Our Services

Macular Degeneration Evaluation and Treatment

The term "macular degeneration" includes many different eye diseases, all of which affect central, or detail vision. Age-related macular degeneration is the most common of these disorders, mainly affecting people over the age of 60. Although there are many types of macular degeneration, age-related macular degeneration (AMD or ARMD) is the most common type. Age-related macular degeneration occurs in two forms: "wet" age-related macular degeneration and "dry" age-related macular degeneration. "Wet" age-related macular degeneration is less common but more aggressive in its development to severe and, often, permanent central vision loss. "Dry" age-related macular degeneration is the more common type and is more slowly progressive in causing loss of vision.

What is wet age-related macular degeneration?

Wet age-related macular degeneration occurs when abnormal blood vessels begin to grow underneath the retina. These new blood vessels (known as choroidal neovascularization or CNV) tend to be very fragile and often leak blood and fluid. The blood and fluid raise the macula from its normal place at the back of the eye and interfere with the retina's function and causes the central vision to blur. Under these circumstances, vision loss may be rapid and severe. Some patients, however, do not notice visual changes despite the onset of CNV. Therefore, periodic eye examinations are very important for patients at risk for CNV. Once CNV has developed in one eye, whether there is a visual loss or not, the other eye is at relatively high risk for the same change.

Diabetic Retinopathy

If you have been diagnosed with diabetes, you may be at risk of losing your vision since your body does not utilize sugar properly and, when the sugar levels rise, damage to the retinal blood vessels may occur. This injury to the retinal vessels is known as Diabetic Retinopathy. Diabetic Retinopathy is the leading cause of blindness in working-age adults.

Intravitreal Injections

Intravitreal injection is injection of medicine into the vitreous cavity within the eye. It is used to treat various retinal disorders, such as wet age-related macular degeneration and diabetic retinopathy. Two types of medicines are typically injected: anti-VEGF drugs and steroids. Anti-VEGF drugs block the signals that cause new blood vessels to form and leak fluid. Steroids reduce inflammation and decrease fluid leakage. Steroids can also be effective when injected around the eye, rather than into the eye. Prior to an intravitreal injection, the eye is numbed with an anesthetic and cleaned with an antiseptic to reduce the chance of infection. It is unusual to experience significant pain during an injection but there may be a pressure sensation.

25-Gauge Vitreous Surgery

Our office specializes in a 25-gauge vitreous surgery. This is a small incision surgery which requires no sutures and in most cases has minimal pain and discomfort after surgery. Most patients are able to return to work the very next day. Dr. Aggarwal has performed more than 1200 of the 25-guage vitrectomies in the past nine years.

Surgical Repair of Retina

Much like the film in a camera, the retina is responsible for creating the images one sees. When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply and source of nutrition. If it remains detached, the retina will degenerate and lose its ability to function. Fortunately, over 90% of retinal detachments can be repaired with a single procedure. There are three different surgical approaches to treating this condition: the scleral buckle procedure, vitrectomy, and pneumatic retinoplexy. If you are diagnosed with retinal detachment, Dr. Stroh will discuss which option suits you best.

Treatment of Retinal Tears

Retinal tears can be treated using either laser photocoagulation or cryotherapy. Laser photocoagulation is a procedure where a special light is directed to the retina and used to create burns in the retina surrounding the retinal tear. Cyrotherapy is a procedure where a freeing probe is placed on the surface of the eye and used to create a freeze extending to the retina surrounding the retinal tear. Whether laser photocoagulation or cryotherapy is used, as the eye heals a scar will form sealing the retinal tear and in most cases preventing a retinal detachment from occurring. Both laser photocoagulation and cryotherapy are usually performed in the doctor’s office. Treatment of retinal tears is usually successful in preventing retinal detachment. Unfortunately, occasionally even after treatment of a retinal tear, retinal detachment may still occur. Therefore, if any new symptoms arise following treatment of a retinal tear, the retina should be re-examined and even in the absence of new symptoms, continued follow-up after treatment of a retinal tear is needed.

Treatment of Retinal Detachment

Some retinal detachments, if diagnosed when the detachment is small, may be treatable with only laser photocoagulation or cryotherapy. More often, however, if retinal detachment occurs, more extensive surgery is usually needed. The surgical procedures, which are frequently used for repair of retinal detachment, include pneumatic retinopexy, scleral buckle and vitrectomy.

The choice of which of these procedures is most appropriate for the repair of a retinal detachment is dependent on many factors. These include the location of the responsible retinal tears and the presence or absence of scar tissue on the retina (proliferative vitreoretinopathy). The decision of which method of retinal detachment surgery is best can only be made after a careful evaluation. Fortunately, with these techniques, it is possible to successfully repair most retinal detachments. While most retinal detachments are successfully repaired with a single operation, in some cases more than one operation may be needed.

For More Information On

Macular Degeneration please visit https://www.nei.nih.gov/health/maculardegen

Diabetic Retinopathy please visit https://www.nei.nih.gov/health/diabetic

Central Retinal Vein Occlusions please visit http://emedicine.medscape.com/article/1223746-overview

Macular hole please visit https://www.nei.nih.gov/health/macularhole/macularhole