Retina specialists are sub-specialized ophthalmologists who take care of both urgent, vision-threatening disease as well as chronic conditions requiring ongoing evaluation and treatment. Pacific Retina’s physicians care for medical and surgical disease of the retina and vitreous (back of the eye) and most of our patients are referred to us by other eye care providers.
Appointments may take between one-and-a-half to two hours or longer if special tests must be done. Eye drops to dilate the eyes are always used for a retinal examination. This may briefly blur your vision and make your eyes more sensitive to outdoor light. For these reasons, we ask that you plan not to drive and to bring sunglasses for the day of your appointment. We can also provide you with special sunglasses when your visit is over.
Your initial office visit may include one or more of the following diagnostic imaging tests, which help your doctor tell you much as possible regarding your diagnosis and condition.
Fundus photography: A digital camera is used to photograph portions of the retina for detailed examination or documentation.
Fluorescein Angiography (FA): A fluorescent, vegetable-based dye is injected into a vein in your arm to study the circulation or patterns of blood flow in your retina.
Optical coherence tomography (OCT): A rapid, painless test that provides very high-resolution images of the structure of the macula, or center of the retina. Pacific Retina utilizes the most advanced, high resolution OCT tests which provide detailed cross sectional views of the retina.
Ultrasonography: A test using sound waves to image the retina. This test is used to evaluate the back of the eye when cataract, blood or other conditions block the physician’s view into the back of the eye. This test is also used to evaluate tumors and inflammatory conditions (uveitis) in the eye
Pacific Retina offers the full spectrum of treatments for retinal conditions, including treatments in the office as well as in the operating room. Below is a list of some common treatments offered at Pacific Retina.
Medications delivered by intravitreal injection include ranibizumab (Lucentis), bevacizumab (Avastin), triamcinolone (Kenalog), and dexamethasone (Ozurdex implant). These medications are used in the treatment of various diseases including age-related macular degeneration, diabetic macular edema, proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, and cystoid macular edema. The success of intravitreal medications has led to an increasing number of diseases treated in this manner.
Laser photocoagulation is used in the office to treat a variety of conditions including: Diabetic macular edema, proliferative diabetic retinopathy, retinal vein occlusion, retinal tears or holes, retinal detachment, high risk lattice degeneration, and retinal arterial macroaneurysm. Depending on the condition being treated, laser may be delivered with the surgeon wearing a headset (indirect ophthalmoscope) while the patient lays in an examination chair, or with the surgeon and patient sitting on opposite sides of table-mounted equipment (slit lamp).
Cryotherapy is a freezing treatment that has been used by retinal physicians for more than xx years in the treatment of retinal tears, retinal detachment, and a few less common conditions such as Coats disease.
Cryotherapy is delivered using a small probe to the outer surface of the eye by the surgeon while the patient reclines in an examination chair. Each treatment freezes a small amount of tissue from the outer surface of the eye through the eye wall to the retina. The freeze damages the retina just enough to form a scar. The scar serves as an adhesive between the retina and the eye wall, thereby sealing any breaks in the retina. In rare cases, cryotherapy is used to destroy abnormal blood vessels that cannot be safely treated using a laser.
Most patients describe the discomfort of cryotherapy as an “ice cream headache.” This sensation usually lasts only a few seconds. Your surgeon will give you numbing eye drops in order to make you as comfortable as possible during treatment.
Because cryotherapy is a non-invasive procedure, patients do not routinely require any eye drops after treatment and there is no significant risk of infection. If the eye feels irritated or dry after treatment, over-the-counter artificial tear drops may be used to sooth the eye. Some patients experience a headache, which may be treated using over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Motrin) as needed. The vision is often blurred for several hours after treatment treatment, and vision in the treated eye may not return to pre-treatment levels for one or two days in some cases.
PDT is a non-thermal or “cold” laser. Unlike the lasers used in retinal photocoagulation, which use thermal energy to create burns in the retina, PDT uses a laser to activate medication given intravenously. Verteporfin is a medication given through an IV. The medication travels throughout the blood stream into the choroid, which lies behind the retina. The choroid is where the abnormal blood vessels of wet AMD originate, and it is also the source of abnormal activity in other diseases such as CSCR, PCV and choroidal hemangioma. The PDT laser activates verteporfin in the region of abnormal blood vessels, thereby closing off the abnormal blood vessels and reducing the leakage of blood and fluid into the space between the retina and choroid.
Positioning by the patient immediately after this procedure is critical. Make sure you understand your doctor’s positioning instructions before leaving the office. You will see your doctor frequently in the weeks following the procedure in order to monitor the process of retinal reattachment and assess the need for further intervention, such as repeating the steps described above or going to the operating room for surgical repair.
Not all retinal detachments can be fixed using pneumatic retinopexy. For those retinal detachments which are amenable to pneumatic retinopexy, the chance of successful repair depends on patient positioning, patient cooperation during the procedure, and characteristics of the retina and other eye tissues. Your doctor will discuss with you the various options available for repair of retinal detachment, depending on the specifics of your detachment.
The term “scleral buckle” refers to a silicone band which is placed around the outside of the eye, gently squeezing the eye wall and supporting the weak areas in the retina, including the tears that caused the retinal detachment. Sometimes multiple silicone elements are used in order to provide appropriate support. In some cases, the surgeon will drain the fluid that has collected under the retina, and after draining this fluid the surgeon may inject a bubble of air or gas into the eye. If air or gas is injected into the eye, the surgeon may ask the patient to position the head after surgery so that the bubble supports the retina while it heals.
Unlike vitrectomy surgery, which takes place primarily inside the eye, scleral buckle surgery takes place primarily outside of the eye. A patch and shield are placed on the eye at the end of surgery, and both the eyelids and the white part of the eye may appear red and swollen when the patch is removed. This redness and swelling usually decrease over 1-2 weeks following surgery. It is normal to experience a foreign body sensation after surgery (a sensation of sand or grit in the eye). This sensation comes from the stitches used on the surface of the eye as well as the eye surface tissue which has been manipulated during surgery. This sensation should decrease as the days and weeks go by after surgery.
The back part of the eye (the vitreous cavity) contains the vitreous gel, a clear substance which is 99% water. “Vitrectomy” refers to removal of this gel. In the operating room and using a microscope, the surgeon usually makes three small openings in the white part of the eye (sclera). These openings are approximately the size of the needles used to draw blood from your arm. The surgeon uses various fine instruments including lights, suction, scissors, forceps and laser probes to perform surgery. At the end of surgery, the gel is not replaced. The eye produces its own fluid, and in some cases the surgeon may leave a bubble of air or gas inside the eye, which the body will absorb and replace with clear fluid. In some complex surgeries, the surgeon may leave the eye filled with silicone oil, which provides long term support to the retina but which requires an additional surgery to remove.
In most cases, vitrectomy refers to much more than just removal of the gel. For example, an epiretinal membrane is removed using tiny forceps, or heavy liquid may be used to flatten a retinal detachment, and laser may be used to seal a tear in the retina. In all of these cases, the gel must be removed before these other steps are possible, and so all of these procedures are referred to broadly as vitrectomy.
During this procedure, your doctor will use a pinpoint laser to treat swelling in the retina (macular edema) or bleeding (vitreous hemorrhage). The procedure typically takes 15-20 minutes in the office.