A dilated pupil is often necessary to examine, diagnose, and treat vision-threatening eye disease in the peripheral retina. While not all patients with retinal conditions have peripheral retinal disease, it is especially important to evaluate the peripheral retina in all new patients, in return patients on a periodic basis, or as signs and symptoms of peripheral retinal disease arise.
Retina specialists are fellowship-trained specialists who diagnose and treat eye conditions that are located behind the pupil.

A retina specialist is an ophthalmologist who completed special training to become a retina surgeon. To become an ophthalmologist, one must obtain a medical degree.
Retina specialists’ training begins in residency, where they are exposed to each of the major fields within ophthalmology.
During training, retina specialists achieve expertise in diagnosing, treating and managing complex retinal diseases such as macular degeneration, retinal detachment, and diabetic retinopathy.

Not always. If the detachment is very localized and has not progressed to involve a lot of the retina, laser can be placed in the office to surround the detachment and lessen the chance of progression. If the detachment has progressed, we would need to discuss several other treatment options, some of which require surgery in an operating room.

Most retina doctors prefer to continue treatments long-term, but to a lesser extent. The goal of this is to lessen the chance of a recurrence of bleeding or leakage from wet macular degeneration. There are certainly people that can get away with getting less injections, and others that need more frequent injections. This variability makes stopping treatment difficult, but worth discussing with your retina specialist.

• 1. Avoid smoking, as this increases the risk of getting macular degeneration complications.
• 2. Check your central vision (with an Amsler grid) in each separately to look for new distortion or
  mini blindspots.
• 3. Have your eyes dilated at least once every two years once you have reached the age of 50.
• 4. Eat a balanced diet enriched with green, leafy vegetables. These vegetables have lutein an zeaxanthin, which have been shown to be beneficial in patients with macular degeneration.

Retinal detachment repair typically requires one to two hours of operating time under local anesthesia at an outpatient surgery center.
Eight hours prior to surgery, patients must avoid all food and drink (this includes chewing gum, lozenges, etc.). You will be notified of your arrival time in advance, but note the arrival time is typically one and a half to two hours prior to your actual surgery time. Arriving late prevents staff from completing the intake process (starting peripheral intravenous line, starting pupil dilation). It is important that you bring a driver along who can take you home after.
After check-in, you will be taken to a pre-op area where your nurse and anesthesiologist take a short medical history.

When your surgical time arrives, your retina specialist will perform a ‘time-out’ to confirm the correct patient, eye, and procedure. Next, you will receive anesthesia through the IV, while the retinal surgeon or anesthesiologist injects local anesthesia around your eye.
Once you have woken from the anesthesia, you are wheeled into the operating room to have your eye cleaned with antibacterial soap prior to the procedure. Another time-out is performed and the surgeon places a drape over your face and upper body. The procedure progresses with you awake, comfortable,
and breathing on your own.
Following the surgery, the surgical eye is patched and you are wheeled into post-op for a short recovery.
Most patients are ready to meet with their transportation within 15 minutes of the completion of the case. The rest of the day is spent relaxing at home. If your surgery required a scleral buckle, more post-operative discomfort/pain is expected, and a pain pill prescription will have been provided by your doctor to ensure that you feel minimal discomfort following surgery. A post-operative visit will be scheduled in the retina clinic the next day, where the patch is removed and additional post-op instructions are given.

The most common restrictions following retinal detachment repair are avoiding air travel, and avoiding looking above the horizon. You should also avoid laying flat on your back, keep tap water out of the eye for 2 weeks, avoid rubbing the eye, and avoid activities that make you red in the face (Valsalva, bearing down, lifting more than 35 pounds). Driving should be avoided for 48 hours after surgery, and depending on the need for positioning, driving the first week may need to be avoided.

Retinal detachments can be treated by retinal laser, gas injection in the eye, vitrectomy surgery, and scleral buckle. The laser is different from the other methods, in that it doesn’t repair the detachment, but instead prevents the detachment from advancing and affecting the center vision.

An eye injection visit starts with a check of your vision and eye pressure. Your eyes may be dilated, especially if you are having new visual symptoms. An image may be taken of your retina. Your retina specialist will then review the images and determine the timeline for future treatments.

The eye injection procedure begins with a drop of numbing, numbing injection. A lid speculum is used to prevent your lashes from touching the sterile needle during the procedure. An antiseptic solution is placed on the eye prior to the injection. The injection takes only a couple of seconds before the
speculum is removed. The eye is rinsed with sterile wash.
Following the eye injection, you are free to resume normal activities apart from swimming for 2 days, contact lens wear for 24 hours, and eye rubbing for 2 hours. The entire eye injection visit typically takes less than 45 minutes.

