Forest Hills Retinal Diagnostic Center

A healthy retina is essential to maintaining clear vision and overall eye functioning. A retinal exam may be recommended by your doctor if any potential retinal abnormalities were detected during a general eye exam, or for patients at a higher risk of developing retinal conditions such as macular degeneration, diabetic retinopathy, retinal detachments and more. During a retinal exam and consultation, one of our doctors will perform a series of diagnostic procedures in order to evaluate the retina for any sign of disease or abnormality. These tests may include Fundus Photography, Fluorescein Angiography, OCT, Visual Field and more. Our doctors will take the time to discuss the results of your exam, as well as any potential risks of retinal disease with you. Patient education and understanding is a top priority of our practice, as it often helps patients achieve the most successful outcome.

Retinal photography is an advanced diagnostic tool that can be used to effectively detect and diagnose a wide range of abnormalities within the retina, the light-sensitive tissue that lines the back of the eye. These photographs can be used to evaluate the health of the optic nerve, vitreous, macula, retina and surrounding blood vessels, to diagnose conditions such as: Macular degeneration Diabetic eye disease Hypertensive retinopathy Retinal photographs are taken during a simple, painless procedure using a high resolution camera and a specialized optical system. Retinal photographs can help track any changes within the retinal tissue that may indicate early signs of a disease. They can also be used to track the progression of certain diseases. It is important for patients to have routine photographs taken so that any abnormalities can be detected as soon as possible.

Fluorescein Angiography is a technique for examining the circulation of blood vessels inside the retina (an angiogram) with the help of a contrast dye (fluorescein dye). These pictures help doctors evaluate the retina and diagnose and track problems such as diabetic retinopathy, macular degeneration, abnormal vessel growth, swelling, leaking, retinal detachment, cancer or tumors. First, the patient's pupils are dilated with eye drops. Then a few photographs are taken with a special ophthalmic camera. Next, the contrast dye is injected, usually in the patient's arm. The dye travels up to the eye within a few seconds and "lights up" the blood vessels for the camera. Once the dye is in place, the doctor will take more photographs. Then the needle is removed. After about 20 minutes, a final set of photographs is taken for comparison.

Optical Coherence Tomography (OCT) is a non-invasive diagnostic test that obtains an extremely high resolution, cross sectional image of the retinal tissues. OCT is used to measure retinal and macula thickness and is very useful in detecting retinal swelling or fluid accumulation secondary to a variety of retinal conditions. It provides very valuable information and is also useful for following the response to a treatment. OCT testing has become a standard of care for the assessment and treatment of most retinal conditions. OCT uses rays of light to measure retinal thickness and can be performed in a few minutes. No radiation or x-rays are used in this test.

Laser retinal surgery can be used to treat a wide range of retina conditions through minimally invasive techniques that produce precise, long-lasting results. Although your eyes may look and feel normal with these diseases, they can often lead to serious complications such as hemorrhaging and blindness. Lasers have been used to treat eye diseases for over 30 years and produce effective results with no damage to surrounding tissue and no need for needles. It has quickly become the standard for eye disease treatment. Laser surgery can be used to treat diabetic retinopathy, retinal vein occlusions, age-related macular degeneration, retinal detachments and more. Depending on the patient's condition, the laser may be used to seal leaking blood vessels, repair tears, remove newly formed blood vessels or destroy tumors. These procedures are performed in the doctor's office and require only anesthetic eye drops to numb the area prior to treatment. Laser treatment usually takes less than 30 minutes to perform, and patients can go home immediately following surgery. Most patients return to work and other normal activities the next day. Several laser treatments may be needed in order to achieve optimal results and to help manage chronic retinal conditions. Results may take a few weeks or months to become noticeable, so it is important to see your doctor for follow-up appointments in order to ensure that you receive the best possible results.

Photodynamic therapy is used to treat a complication of "wet" macular degeneration in which leaks form beneath the retina. These leaks occur in a structure in the eye called the choroidal neovascular membrane, or CNVM. During photodynamic therapy, Visudyne (verteporfin) dye is injected into the CNVM and a narrow-wavelength laser beam is focused on it for about 90 seconds. The dye absorbs the energy and slows or stops leakage by creating blood clots and stopping abnormal blood vessels from growing. Following treatment, patients should avoid direct exposure to sunlight for several days. Patients most likely to benefit from treatment will have newly onset macular degeneration and no scarring. Vision stabilization is maximized with a series of treatments over one to two years.

Intravitreal injections are commonly used to treat retinal diseases such as diabetic retinopathy, macular degeneration, macular edema, macular hole, and retinal vein occlusion. These diseases may cause loss of vision and should be treated as early as possible. Medications such as Lucentis, Avastin, Eylea, Ozurdex, and Jetrea can be injected directly into the eye to help patients maintain their vision and keep vision loss at a minimum. Some patients may see an improvement in their vision from these injections as well, depending on the condition being treated. Intravitreal injections are especially effective in treating wet age-related macular degeneration, which, although less common than the dry form, accounts for more than 90% of blindness caused by the disease. This procedure is performed in our office and requires only a local anesthetic. Before the medication is injected, the eye is numbed with anesthetic eye drops to help minimize discomfort. The eye is then cleaned with an antiseptic solution. The medication is then injected directly into the eye. Intravitreal injections may be administered as frequently as once a month, depending on the condition being treated, in order to maintain eye health and optimize the vision.

