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Photographic tests called fluorescein angiography or optical coherence tomography may be done in order to determine the extent of the damage on the underlying retina.

A fluorescein angiogram is a test where sodium fluorescein dye is injected into the veins of your hand or arm and a series of photographs are taken of your retina. The dye is not x-ray dye, and no x-rays are taken. Rather the dye is a photographic dye and only photographs are taken. The fluorescein angiogram allows the physician to evaluate the blood vessels in the retina as well as the retinal layer and the layer underneath the retina. Patients who undergo a fluorescein angiogram often get a mild yellow discoloration of their skin. The fluorescein dye is eliminated from the patient’s body through the urine, which is discolored for up to 24 hours following the test. The test is generally safe, however, rarely problems, such as allergies to the medication, can occur. Patients who are allergic to x-ray dye are not necessarily allergic to sodium fluorescein. Optical coherence tomography is a newer test which bounces light waves off the retina to obtain an image of the retina in cross section. Optical coherence tomography uses light waves to image the retina very much like sonar waves are used to image the ocean floor. No dye is injected for optical coherence tomography.

An epiretinal membrane, also called a macular pucker, is a thin layer of tissue that forms over the macula, the area of the retina that gives us clear central and reading vision.

Epiretinal membranes often develop on their own as a part of the natural aging process. Particles that have drifted into the vitreous (the gel that fills the eye) settle onto the macula and begin to obscure vision. Membranes may also result from eye conditions or diseases such as retinal detachment, inflammation, injury or vascular conditions. These are called secondary epiretinal membranes, whereas spontaneously formed membranes are called idiopathic.

Many epiretinal membranes do not disrupt vision. Thicker membranes, however, can create wrinkles or puckers in the macula, and small blurry or distorted areas in the center of vision may appear. Vision loss increases as the membrane thickens. Peripheral vision is not affected, and there is no risk of blindness.

Some epiretinal membranes heal on their own. For those that do not, surgery is recommended. The procedure is outpatient with local anesthesia. A vitrectomy is performed to remove the vitreous gel, a saline solution fills the eye and then the membrane is lifted from the macula. The visual results are usually very satisfying.

Fluorescein angiography is the practice of taking photographs of blood vessels inside the eye (an angiogram) with the help of a contrast dye (fluorescein dye). These pictures help doctors evaluate the retina and diagnose problems such as diabetic retinopathy, macular degeneration, abnormal vessel growth, swelling, leaking, retinal detachment, cancer or tumors.

First, the patient’s pupils are dilated with eye drops. Then a few photographs are taken with a special ophthalmic camera. Next, the contrast dye is injected, usually in the patient’s arm. The dye travels up to the eye within a few seconds and “lights up” the blood vessels for the camera. Once the dye is in place, the doctor will take more photographs. Then the needle is removed. After about 20 minutes, a final set of photographs is taken for comparison.

Patients with diabetes are at an increased risk of developing eye diseases that can cause vision loss and blindness, such as diabetic retinal disease (diabetic retinopathy), cataracts and glaucoma. These and other serious conditions often develop without vision loss or pain, so significant damage may be done to the eyes by the time the patient notices any symptoms.

People with diabetes sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. Because diabetic retinopathy often has no symptoms, if you have any form of diabetes you should have your eyes examined regularly by an ophthalmologist.  For this reason it is very important for diabetic patients to have their eyes examined once a year.

Diagnosing and treating eye disease early can prevent vision loss. It is also important to maintain a steady blood-sugar level, maintain normal blood pressure, have your cholesterol level evaluated (and treated if elevated), take prescribed medications, follow a healthy diet, exercise regularly and avoid smoking.

If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina.  Diabetic retinopathy is a complication of diabetes caused by changes in the blood vessels of the retina.

The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Macular degeneration causes a progressive loss of vision. It is the number-one cause of blindness in the U.S.

There are two kinds of macular degeneration: “wet” and “dry.” The “wet” form can be treated in its early stages. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.

Symptoms often associated with macular degeneration include:

• A gradual loss of ability to see objects clearly
• A gradual loss of color vision
• Distorted vision
• A dark or empty area appearing in the center of vision

Wet AMD

There are two main types of macular degeneration. The dry form tends to progress slowly but can result in significant loss of vision. Vitamin supplements may be helpful in slowing down the progression of the dry form. The wet form is the more devastating, more rapidly progressing form. Two new medications have become available in the last year that has offered new hope. They are Avastin® and Lucentis®. Both drugs are injected into the eye. For the first time we have a treatment that can not only stabilize vision in patients, but can actually improve vision in a significant number of people. Dr. Kraut offers these new treatments in office. Other options available in order to maintain a satisfying lifestyle include the prescription of optical devices. Since macular degeneration usually does not affect side vision, the remaining sight can be useful. There are support services and rehabilitation programs available as well.

