At Soll Eye Associates, David S. Rho, M.D. specializes in retinal disorders and also heads the Diabetic Eye Center.

Detached and Torn Retina

The retina ia a nerve layer at the back of the eye that senses light and sends images to the brain. A retinal detachment occurs with the retina is pulled away from its normal position causing blurry vision and blindness if left untreated. The chances of the retinal detachment occurring may be caused by conditions such as nearsightedness, previous cataract surgery, glaucoma, severe injury, previous retinal detachment in the other eye, family history of retinal detachment or weak areas in the retina. Early symptoms of a retinal detachment may be flashing lights, new floaters or a gray curtain moving across the field of vision.

Most retinal tears need treatment with laser surgery or cryotherapy (freezing) which seal the retina to the back wall of the eye. Almost all retinal detachments require surgery to put the retina back in its proper position. There are various types of surgery and the decision of which type to use depends upon the characteristics of the detachment. Regular examinations can detect early signs of retinal detachment and increase the chances of successful surgery and recovery of vision.

Age-related macular Degeneration (AMD)

Age-related macular degeneration is a disease that affects your central vision. It is a common cause of vision loss among people over age of 60. Because only the center of your vision is usually affected, people rarely go blind from the disease. However, AMD can sometimes make it difficult to read, drive, or perform other daily activities that require fine, central vision.

Diabetic Retinopathy

Diabetic retinopathy is damage to retinal blood vessels as a result of high blood sugar levels caused by diabetes mellitus. There are two types of diabetic retinopathy. Nonproliferative diabetic retinopathy (NDPR) is an early stage of diabetic retinopathy in which tiny blood vessels within the retina leak blood or fluid causing the retina to swell or to form deposits called exudates. NPDR does not usually affect vision, but it may cause macular edema and/or macular ischemia, which do. Macular edema is a swelling of the macula, a small area in the center of the retina that controls perception of fine details. Macular ischemia occurs with the capillaries close and vision blurs because the macula no longer receives sufficient blood supply.

Proliferative retinal retinopathy (PDR) is present when abnormal new vessels begin growing on the surface of the retina or optic nerve in response to the widespread closure of retinal blood vessels. Unfortunately, these new vessels do not resupply the retina with normal blood flow and they often produce scar tissue that may cause wrinkling or detachment of the retina. PDR causes visual loss in the following ways: Vitreous hemorrhage, the bleeding of the new vessels into the vitreous. If the eye does not clear the vitreous blood adequately within a reasonable time, vitrectomy surgery may be recommended; traction retinal detachment, the pulling of the retina from its normal position, which can cause visual distortion. More severe vision loss can occur if the macula or large areas of the retina are detached; neovascular glaucoma, increased pressure in the eye resulting from the growth of new abnormal blood vessels on the iris, which may cause pressure on the optic nerve. PDR may be treated by laser surgery or vitrectomy.

Vision loss as a result of diabetes is largely preventable as a result of improved methods of diagnosis and treatment. Early detection and diagnosis of diabetic retinopathy, as well as maintaining strict control of blood sugar levels, are the best protection against loss of vision. People with diabetes should schedule an examination at least once a year, more frequently after the diagnosis of diabetic retinopathy.

Vitrectomy Surgery

Vitrectomy is a type of eye surgery that treats disorders of the retina and vitreous, the clear, jelly-like substance that fills the middle of the eye. The vitreous is removed during vitrectomy and usually replace by a saltwater solution. This surgery may be recommended to treat diabetic retinopathy, some retinal detachments, infections inside the eye, severe eye injury, wrinkling of the retina, macular hole and certain problems after cataract surgery.

Virectomy surgery often improves or stabilizes the vision by removing any blood or debris that may be blocking or blurring light as it focuses on the retina. It also removes scar tissue that can displace, wrinkle or tear the retina, thus reducing vision.

Vitrectomy surgery may require an overnight stay in the hospital. The length of the surgery may vary from one to several hours, depending on the condition of the patient. The surgery is performed while looking in the eye with a microscope using miniature instruments that are placed in the eye through tiny incisions in the sclera. The surgery may include one or more of the following:

• Removal of all cloudy vitreous
• Removal of scar tissue
• Removal of any foreign object in the eye
•Treatment of the eye with a laser to reduce future bleeding or to fix a tear in the retina
•Placement of an air or gas bubble in the eye to help the retina remain in its proper position. The bubble will slowly disappear on its own.
Inject a special fluid that is later removed from the eye.

After surgery there may be some discomfort; it may be necessary to wear an eye patch and use eye drops for some time. If a gas bubble has been placed in the eye, it may be recommended that the patient keep the head in special positions until the gas bubble is gone.

Do not fly in an airplane or travel up to high altitudes until the gas bubble is gone, as a rapid increase in altitude can cause a dangerous rise in eye pressure. Vision after surgery will depend on many variables, especially if your eye disease caused permanent damage to the retina before the vitrectomy.