|A retinal specialist is a medical physician who has completed additional specialized training in diseases of the back part of the eye where the retina is located. All of our eyes have neurosensory retinal tissue, essentially an extension of the brain, which transmits signals from the eye to the visual processing area of the brain. This tissue is not only delicate but it can also reveal problems caused by other diseases elsewhere in your body to your eye doctor. The majority of patients, with or without eye problems, can be cared for by their primary eye care provider. If however, your eye doctor has recommended you see a retinal specialist, you should make that appointment without delay. Many serious and vision threatening conditions may be able to be treated by a retinal specialist. The most common reasons to be referred to a retinal specialist are:
- Age related macular degeneration
- Diabetic retinopathy
- Retinal tears and holes
- Retinal detachment
- Epiretinal membranes & macular holes
- Sudden onset of flashes and floaters
- Ocular trauma involving blunt injuries with a ball or a fist.
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Age-related macular degeneration (AMD) is a deterioration of the eye's macula. The macula is a small area in the retina — the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly.
With macular degeneration, you may have symptoms such as blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision. Many people are not aware that they have macular degeneration until they have a noticeable vision problem or until it is detected during an eye examination.
Treatments for AMD vary depending on the type and extent of AMD and should be discussed with your retinal specialist.
Eye with Dry Macular Degeneration
Eye with Wet Macular Degeneration
Matossian Eye Associates offers genetic testing for age related macular degeneration. As a CLIA approved laboratory, this test can be performed easily and without pain by a simple cheek swab in the office. The test is covered by Medicare and most insurance companies.
Genetic testing is commonly performed and will likely play a larger role in tailoring treatment choices for patients.
There are two tests currently available both of which provide a risk analysis for developing advanced macular degeneration.
One test, Macula Risk, uses smoking history in the risk analysis and should be used if you currently smoke or have smoked in the recent past. The second test, RetnaGene, can be used for patients with a family history of macular degeneration who personally do not have a current diagnosis of macular degeneration.
Your retina specialist will discuss the role of genetic testing as it relates to your family history and eye exam.
If testing is recommended, it can be performed at the time of your appointment. The test results are usually available a few weeks later.
Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina function abnormally. Sometimes these abnormal vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.
Eye with Diabetic Retinopathy
Diabetic retinopathy usually affects both eyes. People who have diabetic retinopathy often don't notice changes in their vision in the disease's early stages. But as it progresses, diabetic retinopathy usually causes vision loss that in many cases cannot be reversed.
The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won't cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages and can result in blindness.
Eye with Proliferative Diabetic
Retinopathy and laser treatment.
Floaters are what you may see when you notice small specks or clouds moving in your field of vision. You can often see them when looking at a plain background, like a blank wall or blue sky. Floaters are actually tiny clumps of cells or material inside the vitreous, the clear, gel-like fluid that fills the inside of your eye.
When the vitreous gel pulls on the retina, you may see what look like flashing lights or lightning streaks. These are called flashes. You may have experienced this same sensation if you have ever been hit in the eye and saw "stars." The flashes of light can appear off and on for several weeks or months.
As we grow older, it is more common to experience floaters and flashes as the vitreous gel changes with age, gradually pulling away from the inside surface of the eye.
Usually, the vitreous moves away from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye — much as wallpaper can peel off a wall. When the retina is pulled away from the back of the eye like this, it is called a retinal detachment. You should have your eyes checked by your eye doctor if you experience sudden floaters or flashes.
In some cases you may not have a specific diagnosis but you may have unexplained vision loss that may prompt a referral to a retinal specialist. Your eyes will be dilated so the retina specialist can get a complete view of your retina through your pupil. Your appointment with a retinal specialist may involve various tests that are usually done on the same day of your appointment:
"OCT" (Optical Coherence Tomography) is a valuable noninvasive test that can be performed on the same day of your appointment. Using a light source to create a cross-section image of the retina, the shape and overall thickness of the retina can be determined. This technology allows for the detection of retinal fluid and also measures the response to treatments for various retinal conditions. The test can be completed within minutes and does not use any radiation.
Click here for more information on the Cirrus OCT used in our office.
OCT color image of normal retina
OCT color image of retinal edema
OCT image of epi-retinal membrane
OCT color image of Macular Hole
"IVFA" (Intravenous Fluorescein Angiography) provides a detailed analysis of the blood flow of the retina and choroid. It uses a vegetable based dye, unlike the iodine dye used for CT scans, and a camera to photograph the dye in the vessels in the back of the eye. The Optomap FA system used at Matossian Eye Associates allows for ultra-widefield high definition angiography which can visualize approximately 80% of the retina in one view. The information obtained is significantly more than that obtained from conventional FA.
The dye is injected in a peripheral vein. It is common for patients to feel a warm flushing sensation and mild nausea. The dye will color your urine orange or yellow for up to twenty-four hours. Your vision may appear tinted for a temporary period. Finally, your skin may have a yellowish tint for a temporary period. Do not wear your contact lenses on the day of your appointment. Plan to have a driver to take you home after your appointment. Tell your doctor if you may be pregnant. The test is safe and has been used for decades; however, rarely patients may be severely allergic to the dye. You should read and understand the informed consent prior to the test.
You can find more patient information on our Optomap system here.
Optomap fluorescein angiogram
image of patient with
Proliferative Diabetic Retinopathy
Normal Optomap Fluorescein
Optomap Fluorescein Angiogram
image of patient with Sickle Cell Retinopathy
Matossian Eye Associates is a multi-specialty ophthalmology practice that has its own retinal specialist available for your convenience in an attempt to bring comprehensive eye care to all its patients.