Optical Coherent Tomography
Photographic tests called fluorescein angiography or optical coherence tomography may be done in order to determine the extent of the damage on the underlying retina.
A fluorescein angiogram is a test where sodium fluorescein dye is injected into the veins of your hand or arm and a series of photographs are taken of your retina. The dye is not x-ray dye, and no x-rays are taken. Rather the dye is a photographic dye and only photographs are taken. The fluorescein angiogram allows the physician to evaluate the blood vessels in the retina as well as the retinal layer and the layer underneath the retina. Patients who undergo a fluorescein angiogram often get a mild yellow discoloration of their skin. The fluorescein dye is eliminated from the patient's body through the urine, which is discolored for up to 24 hours following the test. The test is generally safe, however, rarely problems, such as allergies to the medication, can occur. Patients who are allergic to x-ray dye are not necessarily allergic to sodium fluorescein. Optical coherence tomography is a newer test which bounces light waves off the retina to obtain an image of the retina in cross section. Optical coherence tomography uses light waves to image the retina very much like sonar waves are used to image the ocean floor. No dye is injected for optical coherence tomography.
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An epiretinal membrane, also called a macular pucker, is a thin layer of tissue that forms over the macula, the area of the retina that gives us clear central and reading vision.
Epiretinal membranes often develop on their own as a part of the natural aging process. Particles that have drifted into the vitreous (the gel that fills the eye) settle onto the macula and begin to obscure vision. Membranes may also result from eye conditions or diseases such as retinal detachment, inflammation, injury or vascular conditions. These are called secondary epiretinal membranes, whereas spontaneously formed membranes are called idiopathic.
Many epiretinal membranes do not disrupt vision. Thicker membranes, however, can create wrinkles or puckers in the macula, and small blurry or distorted areas in the center of vision may appear. Vision loss increases as the membrane thickens. Peripheral vision is not affected, and there is no risk of blindness.
Some epiretinal membranes heal on their own. For those that do not, surgery is recommended. The procedure is outpatient with local anesthesia. A vitrectomy is performed to remove the vitreous gel, a saline solution fills the eye and then the membrane is lifted from the macula. The visual results are usually very satisfying.
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Fluorescein angiography is the practice of taking photographs of blood vessels inside the eye (an angiogram) with the help of a contrast dye (fluorescein dye). These pictures help doctors evaluate the retina and diagnose 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.
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Patients with diabetes are at an increased risk of developing eye diseases that can cause vision loss and blindness, such as diabetic retinal disease (diabetic retinopathy), cataracts and glaucoma. These and other serious conditions often develop without vision loss or pain, so significant damage may be done to the eyes by the time the patient notices any symptoms.
People with diabetes sometimes have no symptoms until it is too late to treat them. The retina may be badly injured before there is any change in vision. Because diabetic retinopathy often has no symptoms, if you have any form of diabetes you should have your eyes examined regularly by an ophthalmologist. For this reason it is very important for diabetic patients to have their eyes examined once a year.
Diagnosing and treating eye disease early can prevent vision loss. It is also important to maintain a steady blood-sugar level, maintain normal blood pressure, have your cholesterol level evaluated (and treated if elevated), take prescribed medications, follow a healthy diet, exercise regularly and avoid smoking.
If you have diabetes, your body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina. Diabetic retinopathy is a complication of diabetes caused by changes in the blood vessels of the retina.
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The macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Macular degeneration causes a progressive loss of vision. It is the number-one cause of blindness in the U.S.
There are two kinds of macular degeneration: "wet" and "dry." The "wet" form can be treated in its early stages. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.
Symptoms often associated with macular degeneration include:
- A gradual loss of ability to see objects clearly
- A gradual loss of color vision
- Distorted vision
- A dark or empty area appearing in the center of vision
There are two main types of macular degeneration. The dry form tends to progress slowly but can result in significant loss of vision. Vitamin supplements may be helpful in slowing down the progression of the dry form. The wet form is the more devastating, more rapidly progressing form. Two new medications have become available in the last year that has offered new hope. They are Avastin® and Lucentis®. Both drugs are injected into the eye. For the first time we have a treatment that can not only stabilize vision in patients, but can actually improve vision in a significant number of people. Dr. Kraut offers these new treatments in office. Other options available in order to maintain a satisfying lifestyle include the prescription of optical devices. Since macular degeneration usually does not affect side vision, the remaining sight can be useful. There are support services and rehabilitation programs available as well.
- For more information, visit Avastin® website at Avastin.com
- For more information, visit Lucentis® website at Lucentis.com
- For more information, visit MACUGEN® website at Macugen.com
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Photodynamic therapy is another intervention that may be used in combination with anti-angiogenic therapy in the treatment of patients with wet AMD. Visudyne® is a light sensitizing drug that is injected intravenously into the patient. The drug accumulates in the abnormal blood vessel complex under the retina in the individual with neovascular AMD. A special laser is then used to "excite" the drug, causing a photochemical reaction that results in the hopeful closure of the abnormal blood vessel network. Various protocols are being developed to investigate the potential role of using both anti-angiogenic therapy and photodynamic therapy to maximize the efficacy of treatment in patients with wet AMD.
- For more information, visit Visudyne® website at visudyne.com
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