• For more information, visit Avastin® website at Avastin.com
• For more information, visit Lucentis® website at Lucentis.com
• For more information, visit Eylea® website at Eylea.com

Photodynamic therapy is another intervention that may be used in combination with anti-angiogenic therapy in the treatment of patients with wet AMD. Visudyne® is a light sensitizing drug that is injected intravenously into the patient. The drug accumulates in the abnormal blood vessel complex under the retina in the individual with neovascular AMD. A special laser is then used to “excite” the drug, causing a photochemical reaction that results in the hopeful closure of the abnormal blood vessel network. Various protocols are being developed to investigate the potential role of using both anti-angiogenic therapy and photodynamic therapy to maximize the efficacy of treatment in patients with wet AMD.

• For more information, visit Visudyne® website at visudyne.com

The vitreous is a clear liquid that fills our eyes and gives them shape. When we are young, the vitreous has a thick, gelatinous consistency and is firmly attached to the retina. As we age, the vitreous thins and separates from the retina. Although this usually results in nothing more than a few harmless floaters, tension from the detached vitreous can sometimes tear the retina. If liquid seeps through the tear and collects behind the retina or between its nerve layers, the retinal tear can become a retinal detachment. Retinal detachment can cause significant, permanent vision loss and requires immediate medical treatment.

There are three kinds of retinal detachment. The most common form, described above, occurs when fluid leaks into the retina; people who are nearsighted or who have had an injury or eye surgery are most susceptible. Less frequently, friction between the retina and vitreous or scar tissue pulls the retina loose, something that occurs most often in patients with diabetes. Third, disease-related swelling or bleeding under the retina can push it away from the eye wall.

Signs of retinal tear or detachment include flashes of light, a group or web of floaters, wavy or watery vision, a sense that there is a veil or curtain obstructing vision, or a sudden drop in vision quality. If you experience any of these symptoms, call your doctor immediately. Early treatment is essential to preserve your vision.

A macular hole is exactly what it sounds like: a hole in the macula, the center of the retina responsible for central and reading vision. Specifically, the hole or defect occurs in the fovea, the center of the macula and the most delicate part of the entire retina.

Macular holes almost always develop during the natural aging process, when the vitreous (the gel that fills most of the eye) thins and separates from the macula. This can pull on the macula and cause a hole to form. Less commonly, macular holes are caused by eye injury, intraocular inflammation, retinal detachment and other diseases. Most cases occur in people over the age of 50.

At first, a macular hole may only cause a small blurry or distorted area in the center of vision. As the hole grows over several weeks or months, central vision progressively worsens. Peripheral vision is not affected, and there is no risk of blindness.

Surgery is over 95% effective for the treatment of macular holes. The procedure is outpatient with local anesthesia. A vitrectomy is performed to remove the vitreous gel, and then a gas bubble is injected into the eye to help the hole close. As the eye heals, the fluid is naturally replaced. There is no non-surgical alternative.

In PDR, the retinal blood vessels are so damaged they close off. In response, the retina grows new, fragile blood vessels. These new blood vessels leak and cause a vitreous hemorrhage. Blood in the vitreous, the clear gel-like substance that fills the inside of the eye, blocks light rays from reaching the retina. A small amount of blood will cause dark floaters, while a large hemorrhage might block all vision, leaving only light and dark perception. Retinal laser surgery may be used to shrink the abnormal blood vessels and reduce the risk of bleeding. Drug treatment of the abnormal new vessels (with Avastin and Kenalog) may also prevent them from growing and bleeding.

The body will usually absorb blood from a vitreous hemorrhage, but that can take days, months or even years. If the vitreous hemorrhage does not clear within a reasonable time, an operation called a vitrectomy can be performed. During a vitrectomy, the eye surgeon removes the hemorrhage and the abnormal blood vessels that caused the bleeding, improving the vision.

The new blood vessels can also cause scar tissue to grow. The scar tissue shrinks, wrinkling and pulling on the retina and distorting vision. If the pulling is severe, the macula may detach from its normal position and cause vision loss. A vitrectomy can be performed to remove the scar tissue and allow the retina to settle back in normal position to improve the vision.