Summarized below are different laser treatments, intraocular injections and surgical procedures applied for a variety of retinal problems.
Diabetes Related Eye Problems
Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s effect on the retina is the main threat to vision. Over time, diabetes affects the circulatory system of the retina, and this effect is called diabetic retinopathy.
In its earliest phase, blood vessels in the retina become weakened and leak. These leaking vessels often lead to swelling (or edema) in the retina and cause decreased vision. As the condition worsens, circulation problems cause areas of the retina to become oxygen-deprived (or ischemic). New, fragile vessels (neovascularization) develop in an attempt to maintain adequate oxygen levels within the retina. These delicate vessels hemorrhage easily, causing blood to leak into the vitreous. The result causes symptoms of floaters or decreased vision. In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems, such as retinal detachment.
Diabetic patients should have routine eye examinations so related eye problems can be detected and treated as early as possible. Retinal specialists rely on several tests to monitor the disease’s progression and make treatment decisions. The most common cause of vision loss associated with diabetic retinopathy is diabetic macular edema. Laser treatment applied to the leaky blood vessels (focal photocoagulation) is helpful in preventing further vision loss. Two common procedures used in the treatment of proliferative diabetic retinopathy are pan retinal photocoagulation (PRP) and vitrectomy.
Pan retinal photocoagulation (PRP) is a type of laser surgery used to destroy oxygen-deprived retinal tissues outside of the patient’s central vision. This treatment does create blind spots in the peripheral vision, but PRP prevents the continued growth of fragile vessels and seals the ones that leak.
Vitrectomy is used to remove the blood clots that occur in the gel-like substance that fills the center of the eye, called the vitreous. During a vitrectomy, the retina surgeon removes the blood and vitreous from the eye and replaces it with clear saline solution. The surgeon may also cut strands of vitreous attached to the retina that create traction, which may lead to retinal detachments if not removed.
Diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diabetic patients can also reduce the possibilities of eye complications by scheduling yearly dilated eye examinations with an eye doctor.
Diabetic Retinopathy Treatments
Three laser treatments have been developed for the treatment of diabetic retinopathy at different stages of the disease. Intraocular injections have recently gained traction in the treatment of significant diabetic macular edema. It is important to understand that the goal for each of these procedures is to stabilize the vision; they cannot correct the damage already done.
Focal Laser Treatment
is an in-office procedure used to treat macular edema, or swelling in the anterior part of the eye. Patients undergo a dilated eye examination and a flouroscein angiograph prior to the treatment in order to identify the location of leaky blood vessels that cause the swelling. During the procedure, a laser is used to seal off the leaky blood vessels and prevent further leakage. As the existing blood dissipates, the swelling is reduced. The sooner the problem is diagnosed and the earlier treatment is applied, the higher the likelihood of a successful outcome.
Grid Laser Treatment
also an outpatient procedure that is used to seal off a wider array of leaky blood vessels over a diffuse area. Because there are more leaks, there is also more swelling in the eye. The laser treatment is similar to focal laser treatment except that more leaks are sealed in the eye. Again, the object of this treatment is to reduce swelling in the eye.
Macular Edema may sometimes be somewhat resistant to focal laser treatments, there might be a contraindication to treatment with laser, or your surgeon might feel that laser is not the best option for you. This is when the use of intravitreal injections come in handy. The technique is quite simple and it only takes a matter of minutes. Your doctor will first carefully apply an anesthetic to the eye. After the eye is completely numb he will then deliver the medicine intraocularly. Rarely do patients complain of pain with our technique. An improvement in vision is usually noticed days after the injection. The type of injection that your surgeon will decide to use depends entirely on the characteristics of your particular condition.
Pan Retinal Photocoagulation (PRP)
As the severity of diabetic retinopathy progresses, swelling causes ischemic tissue (oxygen-deprived tissue) that sends signals to the body to produce new blood vessels. These new vessels tend to be abnormal and often break open and bleed, making the situation worse. With PRP, tissue is selectively destroyed using a laser in order to force the new blood vessels to shut down. When successful, this technique reduces the eye’s demand for oxygen and stops the signal for more new blood vessels.
PRP is a same day, outpatient procedure. Patients must have a clinical examination as well as a flouroscein angiograph prior to the treatment. There are no sutures and no patching or eye drops are required afterwards.
A retinal detachment occurs when the retinal tissue detaches from the eye wall in the back of the eye. There are many possible causes for retinal detachment, such as blunt trauma, weakness in the tissue or holes. Retinal detachment is often marked by the sudden loss of half or all of the vision in one eye. It may also be accompanied by light flashes. Retinal detachments are easily diagnosed in a dilated eye examination.
The specific treatment used to re-attach the retina to the eye wall depends on where the detachment occurred. The options include injecting a gas bubble (pneumatic retinopexy) to support the retina while new tissue builds to connect it to the wall of the eye; cryosurgery that creates scar tissue that allows the retina to reattach to the eye wall; or sclera buckle, in which a device is inserted permanently into the eye to reduce tension on the retinal surface.
Patients generally go home the same day as the procedure. Depending on the treatment used, patients may have to maintain a head down position for a few days. The full recovery period can take several months. Retinal re-attachment surgery is usually very successful, although in some cases a second surgery is required.
Macular Degeneration Treatments
Patients who are diagnosed with wet macular degeneration have new options for treatments. Historically laser was the only option for treatment. As the disease progressed we often used lasers to treat the leaking blood vessels. These laser treatments frequently had adverse side effects leaving some patients with permanent dark spots in their vision.
As macular degeneration progresses, new blood vessels may develop in the eye, which can cause scarring and a loss of central vision. To stop the progression of the disease and limit scarring, laser treatments can be applied to stop the growth of new blood vessels. The type of laser treatment used depends on the appearance and behavior of the macula and its surrounding tissue. One new technique, Photodynamic Therapy (PDT), has been successful in treating about 10% of this population.
Like most laser treatments, PDT and other macular degeneration laser treatments are performed on a same day, outpatient basis. Specialized diagnostic testing using fluorescein angiography is conducted in advance to determine the exact location of blood vessels and the amount of scarring taking place. The outcome of this testing determines the type of laser treatment to be used. Optical coherence tomography (OCT) allows us to quantify the amount of fluid and blood that these blood vessels leak into the surrounding retinal cell layers. OCT technology also guides us in the monitoring of these fluid levels as we treat patients.
Experimentation for new treatment techniques for macular degeneration is currently on the rise. We remain in the forefront of research and clinical trials for new techniques in order to provide our patients with state-of-the-art care as it becomes available.