Professional Eye Care Providers Serving Pittsburgh, PA

At Chang Eye Group, we take eye health very seriously and want to do what we can to help keep your eyes in top shape. If you have had previous eye problems or if you are experiencing new eye pain or vision problems, contact us today.

Retina Surgery and Treatments for Retina Vitreous

What Is the Retina and What Does It Do?

The retina is a thin layer of tissue that lines the back of the eye on the inside. The center of the retina (called the macula) is located near the optic nerve, and the peripheral retina extends along the inside of the eye. The purpose of the retina is to receive light that converts into signals and then these signals are sent to the brain for visual recognition.

Signs of Retinal Damage

Any of these symptoms may indicate that you have retinal damage, but only a trained eye doctor can diagnose:

• Flashes of lights
• Sudden increase of floaters
• Shadow or curtain in vision
• Gradually reduced side (peripheral) vision
• New grey spots, strings, or spider webs

Treatments for Retina Vitreous Problems

Our retinal specialist can perform some procedures and treatments in our offices. Other procedures may require an outpatient surgery hospital.

There are a number of surgical options that your surgeon may consider:

• Intravitreal injections: During this procedure, your doctor injects medicine into the vitreous, which is the central space inside the eye. Injections are used to treat several retinal conditions including macular degeneration, macular edema, and retinal vein occlusions.
• Laser treatment: Non-invasive laser treatment is used to treat several conditions including diabetic retinopathy, to limit scarring from wet macular degeneration, or treat retinal tears to prevent retinal detachments. Laser treatment is commonly performed in the office.
• Cryotherapy: Cryotherapy may be used to treat retinal detachments and tears. Cryotherapy freezes and seals abnormal “leaky” blood vessels or retinal tears.
• Scleral buckling: The scleral buckling procedure is commonly used to treat retinal detachment and is completed in a hospital setting. A scleral buckle is placed around the eye and helps to hold the retina in place.
• Pneumatic Retinopexy: Pneumatic Retinopexy is used to repair a retinal tear and detachment. During this procedure, a gas bubble is injected into the vitreous cavity which helps seal the tear and reattach the retina.
• Vitrectomy: Vitrectomy is commonly performed for vitreous hemorrhage, diabetic retinopathy, macular hole, epiretinal membrane, or retinal detachments. During this procedure, which is performed in the operating room, your doctor uses microsurgical instruments to remove the vitreous gel and treat the retinal problem that is affecting vision.
  

Detect and Manage Age-Related Macular Degeneration

Macular Degeneration affects the eye’s macula, which is a small area in the light-sensitive retina, in the back of your eye, which is responsible for your good central vision. There are different kinds of macular problems, but the most common is age-related macular degeneration (AMD).

The macula makes up only a small part of the retina, yet it is much more sensitive to detail than the rest of the retina (called the peripheral retina). The macula is what allows you to thread a needle, read small print, and read street signs. The peripheral retina gives you side (or peripheral) vision.

AMD symptoms include blurriness, dark areas, or distortion in your central vision. It usually does not affect your peripheral vision. For example, with advanced AMD, you could see the outline of a clock, yet may not be able to read the hands of the clock to tell what time it is. While it is a serious eye condition, AMD almost never causes total blindness. Even people with advanced cases retain useful peripheral vision. In many cases, macular degeneration’s impact on your vision can be minimal.

Early detection of AMD is helpful. Many people are not aware that they have AMD until it is detected during an eye examination – this is one important reason for older people to have regular comprehensive eye exams at Chang Eye Group.

Types of Macular Degeneration 

There are two types of macular degeneration:

1. Dry, or Atrophic, Macular Degeneration with Drusen – Most people who have AMD have the dry form. This condition is caused by aging and thinning of tissues of the macula. AMD usually begins when tiny yellow or white pieces of fatty protein form under the retina called drusen.

With dry AMD, vision loss is usually gradual; you should carefully and constantly monitor your central vision. Report any changes in your vision to your eye doctor, as the dry form can change into the more damaging form of macular degeneration called wet (exudative) macular degeneration. While there is no medication to prevent dry macular degeneration, some people may benefit from taking a supplement specifically formulated for AMD patients. This is AREDS II formulation.