While the patient may be legally qualified to drive after the eye injection, each patient is responsible to make an independent assessment of their ability to operate a motor vehicle.
Any discomfort following an eye injection can be treated with cool compresses, artificial tears, or over the counter pain killers. Any patient experiencing severe or worsening pain or loss of vision after an injection should call the office immediately or go to the emergency room if they are unable to reach the
office for any reason.

Patients typically experience little to no pain during an eye injection.

An eye injection or intravitreal injection, is an effective method for delivering medication to the retina.
Eye injections allow retina specialists to administer a targeted dose of medication to suppress inflammation, stop bleeding, and treat swelling. Different classes of medications can be administered, but the most common are anti-VEGF injections (Avastin, Eylea, Vabysmo are examples), and steroid
implants (Ozurdex, Iluvein, Yutiq).
Eye injection visits may require dilation and retinal imaging, in a addition to a conversation with the retina doctor before the 5-10 minute injection procedure.

The macula is a specialized portion of the retina responsible for allowing people to read and drive. Conditions affecting the macula, such as macular degeneration, diabetic macular edema, and retinal vein occlusions, can therefore affect one’s central vision.

A macular hole is a hole that forms in the center of the retina, causing a blind spot in the center vision.
It often requires surgery to correct.

A detached retina occurs when fluid from the vitreous cavity seeps under the retina through a break in the retina (hole or tear). This is often associated with vision loss, and requires urgent treatment.

Age-related changes in the vitreous gel that cause a posterior vitreous detachment usually precede a retinal tear. A retinal tear can lead to a detachment. Age-related changes in the vitreous gel cannot be avoided, and neither can a posterior vitreous detachment. Having a dilated eye exam when symptoms
of a posterior vitreous detachment develop can prevent retinal detachment, as retinal tears can be diagnosed and treated before a retinal detachment develops.

Other causes of a retinal detachment are diabetes, tumors, trauma, and inflammation.

Macular degeneration is a multi-factorial condition caused by an interplay of age, genetics, environmental factors, health habits, and nutrition. Debris accumulates in the macula, the central portion of the retina, and this debris may lead one’s immune system to promote breakdown of support
layers underneath the retina, or lead to vessels growing underneath the retina. The vessel growth (neovascularization) can lead to leakage of fluid, blood, and scarring underneath the retina. Dilated eye exams, vitamin supplements, and monitoring of central vision with an Amsler grid can ensure no treatable changes arise.

Eye floaters are opacities suspended in the vitreous cavity causing a shadowing effects on the retina.
These floaters drift in the vision as the vitreous jelly shifts with eye movement.
The vitreous gel separates from the retina in most individuals between 50-70 years of age. This can be associated with an increase or change in the number or quality of floaters in the eye.
Other sources of floaters include inflammation, blood, and retinal tears.
The onset of new floaters may be sight-threatening and require urgent dilated examination of the eye.

There is an inherited component to macular degeneration, but age is a more

A retinal detachment can be prevented by urgent dilated eye examination when new symptoms of flashes and floaters develop, and by having laser treatment to any tears diagnosed at the time of this examination.

Rarely can macular holes close on their own or with a combination of drops to reduce swelling. Delaying macular hole closure often leads to larger holes, and holes that have a higher chance of not closing with surgery.

Numerous, new floaters can be the only symptom of a retinal tear, detachment, and bleeding in the eye. As such, patients experiencing new floaters should seek urgent dilated retinal examination to rule out any vision threatening issues.

Most detachments of the retina occur following a vitreous detachment. When the vitreous detaches from the retina, it can tug on the retina and cause a tear. This tear allows liquid vitreous to sneak underneath the retina, detaching it.

If you had a detachment where a gas bubble was injected in the eye to steam roll the retina flat, then flying is usually prohibited. The high altitude causes the gas in the eye to expand, and this can block of the eye’s circulation leading to blindness.

The biggest risk factor is not genetics but age. I consider this condition a complex condition, with multiple things that can make you more or less likely to have it. One’s ancestry can predispose to it, but your ancestry does not guarentee you will have it.

If you had a detachment where a gas bubble was injected in the eye to steam roll the retina flat, then flying is usually prohibited. The high altitude causes the gas in the eye to expand, and this can block of the eye’s circulation leading to blindness.

AREDS vitamins have not shown benefit in people with a family history of macular degeneration alone. In fact, the vitamins have not shown benefit in people with early or advanced macular degeneration, but only intermediate macular degeneration sufferers benefited from supplementation. Therefore, one needs an eye exam to determine, 1) if they have macular degeneration, and 2) if they have the intermediate stage prior to starting AREDS vitamins.