At NJRetina, we provide our patients with state-of-the-art diagnostic tests, treatments, and surgery.
At NJRetina, we are visionary experts in retinal care. NJ Retina Physicians are not only leaders in their field nationally, they are recognized locally for their expertise in diagnosing and treating a comprehensive range of medical and surgical retinal disorders, including diabetic eye disease, age-related macular degeneration (AMD), epiretinal membranes, macular hole, and retinal detachment to name a few of the most common. Whether you are having new symptoms and have found us through a friend or neighbor, or were referred to our practice by your local eye doctor, a consultation with a NJ Retina physician will help establish a diagnosis and treatment plan that could help you regain your sight or in some cases -- prevent you from losing it.
Veins are blood vessels that carry deoxygenated blood from all parts of the body back to the heart. Branch retinal vein occlusion is the obstruction of a vein at the site where the artery and vein cross paths. The obstruction leads to congestion of the retinal tissue leading to macular edema and loss of vision. In about 50% of patients, branch retinal vein occlusion is related to hypertension-induced arteriosclerosis (that is, the narrowing and hardening of the arteries). Arteriosclerosis most often affects people who are over the age of 50.
Central retinal vein occlusion (CRVO) is a disorder characterized by blockage of venous blood flow from the retina. The site of the obstruction in a CRVO is usually that portion of the retinal vein that passes through the optic nerve (“central” retinal vein). Similar to a BRVO, the obstruction leads to congestion of the retinal tissue, leading to macular edema and secondary loss of vision. CRVO can be associated with patients who have ocular hypertension or glaucoma.
Central serous retinopathy (CSR), also known as idiopathic central serous chorioretinopathy, is a condition in which there is a collection of fluid beneath the center (the macula) of the retina. The retina is the nerve tissue that lines the back wall of the eye. Much like the film in a camera, the retina is sensitive to light. It transforms light energy to nerve stimuli, and “sends a picture” through the optic nerve to the brain. The macula is the part of the retina that allows a person to have sharp, clear color vision. Our ability to read and to see fine detail depends upon the health of the macula. The collection of fluid beneath the macula can interfere with its function.
The definite cause of this condition is unknown, but this condition has been associated with a “type A” personality, significant life stressors and the use of steroids. CSR typically affects healthy young and middle-aged males between the ages of 20 and 45. Most common treatment options including a course of observation, reduced fluence photodynamic therapy or focal thermal laser.
The CMV virus produces retinal inflammation, hemorrhage, and in its late stages, often retinal detachment by causing retinal tissue necrosis. Severe vision loss or blindness can result. For this reason, prompt retinal diagnosis and treatment is warranted. Therapy with oral and/or intravitreal antiviral drugs are the current mainstays of CMV retinitis management.
Myopia (nearsightedness) is the inability to focus on objects in the far distance, but with the ability to see close objects well. High myopia is defined as a refractive error of at least -6.00 diopters. Degenerative myopia results when there is evidence of degeneration of the retinal tissue due to progressive elongation of the eyeball. Although spectacles and contact lenses can correct this visual abnormality to some extent, patients with degenerative myopia have long-term risk for macular atrophy, choroidal neovascular membrane formation, macular hemorrhages, and retinal tears, holes or retinal detachment.
Diabetic retinopathy can occur in patients with both type 1 and type 2 diabetes mellitus. Retinopathy progresses through two main stages, nonproliferative and proliferative. In the proliferative form, there is a growth of “new” blood vessels, or the development of “neovascularization,” which can significantly increase one’s risk of sudden vision loss from a vitreous hemorrhage. Macular edema can occur at any stage of diabetic retinopathy and is the most common cause of vision loss. Diabetic eye disease is most commonly treated with stricter hemoglobin A1C control, intravitreal anti-VEGF injections, intravitreal steroid injections, or with thermal laser. Hypertension, hyperlipidemia, and pregnancy can result in cases of retinopathy that are more severe, and can further increase the risk of visual loss.
