If it is not successful in stopping the detachment, more extensive surgery is required.

Pneumatic retinopexy:  Many retinal detachments can be repaired by this surgery performed in the office by anesthetizing the eye, sealing the break(s) with laser or a freezing probe (cryopexy), and pushing the retina into proper position with a gas bubble which is injected into the eye. Although this procedure is successful most of the time, it requires the strict cooperation of the patient to remain in proper head position for about five days. If this procedure fails, more extensive surgery in the hospital operating room is sometimes needed.

Scleral buckle surgery:  Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This is a major surgery in which a belt is placed around the eye in the hospital operating room. The eye is often rendered more near sighted by this procedure. Rarely, permanent side effects include double vision. If this surgery is not successful, vitrectomy surgery may be recommended. Scleral buckle surgery is preferred over other methods of surgery if the retinal breaks are located in the inferior (bottom portion) of the retina, where gas bubbles may not be effective in holding the retinal in position. Scleral buckle is also preferred over vitrectomy in eyes with a clear lens, because vitrectomy surgery usually results in cataract formation. Scleral buckle surgery is often used when other attempts at surgery have failed.

The video below demonstrates scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video:

Vitrectomy surgery:  Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed. Sometimes a cataract or lens implant must be removed to adequately repair the retina. This surgery may be repeated if necessary to prevent blindness.

The video below demonstrates vitrectomy surgery. If you are uncomfortable watching surgery, please do not click on this video:

With one or more surgeries most retinal detachments can be repaired keeping useful vision. Vision may not return to normal, as there may be some permanent damage from the retinal detachment resulting in blurred or distorted vision. In some cases additional surgery is needed to removed scar tissue that forms after retinal reattachment surgery.  There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, double vision, deformity, loss of vision/loss of the eye. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask your doctor.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2014-2023 Designs Unlimited of Florida.  All Rights Reserved.

Macular Telangiectasia

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normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is macular telangiectasia (MacTel)?

Macular telangiectasia is a disorder of retinal cells and tiny blood vessels located in the center of the retina. It has also been called juxtafoveal telangiectasis. The retina in your eye is like the film inside a camera. The retina “takes the picture” of objects you look at and sends the message to the brain. The macula is the central portion of the retina that is responsible for sharp reading vision. In MacTel the macula undergoes slow degeneration, and tiny foveal blood vessels become irregular and dilated for unknown reasons. They rarely leak blood or clear fluid in the fovea. MacTel may resemble changes in the retina from drugs that are used to treat breast cancer (Tamoxifen).

Who is at risk for developing macular telangiectasia?

Macular telangiectasia is usually found in males and females during their 5th to 8th decade of life. It may occur in as many as one in every 1,000 persons. MacTel is associated with diabetes, high blood pressure, and tobacco use, but the exact cause has not been determined. Hereditary factors appear significant. Low serum levels of an amino acid called L-serine may play a role, but there are no clear recommendations for supplementation to date.

What are the symptoms of macular telangiectasia?

Blurring of vision is the most common symptom. Distortion of vision may also make reading or seeing small details difficult. Distortion is when straight lines appear wavy or crooked. It may be monitored with the Amsler grid test. Symptoms and clarity of vision may change from day to day. If sudden loss of vision or increased distortion occurs, your doctor should be notified without delay (within a week) as treatment may be needed.

What treatment is available?

There is no cure, but treatment may improve vision or keep the vision from worsening in certain instances. No specific treatment may be recommended if the symptoms are mild. Supplements containing the amino acid L-serine are being investigated. Laser and medicine injections help selected patients. Treatment usually does not return the vision to normal.

Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. Physical activity and use of your eyes will not worsen macular telangiectasia. Magnification may help with reading. If you have any questions, please feel free to ask. If you would like to participate in research, contact www.mactelresearch.com.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2014-2022 Designs Unlimited of Florida. All Rights Reserved.

Central Serous Retinopathy

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central serous retinopathy
anatomy of the eye (click on image to enlarge)

 

What is central serous retinopathy (CSR)?

Central serous retinopathy (also known as central serous chorioretinopathy) is an abnormal leakage of clear fluid under the retina, which causes symptoms of blurred vision often associated with a round or oval dark spot in the central vision. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes a picture” of objects you look at and sends the message to the brain.

What causes central serous retinopathy (CSR)?

The exact cause of CSR has not been well-defined. Classically, it occurs in middle-aged people with type-A personality and who are often under stress at home or work.  However, anyone may be affected regardless of age, personality type, and level of stress. Individuals with type-A personality are perfectionists who often feel pressured by time constraints. Research suggests that hormones released under stress can affect the blood vessels beneath the retina (in the choroid). These vessels may leak an abnormal amount of fluid, which then works its way under the center of the retina. Far-sighted eyes are more commonly affected than near-sighted eyes.  

What other things can aggravate central serous retinopathy (CSR)?