2. Wet, or exudative, macular degeneration – About 10 percent of people who have AMD have the more damaging wet form. Wet macular degeneration occurs when abnormal blood vessels begin to grow underneath the retina. This blood vessel growth is called choroidal neovascularization (CNV). These new blood vessels may leak fluid or blood, blurring or distorting central vision.

The longer these abnormal vessels leak or grow, the more risk you have of losing vision. Also, if abnormal blood vessel growth happens in one eye, there is a risk that it will occur in the other eye. The earlier that wet macular degeneration is diagnosed and treated, the better chance you have of preserving some or much of your central vision. That’s why it is so important that your Change Eye Group doctor monitor your vision in each eye carefully.

Treating the wet form of macular degeneration may involve the use of anti-VEGF injections. Treatment of wet macular degeneration often reduces the risk of severe vision loss.

Test Your Vision Using an Amsler Grid

If you have been diagnosed with dry macular degeneration, you should use a chart called an Amsler grid every day to monitor your vision, as dry macular degeneration can change into the more damaging wet form.

To use the Amsler grid:

• Wear your reading glasses and hold the grid 12 to 15 inches away from your face in good light
• Cover one eye
• Look directly at the center dot with the uncovered eye and keep your eye focused on it
• While looking directly at the center dot, note whether all lines of the grid are straight, or if any areas are distorted, blurry, or dark
• Repeat this procedure with the other eye
• If any area of the grid looks wavy, blurred, or dark, contact your ophthalmologist
• If you detect any changes when looking at the grid, you should notify Chang Eye Group immediately
  

Diabetic Eye Diseases and Treatments

What is Diabetic Eye Disease?

Diabetic patients have a higher risk for eye disease as a complication of diabetes. We call this Diabetic Eye Disease. If you have diabetes, you are at risk for Diabetic Retinopathy, Cataract, and Glaucoma.

Diabetic Retinopathy

Diabetic Retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults under the age of 60. It is caused by changes in the blood vessels of the retina.

In some people with diabetic retinopathy, blood vessels may swell and leak fluid. In other people, abnormal new blood vessels grow on the surface of the retina. The retina is the light-sensitive tissue at the back of the eye, and a healthy retina is necessary for good vision.

Who is at Risk for Diabetic Retinopathy?

People with diabetes – both type 1 and type 2 – are at risk. That’s why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. The longer you have diabetes, the more likely you will develop Diabetic Retinopathy.

During pregnancy, Diabetic Retinopathy may be a problem for women with diabetes. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Your doctor may recommend additional exams during your pregnancy.

How to Protect Your Vision

• If you have diabetes, get a comprehensive dilated eye exam at least once a year.
• If you already have diabetic retinopathy, you may need an eye exam more often.
• Control your blood sugar. Better control of blood sugar levels slows the onset and progression of retinopathy. The people with diabetes who kept their blood sugar levels as close to normal as possible also had much fewer kidney and nerve diseases. Better control also reduces the need for sight-saving laser surgery.
• Studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Controlling these will help your overall health, as well as help, protect your vision.

Stages of Diabetic Retinopathy

1. Mild non-proliferative retinopathy – At this earliest stage, micro-aneurysms occur. They are small areas of balloon-like swelling in the retina’s tiny blood vessels. Generally, there are no symptoms with this stage of retinopathy.
2. Moderate/severe non-proliferative retinopathy – This is a stage where the micro-aneurysms begin to leak fluid or exudates. This can impair a patient’s vision.
3. Severe non-proliferative retinopathy – In severe cases, many more blood vessels are blocked, depriving several areas of the retina of their blood supply. These areas of the retina send signals to the body to grow new blood vessels for nourishment.
4. Proliferative retinopathy – As the disease progresses, some blood vessels that nourish the retina are blocked. At this stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels. This condition is called Proliferative Retinopathy. These new blood vessels are abnormal and fragile. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. By themselves, these blood vessels do not cause symptoms or vision loss. However, they have thin, fragile walls. If they leak blood, severe vision loss and even blindness can result.

