EyeHealth Northwest: Medical / Surgical Services

All physicians at EyeHealth Northwest are trained to diagnose and care for patients with retinal problems. In addition, we also have a fellowship trained vitreoretinal specialist on our staff, Dr. Jonathan Yoken who is a Fellowship trained Retinal Specialist available for retinal disease treatments, surgery and consultations.

The retina is a thin layer of tissue which lines the inside of the eye. Like the film in a camera, the retina senses the light which enters the eye, and translates the images into electrical signals which are then telegraphed to the brain (via the optic nerve). The retina is one of the most delicate and complex organs of our bodies, and currently it cannot be replenished or transplanted if it is damaged.

WHAT IS THE MACULA ?

The macula is a specific area of the retina. It is at the center of the visual field-when looking directly at an object, you are seeing it with the macula, while the rest of the retina is involved with peripheral vision. Although it represents only a small fraction of the total size of the retina-about the size of the capital letter "O" on this page-the macula is crucial for visually demanding tasks like reading, driving a car, and color vision. Diseases of the macula may interfere with "detail vision", making these activities more difficult. Macular problems can also cause images to appear distorted, or may cause an area of cloudiness or darkness to form at the center of the visual field. Fortunately, many diseases which affect the tiny macula may spare the rest of the retina, thereby preserving peripheral vision. Therefore, diseases such as Age Related Macular Degeneration rarely result in complete loss of sight.

The small specks or "bugs" that you may occasionally see moving across your vision are called floaters. They are most visible when you are looking at a plain background such as a white wall or the bright blue sky. Floaters are actually tiny clumps of gel or debris within the vitreous, which is the clear jelly-like substance that fills the inside cavity of the eye. As these floaters move about inside your eye, they are casting shadows onto the retina.

The vitreous is normally attached to the surface of the retina, which lines the inside of your eye, like wallpaper. As we grow older and reach middle age, the vitreous gel begins to breakdown into microscopic clumps and strands. As the vitreous undergoes this degeneration, it sometimes actually separates itself away from the retina. This process is called posterior vitreous detachment, or PVD. PVD can also occur in nearsighted people, people who have sustained ocular trauma, or individuals who have recently undergone an ocular procedure such as cataract surgery, or YAG capsulotomy. When floaters appear suddenly, it can be quite alarming. Usually, when a PVD occurs, you may suddenly see little dots, lines, cobwebs, or clouds filling the vision of one of your eyes. Fortunately, the floaters are usually harmless, and are a result of the normal aging process. Flashes may also occur during a PVD as a result of the vitreous tugging on the retina. The retina feels no pain, but if it is stimulated, it will send a light signal to the brain. This often can be observed as a shooting arc of light, or a burst of light in the corner of your vision that is more easily observed at night or when there is little surrounding outside light. Your eye will continue to function normally with a PVD.

Occasionally, the retina can be torn when a PVD occurs. This may cause a small amount of bleeding, which can appear as new floaters. A retinal tear can be serious if it develops into a retinal detachment. Any sudden onset of new flashes or floaters should be promptly evaluated by your eye doctor. Additionally, if you perceive new symptoms after your evaluation, such as loss of part of your peripheral vision, this requires a repeat examination.

Floaters can often interfere with normal vision and be bothersome while reading or driving. Fortunately, floaters almost always diminish over time and your brain will learn to ignore them, even if it takes several months.

RETINAL TEARS AND DETACHMENT

Detached Retina

What is a retinal detachment?

The retina is normally attached to the inside wall of your eye, like wallpaper. A retinal detachment occurs when the retina is separated from the inside wall of the eye. The retina will not function when this occurs. If the center of the retina, the macula, is involved, the vision is often extremely blurred. If the macula is not involved, there may be some loss of peripheral vision corresponding the part of the retina that is detached.

A retinal detachment is a very serious problem that will almost always lead to blindness if not treated.

What causes a retinal detachment?

The center of the eye is filled with a clear gel called the vitreous. As we get older, the vitreous begins to degenerate into a liquid and this causes it to pull away from the

Retinal Detachment -
Posterior Tears

surface of the retina. This process, called a posterior vitreous detachment, or PVD, usually occurs without damaging the retina. But in some cases, the vitreous may pull hard enough to tear the retina in one or more places. As time passes, fluid from the center of the eye will pass through the tear and begin accumulating beneath the retina, causing a retinal detachment. There are some conditions that increase the likelihood of developing a retinal detachment. These include:

Are there warning signs of a retinal detachment?

Early symptoms of a retinal detachment include flashing lights, new floaters, or a loss of part of the peripheral vision in one eye. These symptoms do not always indicate a detachment is present, but they should be promptly evaluated by your eye doctor.

How are retinal tears and detachments treated?

If your eye doctor discovers a retinal tear, it can usually be treated in the office with laser surgery or cryotherapy. Both procedures are done to seal off the retina around the tear and prevent the development of a retinal detachment. These procedures are usually performed with little or no discomfort in the office and are highly successful. There are sometimes circumstances where a tear or retinal hole may not require treatment, or cases where despite treatment, new tears or a detachment occurs.

Retinal detachments require surgery to correct. There are several different techniques, and in some cases, a procedure can be done in the office to repair the detachment.

Pneumatic retinopexy is a procedure that can be performed in the office to repair a retinal detachment. Depending on the characteristics of the detachment, this sometimes can be an ideal treatment that avoids the need for a trip to the operating room. This procedure is accomplished by injecting a gas bubble into the center of the eye, where the vitreous gel is located. The bubble then floats up against the tear in the retina, and pushes the retina back up against the wall of the eye. The tear still needs to be sealed with cryotherapy or laser. The gas bubble will dissolve on its own.

Scleral buckle surgery is performed in the operating room and involves placing a flexible band around the outside of the eye to counteract the pulling force of the vitreous gel on the detached retina. This also involves cryotherapy to seal the retinal tear. The band usually remains in place indefinitely.

Vitrectomy surgery also requires a trip to the operating room and involves the removal of the vitreous gel from the inside of the eye. Laser is used to reattach the retina, and a self-dissolving gas bubble is placed inside the eye to hold the retina in place while it heals. The vitreous does not regenerate, but the eye will function normally without it.

Sometimes these procedures are performed simultaneously or sequentially depending on the particular characteristics of the detachment.

Are there risks to surgery?

All surgery has risks, even those performed in the office. However, most retinal tears and detachments that are not treated will result in permanent blindness. Some risks of surgery include, but are not limited to infection, bleeding, cataract, elevated eye pressure, and reoccurrence of the retinal detachment. Fortunately, most retinal tear and detachment repair is successful, even if a second operation is required.