A host of factors may aggravate CSR. Sometimes, medical conditions (Cushing’s Syndrome, systemic lupus erythematosus, polycystic ovary disease, sleep apnea), medications (pseudephedrine, prednisone/cortisone/steroid by mouth/cream/injection/spray, OTC medication for the common “cold”, OTC nasal sprays, diet pills, muscle relaxants, and medications for erectile dysfunction), and other agents (testosterone, cocaine, caffeine, niacin, amphetamines, estrogen blockers, etc.) may contribute to the development of CSC. Rarely, CSC may be triggered by pregnancy, or by a viral infection or bacterial infection. Intense exercise has been implicated, as well. Indeed, anything that causes emotional or physiological stress in the body, including intense fasting, may contribute to the development of CSC.

What are non-medical treatments of CSC?

In many cases, the symptoms will disappear with time. Over a period of weeks to months, the abnormal leakage may stop with normal healing. Importantly, avoiding known triggers (listed above) may help. Other helpful measures include stress management, getting 8 hours of sleep per night, and treatment of sleep apnea.  

What are medical treatments of CSC?

The doctor can recommend the best course of action by taking special pictures of the eye called a fluorescein angiogram. The fluorescein angiogram shows where the leak is coming from and how active the leak is. Prescription medication may be helpful if fluid leakage does not go away with time alone. Patients with high blood pressure may benefit from beta-blocker medications. Thermal laser photocoagulation may be helpful if the site of leakage is not close to the center of vision. Side-effects are rare, but may include the appearance of a small, permanent blind spot in the vision. Another laser called Visudyne photodynamic therapy (PDT) may successfully avoid blind spots in the vision in eyes with areas of leakage close to the center of vision. Medicine injections may also be used to treat this condition.

What will happen to the vision?

Usually the vision returns to normal or near normal. Rarely, central serous chorioretinopathy will cause permanently limited central vision with distortion. In about a third of cases, CSC will return at a later date in the same or other eye. Repeated episodes of leakage may result in a build-up of permanent damage to the retina. Therefore, any future decrease in vision should be promptly reported to the doctor. The vision may be monitored with the Amsler grid test.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2023 Designs Unlimited of Florida.  All Rights Reserved.

Tobacco and Eye Disease

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How does tobacco affect the eyes?

Tobacco use is widely known to cause lung damage, but the eyes are also affected. Bothersome irritation of the eyes is caused by smoke from tobacco especially in patients with dry eyes. However, permanent loss of vision may occur from such problems as macular degeneration, retinal vein occlusion, ocular histoplasmosis syndrome, glaucoma, cataract, Grave’s Disease (a thyroid condition that affects the eyes), uveitis (inflammation of the eye), ischemic optic neuropathy, and diabetic retinopathy. Tobacco appears to play a role in causing and/or worsening these conditions. Tobacco is known to promote hardening of the arteries, and this may harm blood flow to the eye. Tobacco also promotes the development of blood clots, which may block blood flow in the eye. Tissue damage also occurs from toxic compounds in tobacco that cause a chemical reaction called oxidation. More research is needed to fully understand the role of tobacco in causing loss of vision.

What resources are available to help stop tobacco use?

Because most people cannot stop tobacco “cold turkey,” many resources are available to help quit the habit. Counseling may provide much needed support in the process of stopping tobacco use. For free classes and one-month’s supply of nicotine replacement therapy, your doctor can refer you to the Area Health Education Center. Alternatively, you may call 1-877-848-6696. The class schedule may be viewed at www.ahectobacco.com/calendar.  If you are interested in talking to informed support staff, please call 1-800-QUIT-NOW. Nicotine replacement therapy plays an important role and several preparations are available over-the-counter. These non-prescription forms of nicotine include gum, lozenges, and patches. Medicare and most insurance companies now cover the costs of prescription medications to help stop tobacco use. These include nicotine nasal sprays, nicotine inhalers, as well as pills (Zyban and Chantix). With the help of counseling, nicotine replacement, and prescription medication, you can live a longer and healthier life without tobacco. For more information please visit www.smokefree.gov.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.

Posterior Vitreous Detachment (PVD)

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What is posterior vitreous detachment?

A posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina.  The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye.  From birth the vitreous gel is attached to the retina and helps to support it.  The retina is a thin layer of tissue that lines the inside of the eye like film in a camera.  Just like film, the retina serves to “take the picture” of objects you look at.  The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.

vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)

 

PVD
A. Vitreous gel fills the eye at birth. B. Vitreous fibers begin to pull away from retina. C. Further separation of vitreous fibers that remain attached to the optic disc. D. Complete separation of vitreous fibers from the posterior retina.

 

What symptoms does posterior vitreous detachment cause?

The most common symptoms of PVD are floaters and flashes.   Floaters are specks, fibers, or veils that appear to move in front of your eye.  Floaters are actually tiny clumps of gel or cellular debris within the vitreous.  PVD sometimes causes bleeding inside the eye.  Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots.  Over time floaters may appear like a cloud or veil that moves across the vision.  Flashes are brief streaks of light that are usually seen off to the side, especially at night, when you turn your head or eyes.  Flashes are caused by vitreous gel tugging on the retina with eye movement.  Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.

