Treatment of Retinal Diseases in Murrieta
Our commitment is to provide compassionate, personalized treatment for disorders of the retina and vitreous using the highest quality techniques. Our physicians have extensive experience treating a wide range of retinal diseases including:
Diabetic Retinopathy is the leading cause of blindness in patients 20-74 years of age. There are two forms: non-proliferative and proliferative. Non-proliferative diabetic retinopathy occurs when blood vessels leak and fluid accumulates in the retina. When the leakage is severe, laser surgery can be used to reduce or eliminate the associated retinal swelling. Vision may not usually improve with the laser treatment, but if performed early enough, it may stop further vision loss. Newer treatment may include an injection of AVASTIN or LUCENTIS™.
Proliferative diabetic retinopathy results from the collapse or closure of blood vessels. The retina becomes sick where the blood vessels have closed and releases stimulants for the growth or “proliferation” of new blood vessels. These new vessels are fragile and can easily bleed causing hemorrhage in the eye and blindness. Laser surgery can drastically reduce the risk of severe vision loss in patients with proliferative diabetic retinopathy. When severe hemorrhage or scar tissue develops the microsurgical procedure termed vitrectomy may be required to restore vision.
Age-Related Macular Degeneration
Macular Degeneration is a common diagnosis describing a large amount of patients; it has many different forms with widely varying severity. For some people the disease causes only slight distortion, but in the worst cases, it can lead to a complete loss of central vision, making reading or driving impossible. It usually affects older patients – retirement age and above. Initial signs of macular degeneration may be picked up earlier, in the 40’s and 50’s. This is important since there is evidence that intervention with nutritional supplements and life-style changes may reduce the development of the blinding disease.
There are two forms of macular degeneration – dry and wet. The dry form results from degeneration of the outer layers of the retina – the light absorbing photoreceptors and the retinal pigment epithelium (RPE). The RPE forms the blood retinal barrier between the outer retinal circulation (choriocapillaris) and the outer retina (photoreceptors). With age, the waste products of vision accumulate beneath the RPE in little mounds called drusen. These proteinaceous and fatty-like deposits impede the flow of oxygen and nutrients and result in degeneration of both the RPE cells as well as the visual cells (photoreceptors).
In the wet form of macular degeneration, abnormal blood vessels grow from the outer retinal circulation (choroid) beneath the retinal pigment epithelium (RPE) and sometimes into the retina itself. These blood vessels can leak fluid and protein and eventually form a scar. With early diagnosis of these blood vessels, laser surgery may be used to close the blood vessels and prevent further vision loss. Fluorescein angiography and indocyanine green angiography may be used to image the abnormal blood vessels and guide laser treatment.
Many patients with wet macular degeneration receive treatment with anti VEGF medicines (anti-vascular endothelial growth factor). These are fairly new drugs and are injected into the eye and work by blocking an essential signal that causes abnormal blood vessels to grow and leak. Some of these drugs include LUCENTIS™, AVASTIN, and/or MACUGEN. Another treatment option is Photodynamic Therapy. This involves using the light activated drug VISUDYNE combined with a laser to stop abnormal blood vessel growth in some patients with web AMD. Talk to your physician at LoBue Laser and Eye Medical Center today about whether this is an option for you.
Floaters and Flashes
Floaters and Flashes are a symptom of the natural aging of the vitreous gel in the eye. The eyeball is filled with gel and liquid and as we grow older, the gel becomes more liquid. Normal floaters are caused by vitreous degeneration. But the presence of new floaters or flashes of light may signal a sight threatening event. As the gel separates from the retina, it may pull on the retina which can lead to the sensation of light flashes. In some cases, the pulling may cause a retinal tear or a blood vessel may tear leading to the sensation of large floaters. A patient with new floaters or flashes should be examined promptly since these signs may indicate a retinal tear. With early diagnosis the tear may be treated with laser surgery or a freezing therapy termed cryotherapy. This will reduce the chance of the tear progressing to a retinal detachment.
Retinal Detachment occurs when the retina is separated from the back of the eye from the fluid beneath it. Most detachments begin in the periphery. A shadow may be noted but central (reading) vision is initially good. With time, the detachment may progress to involve the macula and central vision will be lost. With early diagnosis and treatment, retinal detachments may be repaired by a gas bubble (pneumatic retinopexy), sclera buckle or vitrectomy surgery, and excellent vision may be restored.
Macular Holes is what the name implies. The macula is the area of the retina that provides the best vision for reading and fine detail. A hole in the macula can develop. This hole forms from pulling by the vitreous gel on the center of the retina. Macular hole formation occurs in stages beginning with a cyst (stage 1) and ending with a full thickness hole with separation of the vitreous gel (stage 4). Reading and detail vision is ultimately lost.
Vitrectomy surgery may be used to remove the vitreous gel and close the macular hole. Fine membranes (scar tissue) are peeled from the edge of the hole and a gas bubble or oil bubble is placed in the eye to help seal the hole while it heals. When gas is used, the patient must remain face down for some time after surgery to help the hole seal. If oil is used, it must be removed in a second operation. While most patients benefit, not all patients recover vision. Success rates vary depending on the type of hole, the duration of the hole, and the stage of the hole. The other eye may become affected in 10% of patients. As with all surgeries, the risks, benefits, and alternatives must always be considered and discussed thoroughly with your doctor.
Macular Pucker is scar tissue that has formed in the center of the retina creating distortion and blurring of vision. When the vision is only mildly affected, observation may be the best way to deal with the condition. With significant distortion or blurring, however, vitreous surgery can be used to restore vision in the majority of patients. Patients generally recover half of the vision lost from the macular pucker after surgery. Vision recovery may take weeks to many months.
The LoBue Laser and Eye Medical Centers is here to help you with all of your retinal issues. Since retina problems are very serious and require immediate attention, do not delay in getting into see one of our doctors should you experience any of the symptoms discussed above.