TREATMENTS

Anti-VEGF Therapy

Vascular endothelial growth factor, or VEGF, is a molecule generated by the body that causes new blood vessels to grow. Sometimes this is normal; however, in retinal disorders such as macular degeneration or macular edema from diabetic retinopathy or vein occlusions, the eye produces too much VEGF. This higher level of VEGF causes abnormal blood vessels to grow and causes them to leak fluid or to bleed, causing distortion of vision. Injections of anti-VEGF drugs into the eye block the activity of VEGF and often result in a decrease in the fluid or bleeding caused by the abnormal vessels. This procedure only takes moments and is done in the office.

WHAT ANTI-VEGF THERAPY DRUGS ARE AVAILABLE?

AVASTIN
Avastin, also known as benacizumab, is a medication used to treat swelling in the macula due to wet macular degeneration, and macular edema due to diabetes and retinal vein occlusions.

EYLEA
Eylea, also known as aflibercept, is a medication used to treat swelling in the macula due to wet macular degeneration, and macular edema due to diabetes and retinal vein occlusions.

LUCENTIS
Lucentis, also known as ranibizumab, is a medication used to treat swelling in the macula due to wet macular degeneration, and macular edema due to diabetes and retinal vein occlusions.

TRIESCENCE
Triescence, also known as triamcinolone, acetonide is a steroid medication used to treat swelling in the macula due to wet macular degeneration, and macular edema due to diabetes and retinal vein occlusions.

OZURDEX
Ozurdex, also known as dexamethasone, is an intravitreal implant used to treat swelling in the macula or macular edema due to diabetes and retinal vein occlusions.

VABYSMO
Vabysmo, also known as faricimab-svoa, is a medication used to treat swelling in the macula due to wet macular degeneration and macular edema due to diabetes.

 

KENALOG
Kenalog, also known as triamcinolone, is a steroid medication used to treat swelling of the macula due to diabetes, retinal vein occlusions, and inflammation post cataract surgery.

 

Anti-VEGF therapy options are based upon individual retinal disorders in combination with diagnostic test results.

OCT, Optical coherence tomography maps of a patient who had a branch retinal vein occlusion, or BRVO.

The maps on the top show clinically significant macular edema causing a decrease in vision. The maps on the bottom show the same eye scanned a month later, utilizing state of the art eye tracking after anti-VEGF therapy. Substantially decreased leakage is present allowing for an increase in vision for this patient.

OCT, Optical coherence tomography maps of a patient who has wet macular degeneration, or wet AMD

The maps on the top are an example of a patient with wet macular degeneration.  The maps show macular thickening with subretinal fluid involving the fovea (central vision) and the juxtafoveal retina consistent with wet macular degeneration.

The follow up thickness maps below show NO significant macular thickening, macular edema, or subretinal fluid after an ANTI-VEGF treatment.  The comparison to retinal scans prior to treatment now show NO active leakage.  Treatment was a success!

Cryotherapy

Cryotherapy is a medical procedure performed in the office by a retinal specialist. A small probe is utilized to transmit extreme cold temperatures to the retina to freeze abnormal blood vessels or retinal tears. This treatment may also be used to treat small retinal detachments, retinal tumors, lesions, and other retinopathies.

Prior to treatment, a topical numbing eye drop is instilled followed by a local injectable anesthetic into the surface of the eye. This ensures the patient will be comfortable during the procedure.

After treatment is performed, the patient may experience some redness, swelling, and mild discomfort in the eye. This can usually be alleviated with Tylenol© or Advil©.  Healing may take 10-14 days to be complete and vision may be blurred during that time.

Following the procedure, the doctor will discuss what to expect during recovery, when to schedule a follow-up appointment, and when to resume normal activities.

 

 

Retinal Laser

Retinal laser photocoagulation, sometimes referred to as focal laser, is a minimally invasive procedure performed in the office.  Your physician may choose this option to treat leaking blood vessels in the retina due to disorders such as:

Retinal laser photocoagulation utilizes small, targeted laser burns on the retina in order to slow or stop the growth of the leaking blood vessels.   Focal laser is utilized to treat a relatively small area of the retina with a limited amount of laser burns.  The laser seals the leaking blood vessels in order to prevent, or slow vision loss.  The main goal of retinal laser treatment is to ensure further vision loss is reduced, as well as to work to restore vision that has already been lost, although restoration may only be minimal.

Retinal laser is also used to treat retinal tears.  When retinal laser photocoagulation is performed for a retinal tear, the laser is utilized to support the surrounding retina around the tear by creating a barrier of scar tissue ensuring that it stops the tear from progressing into a retinal detachment.

Multiple treatment options are available for the disorders listed above.

Each patient has individual needs and your physician will discuss all possible treatment options with you.

