The eye care specialists at DelMar Surgical and Cosmetic Treatment Center offer retina surgery Wilmington and Newark, Delaware; Elkton and North East, Maryland and surrounding areas in Delaware, Maryland and southeast Pennsylvania.
The retina is the thin lining of nerve tissue in the back of the eye. It allows light to be processed before sending the information along the optic nerve to the brain, enabling sight. Because the retina plays such a vital role in vision, problems with the retina can have a strong impact on the clarity and quality of vision. Several common conditions involving the retina include diabetic eye disease, blood vessel blockage, and macular degeneration.
What are my Options for Retina Surgery?
Age related macular degeneration is a disease of the retina and the underlying pigmented cells. The pigmented cells accumulate waste products, clump together, and lose the ability to support the retina. The retina overlying the damaged pigmented cells then dies off. This type of retinal damage is called dry macular degeneration.
Occasionally, abnormal blood vessels grow through the layer of clumped pigmented cells. These vessels bleed and leak fluid, causing vision loss. Abnormal new vessel growth signifies wet macular degeneration.
Patients with mild dry macular degeneration may describe a fuzzy spot in the center of their vision. Wet macular degeneration may also cause distortion of straight objects making them appear bent or wavy. In advanced macular degeneration there may be a central blind spot, though peripheral vision typically is unaffected.
Treatment of dry macular degeneration often involves high dose antioxidant vitamins. Wet macular degeneration may be treated with a hot or cold laser or medication injections within the eye.
Both adult onset and juvenile onset diabetic patients can, in time, develop diabetic retinopathy. Adult onset patients in general have more problems with macular edema and juvenile onset patients in general have more problems with proliferative disease. Diabetes is the leading cause of blindness in Americans under age 65 (Macular Degeneration is the leading cause for those over age 65). It is recommended that diabetic patients have a dilated fundus exam every year regardless of symptoms, in order to treat people before they start to have irreversible visual loss.
If your doctor sees new blood vessels (proliferative disease), thickening (macular edema), narrowed blood vessels (ischemia) or otherwise suspects that you may be having problems he will order a fluorescein angiogram (FA) and/or optical coherence tomography (OCT). The FA can determine if there is poor blood flow or rogue blood vessels - these both require peripheral (panretina) laser treatment. While the FA also can determine leakage in the center (the macula) the OCT is better suited to determine whether you have fluid within or even beneath the retina. Depending upon the location of the leakage and the retinal central thickness your doctor will decide whether laser to the macula (around the center), intravitreal medication injection, or both, is indicated.
Laser is done in the office. Macular laser is not painful and only takes about 5 minutes while panretinal laser may hurt somewhat and takes about 10-15 minutes. More than one laser procedure may need to be done depending upon the severity of disease and the response to laser in the affected eye. The most common side effect of laser, permanent loss of peripheral and night vision, is most pronounced after panretinal laser.
Intravitreal injection of steroids or Avastin is used predominantly to reduce the retinal edema (fluid and swelling), thereby improving vision in many cases. Injections are done in the office under topical (eye drop) anesthesia and only take a few seconds once the eye has been cleaned with betadine and antibiotic drops. The needle does cause some pain that usually lasts only a few seconds. Steroids can induce glaucoma and severe inflammation in some patients; these side effects are rarely seen with Avastin, which is why Avastin is more commonly used. These injections may be repeated depending on the amount of residual fluid and the patient's vision. Other uncommon complications from intravitreal injections include retinal detachment and intraocular infection (endophthalmitis).
A few patients with particularly severe diabetic retinopathy will develop bleeding into the vitreous and even scar tissue that can cause the retina to become detached. Panretinal laser is done to prevent these complications. The treatment for bleeding and tractional retinal detachment is vitrectomy surgery. If a patient only has blood to be removed the prognosis is far superior to the patient who has to have adherent membranes removed from the surface of the retina.
If you are seeking retina surgery in Wilmington, please call our practice to schedule your personalized comprehensive evaluation. Our surgeons are professional eye surgeons with experience in retina surgery in Delaware and Maryland. Please view our Facebook page for more information about the Lavenbrug Medical Group and the DelMar Surgical and Cosmetic Treatment Center.