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Frequently Asked Questions

Diagnosis

If I see floaters and flashing lights, do I need to see my eye doctor?

Flashes and floaters are sometimes important signs that a retinal problem such as a retinal tear or detachment is present. Although flashes and floaters may not be serious, a retinal examination must be performed promptly to be sure.

Surgery

General

What is the purpose of retinal detachment surgery?

When the retina is detached, it cannot function properly and vision is lost. The purpose of the surgery for retinal detachment is to reattach the retina. If the surgery is successful, the vision will usually improve. The final vision depends on whether the macula was detached.

Is there a time when an eye is too hopelessly damaged to consider surgery?

This is a difficult question. Whether to perform any surgery depends on whether the patient feels that the benefits of the surgery are worth the risks. This decision will be different for every patient, since every patient’s needs are different. If an eye is badly damaged, there may not be much to gain with surgery, and a patient might decide not to have surgery. If, however, the patient has only one eye, then any vision that is saved will be tremendously important. No two patients, and no two retinal problems, are alike. Your surgeon will help you understand what you can hope to gain with surgery, and what you risk to lose.

Are there risks to general anesthesia?

General anesthesia always carries a degree of risk. Minor risks include postoperative nausea, vomiting, and hiccupping. Some patients experience an upset stomach following surgery. If nausea does develop, it can be controlled with medication. Occasionally, patients will experience some confusion and prolonged sleeping. Very rarely, serious reactions occur that result in liver failure, cardiac arrest, and even death.

Scleral Buckling Surgery

If pneumatic retinopexy does not work, may I then undergo the scleral buckling procedure?

If pneumatic retinopexy fails to reattach the retina, the patient usually can undergo a scleral buckling procedure or vitrectomy.

Does the silicone scleral buckle ever need to be taken off?

Once a scleral buckle is sutured onto the wall (sclera) of the eye, it stays in position forever. It may slightly change the shape of the eye and, after the eye has healed, a new pair of glasses may be necessary. On rare occasions, a scleral buckle placed all the way around the eye may cause pain. If the pain is severe and cannot be relieved with medicine, it may be necessary to loosen or remove the buckle. Rarely, an infection may occur. In such instances, the buckle may need to be removed from the eye. When the buckle is removed, the retina usually remains attached, but may detach. In most cases, however, the scleral buckle remains against the eye forever and causes no serious problem. It cannot be seen by others.

Vitreous Surgery (Vitrectomy)

How is vitrectomy surgery performed?

The surgery is performed using local or general anesthesia. Vitrectomy surgery is performed through an operating microscope, which allows the surgeon to look through the dilated pupil at the retina. Small openings through the sclera are made in order to insert vitrectomy instruments into the eye. A variety of instruments is used, including a fiberoptic light which lights the inside of the eye, and a variety of vitreous cutters, scissors, and forceps.

How long will the vitreous or retinal surgery take?

The length of the surgery depends on the type of problem you have. If you have an epiretinal membrane or uncomplicated retinal detachment, surgery may take less than an hour. However, if the eye needs to have the lens removed, a scleral buckle placed, and scar tissue removed from the eye, the surgery could take two or three hours.

What are the possible complications of vitrectomy surgery?

There are risks to any surgery. The risks must be outweighed by the benefits if surgery is to be performed. Cataracts occur as a side effect of vitrectomy surgery in almost every case. The risks include the development of a tear in the retina, glaucoma, double vision, bleeding into the eye, infection, or redetachment of the retina. Sometimes, though the retina may remain attached, the pressure inside the eye may not be adequate to keep the eye “inflated” to its normal size. The eye may become shrunken and need to be removed. Any one of these complications may result in severe loss of vision, or even the loss of the eye itself.

Post-operative

How long will I be in the hospital for my surgery?

Patients typically come to the Center for Outpatient Medicine at Salem Hospital on the morning of surgery, and leave the same day. If emergency surgery is performed late at night, or if other health problems are present, an overnight stay may be helpful.

Will my eye hurt after surgery?

You may note some discomfort around the eye, but severe pain is unusual. Discomfort can be relieved with medication if necessary. Your eye will remain swollen, red, somewhat tender, and uncomfortable for several weeks. You may also notice a scratchy, foreign body sensation when opening or closing the eye. This is caused by small stitches on the outside of the eye. These stitches will gradually become soft within a few days, and fall out within a week or two.

What instructions must I follow when I go home after surgery?

The amount of physical activity that is allowed depends on the type of surgery that you have had. Your surgeon will discuss with you any restrictions. You will be asked to use some eye medications when you go home. The purpose of the drops is to prevent infection and make the eye more comfortable as it heals.

Will I see better right after surgery?

The vision following surgery depends on the type of surgery that you have had. In general, it takes a long time for you to reach your best vision. The vision in the eye will almost certainly be blurry for many weeks. Your surgeon will discuss with you the chances of visual recovery following your surgery and how much vision you can hope to regain. It is important to realize that recovery of vision following any type of retinal or vitreous surgery takes a long time.

Why is postoperative head positioning important and how long must it continue?

Patients are asked to remain in a certain position after surgery (usually face-down) if they have air, gas, or silicone oil in their eye. These materials rise to the highest point in the eye. If there have been retinal tears that have received laser or cryotherapy during surgery, the air, gas, or oil can help keep the tear closed, and the retina attached, while the laser or cryotherapy takes hold. Occasionally, head positioning is used to allow blood in the eye to settle away from the macula. The length of time varies, and your surgeon will tell you when it is safe to stop this special positioning.

Is it possible that I may not see after surgery?

