Diagnostic Services

Heidelberg SPECTRALIS® OCT

Multi-modality imaging with SPECTRALIS is helping drive the development of novel therapeutics and changing the course of patient management in eye care. Using an upgradeable platform approach, SPECTRALIS has enhanced the role of spectral domain OCT by integrating it with confocal scanning laser ophthalmoscopy (cSLO). The combination of these two technologies has enabled new imaging capabilities, such as TruTrack™ active eye tracking and BluePeak™ blue laser autofluorescence, providing clinicians with unique views of the structure and function of the eye.

Video and Imaging Fluorescein and Indocyanine Green

The transition from static flash photography to dynamic video imaging opens up a new world of diagnostic detail and is especially helpful in recording the fill cycle. SPECTRALIS® FA can be combined with ICG angiography (ICGA), allowing the clinician to view both retinal and choroidal blood flow simultaneously. Clinicians can watch the dye coursing through the vessels and appreciate narrowing and partial blockage not always visible in static images.

Fundus Autofluorescence (FAF)

BluePeak autofluorescence captures fundus autofluorescence (FAF) images, providing both structural and metabolic information about the retina. Without the need for dye, non-invasive BluePeak™ blue laser autofluorescence imaging takes advantage of the natural fluorescent properties of lipofuscin. Lipofuscin is a key component of RPE metabolism. Abnormal accumulation of lipofuscin is associated with many retinal diseases. Characteristic autofluorescence patterns seen in BluePeak images can reveal the extent of geographic atrophy (GA).

It can also assist clinicians in determining the diagnosis and management of hereditary conditions such as Best disease and Stargardt disease. BluePeak imaging is a clinical endpoint in studies of emerging therapeutics for GA and is becoming an essential tool in the management of degenerative diseases of the retina.

ZEISS CIRRUS OCT with Anterior Segment Options

CIRRUS HD-OCT 500, for comprehensive care practices, offers essential OCT capabilities with a broad range of clinical applications in an easy-to-learn, easy-to-use instrument. It aids in the management of glaucoma and retinal disease, retinal assessment for cataract surgery, and anterior segment imaging for corneal disease.

Optos Retinal Imaging

The 200Tx device, designed specifically for general ophthalmologists and vitreoretinal specialists, offers multiple wavelength imaging including options for color, red-free, fluorescein angiography, and autofluorescence. With simultaneous non-contact pole-to-periphery views of more than 80%, or 200 degrees, of the retina in a single capture, the 200Tx helps clinicians discover more evidence of disease and guide their treatment decisions.

Accutome Ultrasound

The Accutome B-scan (ultrasound) system provides high definition quality ultrasound images of the posterior segment of the eye, allowing the physician to diagnose and evaluate certain retinal diseases.

Surgical Services

Retinal Detachment Repair

Almost all retinal detachments can be repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy. But even with a high rate of success for surgery, it is important to act quickly. The longer you wait to have surgery, the lower your chances of restoring good vision will be.

When the retina loses contact with its supporting layers, vision begins to get worse. An eye doctor (ophthalmologist) who specializes in retinal detachments will usually do surgery within a few days of your being diagnosed with a detachment.

How soon you need surgery usually depends on whether the retinal detachment has or could spread far enough to affect central vision. When the macula (the part of the retina that provides central vision) loses contact with the layer beneath it, it quickly loses its ability to process what the eye sees. Having surgery while the macula is still attached will usually save vision. If the macula has become detached, surgery may occur a few days later than it would have otherwise. Good vision after surgery is still possible but less likely.

Your doctor will decide how soon you need surgery based on the result of the retinal exam and the doctor’s experience in treating retinal detachment.

Scleral Buckling Surgery

Your eye doctor places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves pulling (traction) on the retina, preventing tears from getting worse, and it supports the layers of the retina.

Pneumatic Retinopexy

This is an effective in-office procedure for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is usually an outpatient procedure performed with local anesthesia.

During pneumatic retinopexy, the eye doctor (ophthalmologist) injects a gas bubble into the middle of your eyeball. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.

The bubble remains for about one to three weeks to help flatten the retina until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble.