Why is it important to be seen for these symptoms?

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor.  In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina.  A retinal tear by itself causes no pain or visual problems.  However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment.  A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye.  A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.

What causes posterior vitreous detachment?

PVD is usually due to degeneration of the vitreous gel from aging.  Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina.  The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life:  trauma, inflammation, diabetes, and myopia (near-sightedness).

How is posterior vitreous detachment managed?

The most important step is to have a thorough, dilated eye examination.  The eye doctor will check for the presence of a tear in the retina.  If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment.  If a retinal detachment is found, more extensive surgery is required in an attempt to repair it.  If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred.  Generally, there are no restrictions to your activities.

What happens to the floaters and flashes?

There is no treatment to make the floaters and flashes go away even though they may be quite annoying.  The flashes gradually subside and disappear over days to weeks without treatment.  However, the floaters rarely completely disappear.  They will gradually fade and become less obvious over weeks to many months.  For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.

What to be on the lookout for?

After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay.  Sometimes, new tears or a retinal detachment can occur after the eye examination.  In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD.  This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.

PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.

When one eye develops a PVD, the fellow eye will usually do so at a future date.  Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor.  If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well.  But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2014-2023 Designs Unlimited of Florida. All Rights Reserved.

Retinal Vein Occlusion

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What is a retinal vein occlusion (RVO)?

Retinal vein occlusion means blockage of a vein in the retina.  The retina in your eye is like the film inside a camera.  The retina “takes the picture” of objects you look at and sends the message to the brain.  The retina is a living tissue, which requires blood supplied by tiny vessels.  Retinal veins are blood vessels that drain blood out of the retina. An abnormal blood clot in a retinal vein causes a blockage (occlusion) of the blood flowing out of the retina.  Depending on the location of the occlusion, vein occlusions are divided into branch retinal vein occlusion and central retinal vein occlusion.

retinal vein occlusion
anatomy of the eye (click on image to enlarge)

Who is at risk for a retinal vein occlusion?

Retinal vein occlusions occur in 1-2% of people over 40 years of age. Retinal vein occlusions are more common in people who are overweight, use tobacco or estrogen, or have hardening of the arteries, diabetes, high blood pressure, sleep apnea, glaucoma, or blood disorders.

What are the symptoms of a retinal vein occlusion?

Blurring of vision may occur if excess fluid (edema) leaks from the veins into the center of the retina.  Floaters can look like tiny dots or cobwebs moving about in your vision.  They may be due to bleeding from the retina into the central gel of the eye.  Pain is rare and may be due to high pressure in the eye (neovascular glaucoma).

What treatment is available?

There is no cure, but treatment may improve vision or keep the vision from worsening.  Your doctor may allow time for the vein to heal.  Sometimes eye drops or pills may be prescribed.  Medicine injections (Avastin, Lucentis, Eylea, steroids) may help recover vision and may be applied without pain in most cases. Injections may be required for the long-term; about half of eyes with central retinal vein occlusion require injections for at least three years. Injections for retinal vein occlusion are safe in regard to risks of problems outside the eye. However, there appears to be a low risk of stroke (intracranial hemorrhage) of <4/1000 every year of treatment.

Laser may stabilize or improve the vision.  The vision may not return to normal following treatment as there may be some permanent damage to the retina from the occlusion.  In some cases when treatment cannot improve the vision, laser is used to prevent severe pain and complete blindness.

Your doctor is going to order appropriate tests and recommend the best course of action to take at this time.  The retinal vein occlusion will not be worsened by your daily activities or by using your eyes. You may monitor the vision with the Amsler grid test.  It is important to be seen by your primary care doctor to treat risk factors of hardening of the arteries to prevent stroke and heart attack.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

recent BRVO
blood spots and white exudates in retina from recent brach retinal vein occlusion (click on image to enlarge)
healing BRVO
Fewer blood spots as vein occlusion heals with Avastin (click on image to enlarge)
CRVO
Recent-onset central retinal vein occlusion of left eye

Copyright  © 2013-2023 Designs Unlimited of Florida.  All Rights Reserved.

Confusion between PreserVision AREDS-2 and “New” PreserVision AREDS-2

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There is confusion between PreserVision AREDS-2 and “new” PreserVision AREDS-2.   In September 2013 Bausch and Lomb changed the contents of PreserVision AREDS-2 and renamed the new vitamin, “New” PreserVision AREDS-2. The color of the box and the label on the bottle remain the same. The difference between the old and new vitamins is the “new” formulation lacks omega-3 fatty acids. They were removed because the AREDS study group was unable to demonstrate a benefit in patients with age-related macular degeneration (AMD). Other smaller studies have suggested a benefit and additional studies are needed to confirm or refute the value of omega-3 fatty acids in AMD.

Why is the difference important to me?