Macular degeneration is a deterioration or breakdown of the macula. The macula is a small area in the retina at the back of the eye that allows you to see clearly. When the macula is not functioning correctly, your central vision can be affected by blurriness, distortion or dark areas. Macular degeneration is the leading cause of severe vision loss in the United States in people 65 years or older. Many older people develop macular degeneration as part of the body's natural aging process. The most common form of macular degeneration is age-related macular degeneration (AMD). There are two common types of AMD. Most people (about 90%) have a form of AMD called "atrophic" or "dry" AMD, which develops when the tissues of the macula grow thin with age. Dry AMD usually causes a slow loss of vision. A second smaller group of people (about 10%) have a more serious condition called "exudative" or "wet" AMD. Wet AMD occurs when abnormal blood vessels grow underneath the retina. These unhealthy vessels leak blood and fluid, which can scar the macula. For patients with wet AMD, vision loss may be rapid and severe. Some symptoms of macular degeneration may be: A dark or empty area appears in the center of vision Blurred vision Distortion of lines and shapes Dry AMD cannot be treated with medication or surgery, but many patients can function well with magnifying lenses. Treatment for wet AMD can include one or a combination of the following: Thermal Laser Photodynamic Therapy (PDT) Anti-VEGF Injections

If you have Diabetes your body does not utilize sugar properly, and when sugar levels rise, damage to the blood vessels in the retina may occur. This damage is known as diabetic retinopathy and is currently a leading cause of blindness in adults in the United States. There are two types of diabetic retinopathy: Non-Proliferative (Background) Diabetic Retinopathy is the early stage where small retinal blood vessels break and leak Proliferative Diabetic Retinopathy is when new blood vessels grow abnormally within the retina (neovascularization). This new growth can cause vitreous hemorrhage, scarring or retinal detachment, which can lead to vision loss. Symptoms of diabetic retinopathy and its complications may include: Blurred or distorted vision or difficulty reading Floaters Partial or total loss of vision or a shadow or veil across field of vision

Blood vessels carry blood to and from the light sensitive structure in the back of the eye called the retina. Blood from the retina is drained from smaller branches of retinal veins into the larger central retinal vein and away from the eye. A retinal vein occlusion occurs when one of these veins is blocked or obstructed. Symptoms of retinal vascular disease are sudden blurring or loss of vision in all or part of one eye. There are two different types of retinal vein occlusion. Central retinal vein occlusion (CRVO) occurs when the main vein of the eye becomes blocked. Branch retinal vein occlusion (BRVO) occurs when one of the smaller branches of vessels becomes blocked. Certain illnesses increase your risk for developing retinal vein occlusion including: Diabetes Glaucoma High blood pressure Cardiovascular disease Complications of retinal vein occlusion may include: Macular edema or swelling of the macula which causes blurred and/or decreased vision Abnormal blood vessel growth or neovascularization. Neovascular glaucoma or painful pressure in the eye can occur in severe cases of CRVO There is no known cure for retinal vein occlusion though the complications listed above can be treated with intravitreal injections or laser surgery to stabilize or improve vision. You may be able to prevent retinal vein occlusion from occurring by properly managing any health conditions which increase the risk of retinal vascular disease.

Floaters appear as small specks or clouds moving in your field of vision. You may see them more clearly when looking at a plain background, such as a blank wall. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of the eye. Floaters can have different shapes such as little dots, circles, lines, clouds or cobwebs. Floaters may be a symptom of a tear in the retina, which is a serious problem because it may lead to retinal detachment. Other floaters are harmless and fade over time, requiring no treatment. When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. Floaters often occur when the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. In some cases the retina can tear if the shrinking vitreous gel pulls away from the wall of the eye. When the vitreous gel inside your eye rubs or pulls on the retina, you may see what looks like flashing lights or lightning streaks. These flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. You should see your ophthalmologist as soon as possible if: One new, large floater or "showers" of floaters appear suddenly. You see sudden flashes of light.

A retinal detachment occurs when the retina is pulled away from its normal position. A retinal detachment is a medical emergency which if not promptly treated, can cause permanent vision loss or blindness. Fortunately, retinal detachment has clear warning signs and symptoms including: Flashing lights New floaters A shadow or curtain over a portion of your field of vision Sudden blurred vision These symptoms do not always mean a retinal detachment is present; however, you should see your ophthalmologist as soon as possible. Unfortunately, many people don't appreciate the urgency of the warning signs of retinal detachment and they tend to put off seeing a doctor in the hope that symptoms will disappear. In some cases, symptoms temporarily diminish only to be followed by a loss of vision over the next few days or weeks caused by advanced retinal detachment. At this stage, retinal detachment can't always be successfully repaired and vision loss may be permanent. It is crucial to see your ophthalmologist at the earliest signs of retinal detachment. Surgery is the only effective treatment for retinal detachment. The decision about which type of surgery and anesthesia to use depends upon the characteristics of your detachment.