Despite our increasing knowledge about retinal detachment and vitreous disease, and despite the sophisticated surgical equipment and techniques that we bring into the operating room, it may be impossible to improve a patient’s vision. The chance for blindness with severe retinal disease is real. When considering surgery, the patient and the doctor must weigh the risks, including the possibility of total blindness, against the possible benefits of either stabilizing or improving vision. It is important for the patient to know that surgery may fail due to complications, or simply due to the progressive nature of the retinal disease.

Macular Degeneration

General

Will using my eyes hurt them?

No. It is important to know that you cannot hurt your eyes by using them. There is no way in which using your eyes – reading, watching television, or driving for long periods of time – can do your eyes any harm.

Do I need to wear sunglasses?

This is an area of some uncertainty, but the best evidence to date does not show that sunlight contributes to AMD. Heavy sun exposure can, however, contribute to cataract.

Is it normal to have trouble adjusting quickly between bright sunlight and dim light or shadow?

Many elderly people, and especially those with macular degeneration, have difficulty adjusting quickly from bright light to dim light or shadow. It might be difficult to see when driving from bright sunlight into a dark tunnel. Some may find it difficult to read the menu in a dark restaurant when they have just come in from bright daylight. This problem may be helped by using clip-on sunglasses over regular glasses. These clip-on sunglasses can be slipped off easily when going from light to dark and can then be slipped back on again when going from dark to light.

Many people with drusen or other forms of macular degeneration experience difficulty driving at night and, in such cases, may find it best to avoid driving at night.

Can anything help if central vision is lost in each eye?

Anyone who has lost detail vision in both eyes can be referred to a low vision specialist whose job is to teach those techniques that use the remaining vision to its fullest. Low vision specialists can fit magnifying lenses for close-up vision and telescopic lenses for seeing at a distance. And there are other visual and mechanical devices such as filters, increased lighting, and special reading aids that can help with the goal of living life to the fullest even with reduced vision. Low vision counselors have information about books on tapes, radio programs that read the news, and support groups that meet to help people cope with the problems of central vision loss.

Treatment

What is the purpose of AMD treatment?

CNV (abnormal blood vessels) can cause severe visual loss. The goal of treatment is to stop the growth, bleeding, and leakage from CNV. In doing so, we hope to stop any further vision loss, and, if possible, recover some of the lost vision.

Will I have to go to the hospital?

No, treatments are done in the office.

Are the treatments safe?

In the majority of cases no complications occur but, as with all medical procedures, there are some risks. Laser treatment may cause bleeding or an unusually large scar. A small percentage of patients receiving PDT will have sudden loss of vision, which rarely can be permanent. Infection following an injection is very rare, but can cause more damage than the AMD if not recognized and treated immediately. If there is ever severe vision loss or significant pain following a treatment, contact your doctor immediately.

How many treatments will I need?

This varies greatly. It is important to remember that AMD is a chronic disease. While our treatments can lessen the damage caused by AMD, no cure is available. Some people will need to come in monthly for repeat treatments, while some will only need treatment once or twice a year.

Is there any pain caused by treatment?

Laser surgery for CNV (abnormal blood vessels) is almost always painless, although a few patients do experience some slight discomfort. Sometimes, the eye has to be immobilized. An anesthetic is injected behind (not into) the eye so that it cannot move and will not be able to feel anything. After the laser treatment, the eye is patched for several hours.

Some patients have back or chest pain during PDT. If this happens, tell the staff. Often, just standing up or slowing the Visudyne infusion eliminates or lessens the pain.

Pain with anti-VEGF injections is rare and, when present, gone in seconds.

How long does treatment take?

This depends on the type of treatment.

PDT requires the preparation of the drug, measurements of height and weight, several calculations, placement of an intra-venous line (IV) and slow infusion of the drug, and carefully timed laser treatment. It is best to plan on at least 2 or 3 hours.

Intra-vitreal injections require preparation of the eye, which includes dilation. The injection itself is a matter of seconds, but the entire appointment may take and hour.

Laser treatment like injections requires some time to prepare the eye. The treatment itself takes 10-15 minutes.

Will removing the CNV (abnormal blood vessels) or scar by surgery help my vision?

In most cases, no. Scientific studies are being conducted regarding the transplantation of macular tissues (especially retinal pigment epithelium), but this is only at an experimental stage and not useful for patients at this time.

Post-treatment

What will my vision be like immediately after treatment?

Following an injection, you may see some of the medicine floating around in your eye. This usually clears rapidly, but one of the medications (Kenalog) may take a couple of weeks to clear.

Following PDT, you will probably see a blank spot in your central vision. This tends to fade over a period of several weeks. In some eyes, particularly if there was a central blank spot before treatment, the spot will become faint or gray.

After laser treatment, vision is often more blurred than before treatment but usually improves within four weeks. But there will usually be a black or blank area or blind spot where the laser beam was focused on the CNV (abnormal blood vessels). This blank spot will be permanent. A person who has had laser will be asked to trace the outline of this spot by drawing it on the Amsler grid to be sure that it doesn’t enlarge.

Do I need to avoid any activities after treatment?

Following an injection it is best to avoid swimming pools or hot tubs for a minimum of 3 days, to reduce the risk of infection.

After PDT, it is important to avoid direct sun light and halogen lamps for at least 3 days. This means that you should not go to the dentist, or be examined or treated under the kind of surgical lamps many doctors use.

How does one know if the treatment has helped?

After treatment you will return for a follow-up examination and possibly an OCT or fluorescein angiogram. If the CNV (abnormal blood vessels) has been controlled, another follow-up appointment is given. Your eye will be examined again; the testing and treatment may be repeated.

What if the treatment did not work?

The next step would be to determine why the treatment isn’t working. Sometimes it is necessary to change to a different drug, or to combine the available treatments in a different way, or to treat more often. In some cases, the damage to the macula is already permanent by the time treatment is started. In such cases, even if the treatment controls leakage, this may be of no visual benefit, and treatment will be stopped.