The importance in the difference for patients lies with the dosage. The recommended dosage for the older PreserVision AREDS-2 was two softgels twice a day. The recommended dosage for the “New” PreserVision AREDS-2 is one softgel twice a day. To avoid an error in dosing, patients need to be aware of which of the two similar vitamins they are taking.

Is there a cheaper version of AREDS-2 vitamins?

Yes.  As the patent expired on the ARED-2 formula, there are less expensive options now available.  The least expensive AREDS-2 vitamin that I am aware of at the time I write this blog is Equate Advanced Eye Health Complex by Walmart.  This vitamin is equivalent to the “New” PreserVision AREDS-2, but much less expensive. It is taken one pill twice-a-day.

By Scott E. Pautler, MD

 

PreserVision AREDS 2
PreserVision AREDS 2 (click to enlarge)
New PreserVision AREDS2
New PreserVision AREDS 2 (click to enlarge)

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2023 Designs Unlimited of Florida.  All Rights Reserved.

Sub-Tenon’s Steroid Injection

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Why is a sub-Tenon’s steroid injection performed?

A sub-Tenon’s steroid injection (STS) is an office procedure performed to decrease inflammation, swelling, or leaky blood vessels inside the eye. The steroid medicine acts to decrease inflammation and leakage from blood vessels from a variety of causes, thereby offering the opportunity for improvement in vision. The effect of STS lasts for several months after which repeated injection may be considered if necessary.

How is a sub-Tenon’s steroid injection performed?

Anesthetic solutions are used to make the procedure pain-free. A pressure sensation is often felt as the steroid is injected next to the eye with a very thin, short needle. The procedure is brief.

Periocular steroid injeciton
Sub-Tenon’s Steroid Injection (click on image to enlarge)

Will the injection affect my vision?

The vision may be slightly blurred immediately after an injection. The anticipated improvement in vision occurs slowly over a period of weeks to months. Sometimes, the pressure inside the eye increases and may require eye drops for several months. There may also be an increased rate of cataract formation. It is common for the upper lid to droop slightly; this improves over several months.  Rare risks of steroid injection include bleeding, infection, retinal detachment, glaucoma, and loss of vision. Please report any severe loss of vision to the doctor without delay.

How do I care for the eye after injection?

If a patch is placed on the eye, keep it on as directed by the doctor, usually 2-3 hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after STS. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.

Avastin Therapy for Retinal Disease

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What is Avastin therapy?

Avastin therapy is a treatment for retinal conditions involving abnormal blood vessel leakage including wet-type age-related macular degeneration, myopic macular degeneration,  retinal vein occlusion, diabetic retinopathy, and cystoid macular edema. The treatment involves the painless injection of medication into the eye to stop the leakage and improve vision. The benefits of treatment last one or more months. Repeat injections are common in order to keep the leakage from returning. When the problem has stabilized, the injections may be given less often or discontinued in some conditions. Avastin has not been reviewed by the FDA for use in the eye; therefore, it is used off-label. Safety and effectiveness has been established through extensive experience with the use of Avastin in the eye for a multitude of problems since 2005. There are other similar drugs that have been FDA-approved for use in the eye including Lucentis, Eylea, Vabysmo, and Beovu. These drugs are much more expensive than Avastin. Avastin costs about $50 compared to $2,000 with the FDA-approved drugs. There may be reasons to use one medication over another depending on the diagnosis.

How effective is Avastin therapy?

Avastin has been found to be effective in the treatment of a variety of retinal disorders of blood vessel leakage. It was shown to be as effective as Lucentis in the treatment of wet-type macular degeneration in most patients. Avastin is also effective in the treatment of macular edema, retinal vein occlusion, diabetic retinopathy and other conditions of the eye.

What are the risks of Avastin therapy?

Severe complications are very rare, but risks of Avastin injection include bleeding, infection, inflammation, glaucoma, retinal detachment, cataract, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the results of surgical repair are poor. There may be an increased risk of difficultly with future cataract surgery estimated to be about 1%. In these cases the zonules that hold the cataract in place may become weaken from Avastin injection. When this occurs, special techniques are required to remove the cataract and place a lens implant. Rarely, two procedures are required to accomplish the task. Studies are ongoing to determine if there may be an increased risk of stroke with Avastin therapy. Further research is needed. However, pregnancy should be avoided while on Avastin therapy.

There appears to be a greater risk of high eye pressure (glaucoma) in eyes treated with Avastin compared with Lucentis and Eylea. This may be especially important in patients at increased risk of glaucoma due to past high eye pressures or positive family history of glaucoma.

Because Avastin must be measured and placed in a syringe by a compounding pharmacy after manufacture, there may be increased risk of complications with Avastin compared with other similar drugs such as Lucentis, Eylea, Beovu, and Vabysmo. There may be an increased risk of infection due to the introduction of bacteria during repackaging.  Some patients experience persistent round floaters due to silicone droplets used to lubricate the syringe from the pharmacy.  Over the years, there have been concerns over needle quality (sharpness), which can make injection more uncomfortable.

intra-ocular injection
Intra-vitreal injection

What do I expect after an Avastin injection?