There are many inherited retinal diseases. These disorders often affect the macula, which is the part of the retina responsible for sharp central vision including color vision. The type of inherited retinal disease is dependent on the gene that is affected in the patient. As a result, depending on the type of gene involved, these diseases can run in families, i.e. be inherited from one’s parents or be transmitted to offspring. Retinal evaluation, ERG testing, genetic testing and counseling can be important in the management of these diseases. Some cases can cause severe vision loss and are often slowly progressive.
Although relatively rare, various types of tumors can occur within the eye. Examples of intraocular tumors are choroidal nevus, choroidal melanoma, hemangioma, osteoma, melanocytoma, and retinoblastoma. There are a wide spectrum of treatment options for tumors depending on whether it is benign or malignant.
Lattice degeneration is a thinning of the peripheral retina. This condition does not interfere with central vision or cause any symptoms, so it is often undetected unless a patient undergoes a thorough peripheral retinal exam. This condition is often inherited and is found more commonly in people who are myopic (nearsighted). In many cases, no treatment is needed. Some cases of lattice can be associated with retinal hole or retinal tear and can elevate one's long term risk of developing a retinal detachment. A comprehensive retinal evaluation is needed to tailor the management plan for each patient which in some cases could involve laser treatment.
The leading cause of visual loss in the senior population of the United States is age-related macular degeneration (AMD). This condition causes deterioration—and possibly the eventual loss—of central vision. There are two types of AMD, dry and wet. Assessing risk factors and evaluating the macula, via careful retinal examination and sophisticated diagnostic testing can help classify AMD into these categories. There are numerous FDA-approved treatments for wet macular degeneration, all of which are available at NJ Retina.
Cystoid macular edema (CME) refers to swelling of the central retina (macula), which is usually secondary to abnormally leaky retinal blood vessels. CME can occur following cataract surgery, from inflammation or from retinal vascular disorders such as retinal vein occlusion. CME produces blurring of the central vision and/or metamorphopsia (distortion). Fluorescein angiography is frequently used in the evaluation of macular edema. Many eye disorders can cause macular edema, but diabetes and recent cataract surgery are most common.
Macular hole is most commonly an acquired defect that occurs in the central part of the retina called the fovea - the part of the macula responsible for tasks such as reading small print. The retinal tissue defect causes a central gap in vision that causes vision loss. Most cases of macular holes are idiopathic and are repaired with vitreoretinal surgery.
Macular pucker is caused by a transparent membrane of scar tissue that grows over the surface of the central retina. The eventual contraction and shrinkage of this membrane can wrinkle and distort the underlying macula, impairing central vision. Most cases of symptomatic epiretinal membrane are repaired with vitreoretinal surgery.
Retinopathy of prematurity is a serious cause of blindness in some babies who are born prematurely. The retinal blood vessels do not develop completely until the ninth month of pregnancy. When babies are born prematurely, there is a region of the retina that has no circulation. Often the retinal blood vessels will continue to develop following birth and no problems will occur. However, in some patients abnormal blood vessels develop which cause scar tissue to grow into the eye. The scar tissue can pull on the retina causing it to detach from the wall of the eye. Although surgery can be performed on babies with retinal detachments, the prognosis for recovery of vision is very poor.
Penetrating ocular trauma represents a challenging problem due to the variety of potential injuries. Vitreous surgery techniques that were first developed for repair of damage caused by complications of diabetes can be used to repair many cases of ocular injury (penetrating ocular trauma). The timing of vitreous surgery for these problems is crucial. If the injury is severe, the eye is usually stabilized with an initial operation to close the laceration of the wall of the eye.
Retinal artery occlusion is a blockage in one of the small arteries that carry blood to the retina. Retinal arteries may become blocked by a blood clot or fat deposits that get stuck in the arteries. These blockages are more likely if there is hardening of the arteries (atherosclerosis) in the eye. Most commonly found in patients with carotid artery disease, diabetes, heart issues, high blood pressure, or temporal arteritis.