Vitrectomy

This is an increasingly common treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble (SF6 or C3F8 gas) or silicone oil. An advantage of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks. Silicone oil (PDMS) needs to be removed after a period of two to eight months, depending on the surgeon’s preference. Silicone oil is more commonly used in cases associated with proliferative vitreoretinopathy (PVR).

A disadvantage to vitrectomy is that it always leads to more rapid progression of a cataract in the operated eye. In many places, vitrectomy is the most commonly performed operation for the treatment of retinal detachment.

Epiretinal Membrane Peel

The surgeon can remove or peel the membrane through the sclera and improve vision by two or more Snellen lines. Usually the vitreous is replaced at the same time with clear (BSS) fluid in a vitrectomy.

Surgery is not usually recommended unless the distortions are severe enough to interfere with daily living since there are the usual hazards of surgery, infections, and a possible retinal detachment. More common complications are high intraocular pressure, bleeding in the eye, and cataracts, which are the most frequent complication of vitrectomy surgery. Many patients will develop a cataract within the first few years after surgery. In fact, the visual distortions and diplopia created by cataracts may sometimes be confused with epiretinal membrane.

Click here for before and after images.

Macular Hole Repair

This surgery involves using tiny instruments to remove the vitreous gel that is pulling on the macula. The eye is then filled with a special gas or oil bubble to help flatten the macular hole and hold the retinal tissue in place while it heals.

Click here for before and after images.

Office Treatments

Intravitreal Injections

Avastin, Lucentis, Eylea, and Kenalog are all intravitreal (injected into the back of the eye) injections. These injections are the most used medical procedures in the United States. It is the best form of treatment for exudative (wet) AMD, diabetic retinopathy, retinal vein/artery occlusions, and choroidal neovascular membrane (secondary to many retinal conditions).

Avastin, Lucentis, and Eylea are all “anti-VEGF” medications. VEGF (Vascular Endothelial Growth Factor) is what makes new blood vessels (neovascularization) that aren’t supposed to be there. These intravitreal injections are to stop or slow that process down.

Kenalog is a steroid injection used to treat macular edema. Conditions such as diabetes, uveitis, and vein occlusions can cause swelling in the macula (the center of the retina responsible for your pinpoint vision). If the swelling does not go down with steroid drops, your doctor may use Kenalog to help treat the swelling.

Panretinal Photocoagulation and Barrier and Focal Lasers

The Pascal laser system is a unique tool that controls laser delivery in four ways, enabling greater precision and control at the tissue level. With the Pascal system, we can help treat retinal tears with the Barrier laser. For proliferative diabetic retinopathy, we can help manage the new blood vessel growth by using the panretinal photocoagulation method. We are also able to laser more focalized areas with the Focal laser method for isolated incidents.

Pneumatic Retinopexy

This is an effective in-office procedure for certain types of retinal detachments. It uses a bubble of gas to push the retina against the wall of the eye, allowing fluid to be pumped out from beneath the retina. It is usually an outpatient procedure performed with local anesthesia.

During pneumatic retinopexy, the eye doctor (ophthalmologist) injects a gas bubble into the middle of your eyeball. Your head is positioned so that the gas bubble floats to the detached area and presses lightly against the detachment. The bubble flattens the retina so that the fluid can be pumped out from beneath it. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.

The bubble remains for about one to three weeks to help flatten the retina until a seal forms between the retina and the wall of the eye. The eye gradually absorbs the gas bubble.

Cryopexy

This is used to fix tears in the retina and prevent a retinal detachment. This method works well to treat certain retinal tears, but some people will need future treatment for a tear in another part of the retina.

Endophthalmitis Management

Endophthalmitis is an inflammation of the internal coats of the eye. It is a possible complication of all intraocular surgeries, particularly cataract surgery, possibly resulting in loss of vision and the eye itself. Infectious etiology is the most common, and various bacteria and fungi have been isolated as the cause of endophthalmitis. Other causes include penetrating trauma and retained intraocular foreign bodies.

An endophthalmitis patient needs urgent examination by an ophthalmologist and/or vitreo-retina specialist. A specialist will usually decide on urgent intervention, providing an intravitreal injection of potent antibiotics and preparing for an urgent pars plana vitrectomy as needed. In severe cases, enucleation may be required to remove a blind and painful eye.