If a patch is placed on the eye, keep it on as directed by the doctor, usually 3-4 hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the office.

By Scott E Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

Argus II Retinal Implant

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What is the Argus II retinal implant?

The Argus II retinal implant is an electronic instrument used to restore limited vision in patients who are blind in both eyes from retinitis pigmentosa. The retina is a thin layer of delicate tissue in the back of your eye, which lines the inside wall like the film in a camera. The retina “takes the picture” of objects and sends the message to the brain. Retinitis pigmentosa is a group of inherited diseases that affects the retina and may cause a profound loss of vision.

How does the Argus II retinal implant work?

The Argus II retinal implant system has several parts. There is a small video camera placed on glasses. The camera records video images and transmits the information to a video processor worn on the belt around the waist. The processor then converts the video information into a digital code that is transmitted to an implant that has been surgically inserted into the eye. The implant includes a set of diodes that are placed inside the eye on the surface of the retina and a coil that is secured to outside of the eye wall underneath the skin where it cannot be seen.

Who is eligible for the Argus II retinal implant?

In February 2013 The FDA granted approval for the use of the Argus II retinal implant only to patients with severe vision loss due to advanced retinitis pigmentosa. Eligible patients must have had good vision early in life and lost all but bare light perception or worse. Patients must also be older than 25 years of age. Researchers hope that with further research the device will be approved in the future for patients with less severe vision loss and for patients with other types of retinal disease. The implant is expected to become available in late 2013.

How much is the vision improved with the Argus II retinal implant?

The improvement in vision is very limited, but helpful in select patients. No clear image is seen. However, eligible patients with the retinal implant are able to see borders between light and dark. This allows them to function better with simple visual tasks such as walking and seeing objects with high contrast. The amount of improvement varies from patient to patient. Because there are risks to surgery, the FDA is appropriately cautious in its approval of the device only for patients with profound loss of vision.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345188/

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to RvaAdmin@rvaf.com. We accept Medicare, most insurances, and self-pay.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

Myopia (near-sightedness)

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is myopia?

A myopic eye is a near-sighted eye.  Without glasses the vision is usually quite good at near, but blurred at distance.  Myopia affects 25% of Americans and about 22% of the world population. High myopia (greater than -6.00 diopters) is less common, affecting about 2% of the world population and projected to rise to 10% by the year 2050.

What causes myopia?

Myopia is an inherited condition that usually develops in childhood or early adulthood.  The eye, which is round like a ball at birth, becomes oval like an egg.  The outer appearance of the eye is not usually changed, but the elongation of the eye changes the focus of the eye from distance to near. There is evidence to suggest that extensive near work (e.g. reading) may worsen myopia.

myopia
A myopic eye has elongated somewhat like an egg. Incoming images do not focus on the retina in the back of the eye.

Why is it important to know about myopia?

Although most people with myopia do not develop complications, highly near-sighted people are at increased risk of losing vision from glaucoma, cataract, macular degeneration, and retinal detachment. The higher the degree of near-sightedness (myopia greater than -6.00 diopters), the greater the risk of loss of vision.

Glaucoma is a condition in which the pressure inside the eye damages nerve tissue that helps you see.  This pressure usually causes no pain or discomfort and pressure measurements may be normal at times.  Over months to years, the pressure slowly takes away the side vision.  If undetected and untreated, it may cause total blindness.  The best way to diagnose glaucoma is to have regular eye exams each year with pressure measurements.  Treatment is effective in preventing vision loss through the use of eye drops.  Sometimes, laser or surgery is needed.

Myopic macular degeneration is an uncommon cause of vision loss from severe myopia. The macula is the central part of the retina in the back of the eye.  The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera.  In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.  In very near-sighted eyes, the retina becomes stretched as the eye elongates.  As a result, the central vision may become blurred or distorted even with proper glasses.  Distortion is when straight lines look wavy or crooked.  Blood vessels under the macula may bleed causing sudden blurring, blind spot, or distortion.  Any of these symptoms should be reported to the eye doctor without delay, as early treatment with medicine injections and/or laser may prevent further loss of vision.

Retinal detachment is a separation of the retina from the inside wall of the eye. When the retina detaches, it is no longer in proper position inside the eye.  Instead, it is like film that has unrolled inside a camera.  When this occurs, a camera cannot take a picture.  Similarly, when the retina detaches, the eye loses vision.  Warning symptoms prior to retinal detachment may include new floaters or brief flashes of light in the side-vision.  Later, a dark curtain or shadow slowly starts off to the side and takes away the vision as the retina detaches.  Laser or surgery repairs most retinal detachments.  It is important to diagnose a retinal detachment early in order to prevent permanent damage to the retina.  Report any new floaters, flashes, or loss of side-vision to your eye doctor without delay.

How is myopia treated?