As part of the aging process, at some point in our life, the vitreous will shrink and separate from the back of the eye. Because the retina is an extremely thin and fragile structure, if the vitreous separation produces sufficient force, it can cause a break or tear in the retinal surface. This is often an urgent problem requiring prompt referral and treatment with laser or incisional surgery.
This inflammatory attack against oneself is directed at such sensitive structures within the eye that pain and loss of vision may occur. In severe cases if the inflammation is not halted blindness may occur. Uveitis is not a single disease, but rather can be triggered by a host of infections, autoimmune and malignant disorders.
Depending on which part of the eye is inflamed in uveitis, various combinations of these symptoms may be present: redness, light sensitivity, floaters, blurry vision, and pain. These symptoms may come on suddenly, and the patient may not experience any pain.
A retinal examination is the first step in diagnosing potential diseases. At NJRetina, we evaluate your retinas for any signs of abnormality, which may include performing diagnostic procedures such as fundus photography, fluorescein angiography, optical coherence tomography, and visual field. If a retinal disease is diagnosed, we use our expertise and rely on state-of-the-art equipment and technology to safely and accurately treat your disease.
Cryotherapy involves the application of a very cold probe to the outside of the eye, which, because of the thin nature of the eye wall (sclera), transmits the freezing temperature to the retina.
Like a laser, the intense cold stimulation to the retina can seal abnormal leaky retinal blood vessels or seal retinal tears. This technique is often preferable to laser in treatment of certain conditions in the far periphery (corners) of the retina, especially when problems such as vitreous hemorrhage or cataract obscure the passage of light into the eye, limiting the effectiveness of laser.
Cryotherapy is often performed in conjunction with surgical treatments for retinal detachment, such as pneumatic retinopexy.
The injection of medications such as bevacizumab (Avastin®), ranibizumab (Lucentis®), aflibercept (Eylea®), brolucizumab (Beovu®)), triamcinolone acetonide (Triescence®), dexamethasone steroid implant (Ozurdex®), has become common in the treatment of several retinal diseases include wet macular degeneration diabetic macular edema, diabetic retinopathy and macular edema secondary to retinal vein occlusion. Intraocular injection takes place in the doctor’s office and has a rapid recovery time. Common side effects including redness (bleeding) on the surface of the eye, transient irritation, and tearing.
Laser photocoagulation is a type of laser treatment to the retina performed in the office. The procedure may take a few minutes, or can last up to half an hour, depending on the type and extent of treatment needed. Most patients do not require a patch or medications following retinal laser and can resume normal activities immediately.
Different laser procedures are used in the treatment of specific retinal diseases:
Patients with disorders affecting the blood vessels of the macula, in particular diabetic retinopathy and retinal vein occlusion, often require focal macular laser treatment. The laser decreases the leakage from damaged blood vessels, helping to preserve normal retinal thickness and function. The procedure is painless and does not take long to perform.
When abnormal retinal blood vessel growth (neovascularization) occurs in diseases such as proliferative diabetic retinopathy or retinal vein occlusion, laser must be applied in a “scatter” pattern to large areas of the peripheral retina. These areas of the retina have poor blood flow (called ischemia) and are responsible for releasing growth factors that cause the neovascularization. Untreated, retinal neovascularization often leads to bleeding in the eye (vitreous hemorrhage), traction retinal detachment, and/or neovascular glaucoma.
After laser is applied, the blood vessels tend to stabilize or regress. Since this treatment affects the function of the retinal periphery, some patients will experience decreased peripheral and night vision. The size of the pupil and the central vision may also be affected in some patients.
Although these treatments have recently fallen out of favor following recent success with intravitreal injections, they remain an important component in the treatment of select patients and NJRetina is one of the few medical practices in NJ that currently offer them.