The retinal laser procedure is performed in the office.  The eye of concern will be anesthetized, or numbed with topical eye drops prior to the procedure.  The eye will also be dilated in order to allow the physician to view the retina as clearly as possible.  A contact lens will be placed on the eye during the time of the procedure to magnify the vessels of concern.  You will experience multiple bright light flashes, as the physician targets the leaking blood vessels with the laser.  A technician will be by your side to provide support and assistance.  For most patients, the treatment takes minutes to complete as the physician secures the problematic blood vessels.  In some cases, multiple laser sessions may be required and your physician will review all options with you.

After the laser treatment is complete, your vision may appear darker than normal, blurry, and/or you may see spots.  This is normal and your vision will be restored after a few minutes or within the next day.

Patients should have a family member or friend to drive them home as their pupils will be dilated for a few hours and they may be light-sensitive.

Retinal laser photocoagulation has a low risk of infection; however, patients may experience areas of decreased vision and reduced night vision.  These effects may be temporary, but may last longer.  The risk of severe, permanent loss of vision without treatment is greater than the mild side effects in vision post (after) laser treatment.  Your physician will discuss the process with you and answer any of your questions.

A multicolor image and an infrared image of a retina treated with focal retinal laser for leakage due to background diabetic retinopathy.  The laser marks spare the central vision, thus maintaining optimal central vision.

Pan Retinal Photocoagulation (PRP)

Pan retinal laser photocoagulation, or PRP is a minimally invasive procedure performed in the office.  Your physician may choose this option to treat leaking blood vessels in the retina due to proliferative diabetic retinopathy.  Proliferative diabetic retinopathy effects a wider area of the retina, therefore when compared to focal laser treatment for other retinal conditions, more laser burns may be needed to stabilize the central vision and prevent further vision loss.

PRP targets abnormal blood vessels due to proliferative diabetic retinopathy, or PDR.  If left untreated, PDR can severely decrease vision, both centrally, and peripherally.  The purpose of the laser is to slow or stop the abnormal blood vessel growth in the retina.  Multiple laser burns are made throughout the periphery, and/or the area surrounding the central vision, or macula.  If these abnormal vessels are not treated, conditions such as vitreous hemorrhage, macular edema, and tractional retinal detachments may occur, causing the need for invasive surgical procedures, as well as possible severe vision loss.  Pan retinal photocoagulation is a preventative treatment option your physician will discuss with you.

The PRP procedure is performed in the office.  The eye of concern will be anesthetized, or numbed with topical eye drops prior to the procedure.  The eye will also be dilated in order to allow the physician to view the retina as clearly as possible.  A contact lens will be placed on the eye during the time of the procedure to magnify the vessels of concern.  You will experience multiple bright light flashes, as the physician targets the leaking blood vessels with the laser.  A technician will be by your side to provide support and assistance.  For most patients, the treatment takes minutes to complete as the physician secures the problematic blood vessels.  In most cases, multiple laser sessions may be required and your physician will review all options with you.

After the laser treatment is complete, your vision may appear darker than normal, blurry, and/or you may see spots.  This is normal and your vision should be restored within the next few days.  The PRP laser treatment may cause your eye to feel some discomfort over a few days.  Again, the purpose of the PRP laser is to ensure central vision is sustained.  The peripheral blood vessel growth in proliferative diabetic retinopathy will not go away on its own.  Without treatment, the expectation of loss of vision is imminent.

Patients should have a family member or friend to drive them home as their pupils will be dilated for a few hours and they may be light-sensitive.

Retinal laser photocoagulation has a low risk of infection; however, patients may experience areas of decreased vision and reduced night vision.  These effects may be temporary, but may last longer. After PRP treatment, peripheral vision may be decreased momentarily or indefinitely.  However, the goal of the PRP laser is to ensure central vision will be secured.

The risk of severe, permanent loss of vision without treatment is greater than the mild side effects in vision post (after) laser treatment.  Your physician will discuss the process with you and answer any of your questions.

A Fluorescein angiogram study, or Intravenous Fluorescein Angiography (IVFA) of a retina with proliferative diabetic retinopathy.

The fluorescein angiogram study above is an example of the leaking blood vessels in the peripheral retina with areas of ischemia (or lack of blood flow) due to proliferative diabetic retinopathy.  The angiogram aids the physician in the areas necessary to treat with PRP to ensure central vision is stable.

A fluorescein angiogram study, or Intravenous Fluorescein Angiography (IVFA) of a retina post(after)   Pan Retinal Photocoagulation (PRP) treatment.  The image shows the laser was successful as there is no active neovascularization, or leaking blood vessels in the peripheral retina, ensuring central vision remains stable.

PDR Vitrectomy

PDR Laser

Surgical Procedures