The standard treatment of myopia is to refocus the eye with eye glasses or contact lenses. LASIK and PRK surgery flatten the cornea to focus images onto the retina. Orthokeratology is a controversial method used to flatten the cornea with contacts lenses worn overnight. Lens implants are a more aggressive measure to focus light in highly near-sighted eyes. All of these methods of treatment are simply aimed to focus the vision.  They are not designed to correct the underlying problem of elongation of the eye that leads to complications and loss of vision.  Diluted atropine eye drops appear to reduce the progression of myopia in an effort to avoid complications of severe elongation of the eye.

Will LASIK surgery help prevent these complications of myopia?

Although LASIK surgery is very effective at flattening the cornea to help eliminate the need for glasses, it does not restore the spherical shape to the eye.  Therefore, it is still necessary to be aware of the warning signs of possible complications from myopia.

What are the Do’s and Don’ts?

Using your eyes to read or work at a computer will not weaken them. Avoid intensive rubbing of your eyes.  Remember to have your eyes examined once a year.  Report the following symptoms to your eye doctor without delay:

¨     Blind spot or distortion of central vision

¨     New floaters or flashes of light

¨     Loss of side-vision

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

Floaters and Flashes

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vitreous gel
Vitreous gel fills the eye (Click on image to enlarge)

 

What are floaters and flashes?

Floaters are small specks, fibers, or bug-like objects that may appear to move in front of your eye.  They appear black or gray and may be few or numerous.  At times they may appear like a veil or cloud moving in the vision even after the eye is still.  They are frequently seen when looking at a brightly lit background, like a blank wall or blue sky.  Floaters are actually tiny clumps of fiber or cellular debris within the jelly-like fluid (vitreous) that fills the inside of the eye. Many dot-like floaters may be due to bleeding inside the eye, especially when they come on suddenly. Long-standing, numerous, dot-like floaters may represent inflammation in the eye.

Floaters image
Floaters as simulated in photograph (click on image to enlarge)

Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes.  They may appear curved or like a brief lightning flash and last for only a second. Flashes are caused by fibers in the vitreous gel tugging on the retina with eye movement. This type of flashing light is different from migraine.

What do these symptoms mean?

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous.  In some instances, the retina may tear and cause blindness from detachment of the retina.

What causes floaters and flashes?

Floaters and flashes are usually due to degeneration of the vitreous gel in the eye from ageing.  Over time, the vitreous shrinks, condenses, and pulls away from the retina.  The condensation causes floaters and the pulling irritates the retina and is perceived as flashes of light. Myopia (near-sightedness) is a common cause of long-standing floaters.

What should be done about these symptoms?

The most important step is to have a thorough dilated eye examination, preferably by a retinal specialist.  The need for examination is urgent if the onset of symptoms is sudden. The eye doctor will check for the presence of a tear in the retina.  If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment.  If a retinal detachment is found, more extensive surgery is required in attempt to repair it.

Once an exam has demonstrated no retinal damage, he symptoms of flashes and floaters do not require specific treatment.  The flashes usually occur less frequently over time.  It may take days or weeks for the flashes to subside. Rarely, flashes will continue over many years.  Likewise, floaters subside with time, but take weeks to months to become less noticeable.  It is best not to concentrate on following floaters by moving your eyes as it may make them more bothersome. Depression and stress may worsen the degree in which floaters interfere with daily visual activities.

Many people have long-standing floaters that are not bothersome. In these cases, no treatment is needed after an examination to insure good eye health. Very rarely floaters will persist and interfere with vision. In these unusual cases, vitrectomy surgery may be considered. There are options to consider.

What should you be on the lookout for?

After examination or treatment, any significant new floaters (especially, many new dot-like floaters) or any loss of side vision should be reported to the doctor without delay.  An occasional flash of light in itself is not usually indicative of damage to the retina.  Sometimes, new tears or a retinal detachment can occur at a later date after the initial examination.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2014-2022 Designs Unlimited of Florida.  All Rights Reserved.

Macular Hole

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globe anatomy
anatomy of the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is a macular hole?

Macular hole means there is a tiny hole in the center of the retina.  The retina is a thin layer of tissue in the back of your eye which lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain.  The macula is the center of the retina and gives you sharp central vision for reading and seeing fine details.  When the macula is damaged, the central vision worsens.  Macular hole is not macular degeneration and does not lead to macular degeneration. Macular hole affects both eyes in only about 10% of cases.

What causes a macular hole?

A macular hole is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  When you are born the vitreous gel is thick, clear, and filled with tiny, invisible fibers.  With age or trauma, the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the pulling may result in a macular hole.