When a retinal tear or a small retinal detachment occurs, laser treatment may be applied to prevent further accumulation of fluid beneath the retina and minimize the risk of a vision-threatening retinal detachment. The laser is applied around the retinal defect. Over the course of a few weeks, the treated area develops a scar, which forms a tight seal between the retina and the underlying tissue. This procedure is sometimes performed around weak areas in the retina, such as lattice degeneration, in patients who may be at higher risk for retinal detachment. Laser retinopexy is often performed in conjunction with surgical treatments for retinal detachment, such as vitrectomy or pneumatic retinopexy.
Pneumatic retinopexy is an in-office method of repairing certain types of retinal detachment. It relies on an injection of a small amount of expansile gas into the vitreous cavity in the center of the eye. The gas bubble floats in the eye, and it can be positioned against the retinal tear responsible for the retinal detachment by having the patient hold his or her head in a certain position. This positioning prevents fluid from passing through the retinal defect, allowing the detachment to resolve. The bubble also presses the tear flat against the wall of the eye. Laser retinopexy and/or cryotherapy is often used in combination to produce a strong bond between the edges of the retina, where it was torn, and the wall of the eye.
After placement of the gas, the patient must maintain the appropriate head position for up to 1 week to allow maximum gas-retinal hole or tear contact. The intravitreal gas spontaneously dissolves several weeks after its placement, at which time the retina should be permanently reattached. In some cases, surgery may ultimately be required if a pneumatic retinopexy procedure is unsuccessful.
Retinal detachment is a serious eye problem that causes blindness if not treated. Some cases of retinal detachment can be repaired with scleral buckling surgery. This technique results in indentation of the eye wall, thereby closing the retinal breaks in the retina and flattening the retina against the wall of the eye.
Following successful retinal surgery, vision will be quite blurred at first and improve very gradually over a period of many months. Just how well you will be able to see depends upon the complexity of the problem before surgery and your body’s own capacity for healing. Be patient with your eyes and try not to expect too much too soon!
In most cases, an eye patch is necessary for only one day after surgery. However, if the patient feels more comfortable wearing a patch, it is not harmful to wear the patch for more than one day.
A vitrectomy, sometimes called vitreous surgery, refers to the removal of the vitreous gel from the eye. This procedure is performed in an outpatient operating room, using an operating microscope. There are several retinal disorders for which vitrectomy surgery may be the appropriate treatment including retinal detachment, epiretinal membrane, macular hole, and in select cases, vitreous floaters.
Detaching the vitreous gel from the retinal surface is an important part of macular hole surgery. In addition, there are frequently thin membranes on the retinal surface surrounding the hole that are peeled to release traction on the retina and allow the hole to close.
Perhaps the most important part of the surgery, however, is filling of the vitreous cavity with a bubble of gas. This gas bubble must press against the macular hole in order for the hole to close. Since the macula is located at the back of the eye, the eye should be looking downward in order for the bubble to float against it and exert the maximal amount of force.
For this to occur, the patient must remain in a facedown position after the surgery. For most patients, 5-7 days of facedown positioning is recommended. The macular hole can be closed with high success rates in modern-day surgery. This is usually accompanied by a significant improvement in vision and reduction of central visual distortion. Most patients, however, will not recover all the vision that was lost, and will recognize some limitations. The healing process can continue for 12-18 months following surgery, during which time cataract surgery may be needed if the patient did not have prior cataract surgery.
A macular pucker is caused by a thin membrane of scar-like tissue on the surface of the retina. After the vitreous gel is removed from the eye, small instruments are used to gently peel this tissue and remove it from the eye. Gas or air might be placed in the eye in order to help smooth out the retina and to prevent retinal detachment; some patients with macular pucker can also have retinal tears or a history of retinal detachment.
Successful peeling of the pucker from the retinal surface is almost always achieved, and this usually leads to visual improvement and reduced distortion. Many patients, however, still experience some distortion and limitation of the vision.
Vitrectomy is sometimes recommended in diabetics for the treatment of macular edema, vitreous hemorrhage, or traction retinal detachment. In some patients, membranes form on the surface of the retina. Traction from these membranes and from the vitreous gel may contribute to macular edema. Removing the vitreous and the membranes may therefore improve macular edema.
In more severe cases, the vitreous gel and the membranes on the retinal surface pull very forcefully on the retinal surface, causing elevation of the retina, or traction retinal detachment. Vitrectomy to remove the vitreous and the membranes allows the retina to flatten again.
When neovascularization causes vitreous hemorrhage, blood suspended in the vitreous gel obscures the vision. This blood often clears spontaneously, though it may take several months in some cases. If the hemorrhage is significant and does not clear in a reasonable amount of time, then vitrectomy to remove the blood-filled vitreous may be considered.
During vitrectomy in diabetics, panretinal photocoagulation laser treatment is often performed using a small fiber-optic inside the eye. Also, gas or air might be placed in the eye to help smooth out the retina and to prevent retinal detachment. If a bubble is used, then positioning after the surgery may be necessary.
Certain types of retinal detachment are treated with vitreous surgery. Examples include detachments with significant bleeding in the eye, detachments associated with cytomegalovirus retinitis or other infections, and detachments with traction from the vitreous gel or membranes on the retinal surface.
A scleral buckle may also be concurrently utilized in some cases. A gas or silicone oil bubble is used to fill the vitreous cavity and keep the retina in position while it heals. If a gas bubble is used, then positioning after the surgery is necessary, often for up to one week. Laser treatment applied during the surgery helps keep the retina permanently attached.
Vitrectomy may be necessary in certain patients with uveitis in order to obtain a specimen of the vitreous, which can then be evaluated in for diagnostic purposes. Vitrectomy can also improve vision by removing inflammatory debris and by improving macular edema. In addition, uveitis is sometimes more easily controlled once the vitreous gel is removed.
Some symptoms of retinal problems are common to various retinal diseases. This means that, before you are diagnosed, a particular symptom does not necessarily point to a specific retinal disease. Your retina specialist will be able to determine which retinal condition you are experiencing. It’s important to know that changes in vision in one eye may go unnoticed if the other eye has good vision and compensates for the eye with retinal challenges. That is just one reason both eyes need to be tested separately to detect any changes or issues.
Floaters are small moving spots in a person’s vision caused by shadows cast onto the retina. These shadows are created by cells or other material causing opacities (blockages of light) within the vitreous gel. Although these objects look to you like they are in front of your eye, in fact they are floating inside it. Floaters can have different shapes, such as dots, circles, or cobwebs. Floaters often develop later in life when the vitreous gel begins to shrink and to pull away from the back of the eye wall. This problem is called a posterior vitreous separation.
Continued shrinkage of the vitreous gel can cause a tugging or traction on the retina that produces intermittent flashes of light. A flash is a similar sensation to having been bumped in the eye and seeing “stars.” Any patient with a sudden new onset of floaters or flashes of light should have their retinas examined to determine what is causing these symptoms.
A thorough retinal examination should be undertaken to determine the cause of any new floaters or flashes, and to ensure that timely treatment is performed, in the event there is a retinal tear or detachment.
The macula is the center of the retina and is responsible for our central vision, which we use to read and recognize faces, for example. Many conditions affect the macula, such as age-related macular degeneration, diabetic macular edema, macular hole, and macular pucker.
Very often, the earliest symptoms produced by these conditions is a distortion of the vision, rather than visual loss. For example, a telephone pole might look curved or bowed rather than straight. A retinal specialist should evaluate new onset metamorphopsia as soon as possible. One can test themselves for metamorphopsia by using an Amsler grid at home.
Any sudden drop in a patient’s visual ability may be a symptom of any number of retinal diseases. If the disease process is located in the central portion of the retina, the patient will notice an inability to use the eye for reading or other detail-oriented tasks.
If the retinal pathology is in the corner of the retina, a patient will experience a gray or black “veil,” or curtain, obscuring any portion of the side vision. This symptom is especially significant if the area of peripheral vision loss appears to be moving towards the center, because it may be a sign of retinal detachment.
Prompt retinal evaluation is recommended.