What are the symptoms of a macular hole?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens; often with distortion (straight lines look crooked).  Sometimes there is a small blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

In a small number of cases, a macular hole may heal itself. In other cases the vision improves with a medicine injection (Jetrea®). If this fails or is not possible, a surgery may be performed that releases the abnormal pulling of the vitreous on the macula.  A gas bubble (pneumatic retinopexy) is then placed in the eye to close the hole in the macula.  Strict facedown positioning is recommended for several days following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The most common side effect of surgery is cataract formation.  Cataracts develop after surgery in most eyes over several months to years.  About 5% of eyes require more than one surgery to close the macular hole.  In 2-3% of eyes, the retina may detach during or soon after surgery as a result of continued pulling on the retina by vitreous fibers.  This requires additional surgery to prevent profound loss of vision.  Unommon risks of surgery include hemorrhage, infection, blindness and loss of the eye.

Surgery to close macular hole is usually successful in improving vision, though the vision rarely returns completely to normal.  Some residual distortion and central blurring of vision is common. The vision improves very slowly after surgery over several months to years.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2001-2022 Designs Unlimited of Florida.  All Rights Reserved.

For more information please visit Retina Vitreous Associates of Florida.

Vitreomacular Traction Syndrome

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vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is the vitreomacular traction syndrome?

The vitreomacular traction syndrome is a condition in which the vitreous gel, which fills the inside of the eye, pulls on the macula. The macula is the center of the retina and gives sharp central vision for reading and seeing fine details. The retina is a thin layer of tissue in the back of the eye that lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain. When the macula is damaged, the central vision worsens.

What causes the vitreomacular traction syndrome?

The vitreomacular traction is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  At birth the vitreous is a thick and perfectly clear gel.  With age or trauma the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the vitreous may pull the macula away from its normal position, distorting this normally smooth tissue.

normal OCT
Normal macula as seen on optical coherence tomography (click to enlarge)
VMT
Vitreomacular traction as seen on optical coherence tomography (click to enlarge)

What are the symptoms of the vitreomacular traction syndrome?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens, often with distortion (straight lines look crooked).  Sometimes there is a vague blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

If the symptoms are mild, no treatment is needed.  Medicine injection (Jetrea®) or vitrectomy surgery may help if there is significant loss of vision.  In most cases the vision improves with injection or a surgery that releases the abnormal pulling of the vitreous on the macula.  A gas bubble may be placed in the eye to smooth out the macula.  Strict facedown positioning may be recommended for one week following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The surgery is usually successful in returning vision, though the vision may not return completely to normal.

The image below shows the separation of vitreous fibers from the macula after Jetrea injection:

Jetrea VMT
Vitreomacular traction relieved by Jetrea (click to enlarge)

Below is a video that reviews the anatomy of the eye, information on vitreomacular traction, and an example of vitrectomy surgery:
https://youtu.be/r-5Az8_DU3U

Below is the case of a 70-year-old woman who had mild VMT. She was observed over several years and the traction released without surgery.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.

How to find a good retina doctor?

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Why is it necessary to find a good retinal doctor?

Finding a good retinal doctor is important to receive the best level of care. Your doctor should be up-to-date on the latest treatments and be able to choose from among the many choices of treatment to determine which is the best for you as an individual. Some doctors may not keep up with new treatment options and, therefore, may not offer these choices to you as a patient. Moreover, some treatments work better for some patients, but do not work well for others. You must rely on your retinal specialist to offer the best treatment for you. To do so, your doctor must get to know your eyes and you as a person in order to choose what is best for you. The retinal specialist must then review the options and explain why he/she has chosen your treatment plan. All treatments have benefits, risks, and limitations. All of this information must be explained to you. It is helpful if the doctor gives you written information to take home to review after the visit.

How do you go about finding a good retina doctor?

This task is not easy or as obvious as it may seem. At a minimum, your retina doctor should be a medical doctor (MD or DO) and completed a residency in ophthalmology and should be board-certified by the American Board of Ophthalmology.  You can find out online if your doctor is certified. Board certification is essential, but it is only the first step in finding your retina doctor.

Be aware that some ophthalmologists call themselves retina specialists, but they have not completed a retina fellowship program. A retina fellowship is a one or two-year program of highly specialized training, which is undertaken after a general ophthalmology residency program. You may ask your doctor if he/she completed a fellowship in retinal disease and for how long (one or two years). Some information is available to you at the web site of the American Society of Retinal Specialists. You may prefer a doctor who has been trained at a highly reputable university. One source of information is Castle Connolly.

A number of additional factors may be important in the decision to choose the best retina doctor for you:

Does your doctor do research? This issue has a good side and a possible bad side. In general, research may help a doctor to stay up-to-date on diagnosis and treatment. On the other hand, intensive research may draw the doctor’s attention away from information that does not pertain to his/her research interest. In this scenario, the doctor may become an expert in a small area of research and fall behind in the general knowledge of patient care that is important to your care. Simply put, you may prefer a doctor whose primary interest is patient care, not scientific research. Having said that, there are superb retina doctors who excel at both research and patient care. When interviewing a retinal specialist, try to gain a sense as to whether the doctor is more interested in you and your eye problem or his/her research.

Who referred you to the retinal specialist? Although this may not be an important issue, it is something to consider. In years past, doctors referred their patients to other doctors primarily on the basis of their knowledge about who provided the best care. There was no incentive to refer to anyone but the best for their patients. Due in large part to considerable financial duress imposed by government regulation and the insurance industry, general eye doctors have found the need to reap financial gains by hiring retina doctors to work for them. In this setting, the referring doctor may choose a retina doctor who works in the same clinic (or a separate building owned by the same clinic) because he/she makes money from doing so. The clinic retinal doctor may well not be the best doctor available in the area for your care. When in doubt, get a second opinion outside the clinic.

Are you comfortable with your retina doctor? This is a simple, but exceedingly important question to ask yourself. If you do not feel comfortable with your doctor, you may not follow through with instructions properly. You may not ask questions and gain an understanding of your problem. Never hesitate to seek a second opinion. A good doctor is not threatened by second opinions. In fact, good doctors often offer second opinions to their patients who appear uncertain or distressed.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Diabetic Retinopathy

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Diabetes mellitus is a group of conditions characterized by abnormally high blood sugar levels.  Short-term side effects include increased thirst, frequent urination, and weight changes.  Long-term complications include numbness of the hands and feet, loss of vision, kidney failure, as well as hardening of the arteries leading to amputation, heart attack, stroke, and premature death.  Diabetes affects about one million Floridians and 16 million Americans.  It is the leading cause of blindness in America among adults.  Several studies have proven that strict control of blood sugar levels dramatically decreases the risk of blindness and other complications of diabetes.  The National Eye Institute proved that laser treatment may save vision if diabetic eye damage is detected early.  The American Diabetes Association recommends annual eye examinations for all adults with diabetes to prevent blindness.

What is the retina?

The retina is a thin layer of delicate nerve tissue, which lines the inside wall of the eye like the film in a camera.  In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.  The retina has two main areas.  The macula is the central area that gives you sharp, central vision and color vision.  The peripheral retina is the part of the retina that gives you side vision and night vision.

What is diabetic retinopathy?

Diabetic retinopathy is a condition that occurs after many years of high blood sugar.  It consists of damage to tiny blood vessels within the retina resulting in abnormal leakage of fluid and blood inside the eye.  If not detected or treated, diabetic retinopathy may cause bleeding, scar tissue formation, retinal detachment, and blindness.

Stages of diabetic retinopathy:

Non-proliferative diabetic retinopathy: The first stage of retinal damage consisting of a weakening or blockage of tiny blood vessels, which does not require treatment with laser unless macular edema develops.

Diabetic macular edema: Swelling of the central retina (the macula) due to abnormal leakage of fluid from small blood vessels weakened by diabetes.  Blurring of central vision may advance to legal blindness.

Proliferative diabetic retinopathy: The second stage of diabetic retinopathy in which abnormal, weak blood vessels begin to grow from the retina into the clear gel (vitreous) which fills the inside of the eye.  If not treated, this serious stage often results in blindness from bleeding.  Symptoms include new “floaters” or sudden loss of vision.  Retinal detachment may occur from diabetic scar tissue, which pulls the retina off the eye wall.  Retinal detachment causes a dark shadow in the vision or total loss of vision.  Laser and vitrectomy surgery best control these problems if detected early.

How is diabetic retinopathy diagnosed?

Because no symptoms may be present until severe damage to the retina has occurred, it is essential that all adults with diabetes have a complete, dilated eye examination at least once a year.  The eye doctor can see into the eye with an ophthalmoscope to diagnose retinopathy.  If significant changes are found, photographs can be taken to record the changes. A fluorescein angiogram may be performed in the office by injecting a fluorescent dye into the vein of the arm while photographs are taken of the retina.  It supplies important information about the health of the retinal blood vessels.

How is diabetic retinopathy treated?

No treatment is needed if the vision is not threatened.  If blood vessel damage is significant, painless injections of medicine (Avastin) may be required to improve vision. Laser treatment performed in the office can often prevent severe visual loss.  Laser produces heat, which serves to cauterize the damaged retinal blood vessels.  Usually there is no pain, but if extensive laser is needed, an anesthetic injection may be given around the eye.  In severe cases of bleeding and scar tissue formation, vitrectomy surgery is performed as a one-day surgery in the hospital.  With laser and vitrectomy surgery, most people can retain useful vision. However, some people lose vision despite all efforts with treatment.

What can I do to prevent diabetic damage?

Strict control of the blood sugar has been proven to reduce the rate of progression of diabetic retinopathy by about 70%.  In addition, loss of vision can be minimized by optimal control of other health problems such as physical inactivity, obesity, hypertension (<130/<80), cholesterol (<200) and triglycerides (<150), heart failure, and kidney failure.  Tobacco use is strongly discouraged.  Daily aspirin use is recommended.

PREVENT BLINDNESS THROUGH GOOD MANAGEMENT OF DIABETES AND REGULAR DILATED EYE EXAMINATIONS.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013 Designs Unlimited of Florida.  All Rights Reserved.