How is Diabetic Retinopathy Treated?

During the early stages of Diabetic Retinopathy, no treatment is needed, unless you have macular edema. To help prevent the progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. The treatment for macular edema is with focal laser treatment and/or anti-VEGF injections.

Proliferative retinopathy is treated with laser surgery. This procedure is called Pan Retinal Photo Coagulation (PRPC). PRPC laser treatment helps to shrink the abnormal blood vessels. Two or more sessions usually are required to complete treatment. Although you may notice some loss of your side vision, PRCP treatment can save the rest of your sight.

PRCP laser treatment works better for the fragile, new blood vessels that have started to bleed. That is why it is important to have regular, comprehensive dilated eye exams. Even if bleeding has started, PRCP treatment may still be possible, depending on the amount of bleeding.

If the bleeding is severe, you may need a surgical procedure called a vitrectomy, which removes blood from the center of your eye. During your evaluation, your doctor will discuss any surgical options or treatments that may be necessary.

Glaucoma and Its Treatments

Understanding Glaucoma

Glaucoma is often called “the silent thief” because Glaucoma can steal your vision, without any warning or symptoms. Of the estimated three million Americans who have glaucoma, only about half are aware they have it. Glaucoma does not cause pain and the damage to your eyesight progresses slowly.

This is one of many reasons why annual eye exams are vital. Glaucoma should be evaluated by your eye doctor, during an eye examination when testing reveals elevated intraocular pressure (IOP) or cupping of the optic nerve.

What Is Cupping of the Optic Nerve?

The optic disc has a center portion called the “cup” which is normally quite small compared to the entire optic disc. In people with glaucoma damage, because of increased pressure in the eye and/or loss of blood flow to the optic nerve, these nerve fibers begin to die.

This causes the cup to become larger in comparison to the optic disc, since the support structure is not there. Optic nerve cupping progresses as the cup becomes larger in comparison to the optic disc.

What Causes Glaucoma?

Glaucoma damages the eye’s optic nerve, which is made up of many nerve fibers, like an electric cable is made up of many wires. The optic nerve connects your retina, where images are projected, to your brain, where the images are interpreted. Elevated IOP damages the fibers in the optic nerve, and if left untreated, this causes blindness.

The precise cause of glaucoma is unknown. A family history of glaucoma raises your risk of developing the disease. Other risk factors include age, African or Hispanic ancestry, past eye injury, and conditions that affect blood flow (migraines, diabetes, low blood pressure).

Early detection of glaucoma and treatment with eye drops, surgery, or both, can slow the progression of glaucoma and preserve the vision you have. There are five simple steps that are essential to managing glaucoma:

1. After the age of 40, have yearly eye examinations that include the measurement of IOP.
2. If you are found to have elevated IOP, follow the doctor’s treatment plan to control it.
3. Continue to have your IOP measured at intervals recommended by your doctor.
4. If surgery is indicated, don’t delay it, and follow the surgeon’s instructions.
5. Continue to follow your doctor’s recommendations for monitoring and treating glaucoma.

Surgical Treatment

While most of the time glaucoma is managed with eye drops that lower IOP, surgery may be recommended for other patients. Glaucoma surgery improves the flow of fluid out of the eye, lowering IOP and can lessen the need for prescription eye drops.

In the eye, a clear fluid circulates inside the front portion. To maintain a constant healthy eye pressure, the eye continually produces a small amount of this fluid, (called aqueous humor) while an equal amount of this fluid flows out of your eye. If you have glaucoma, the aqueous humor does not flow out of the eye properly, elevating the IOP.

There are a number of surgical options that your surgeon may consider:

• SLT Laser: In Selective Laser Trabeculoplasty(SLT), the surgeon uses a low-level energy laser to target specific cells in the mesh-like channels where fluid flows out of the eye. Using very short applications of light, the surgeon enlarges the openings so fluid will flow more readily. The treatment has been shown to lower IOP. The advantage of this laser procedure is that if the pressure elevates the procedure can be repeated.
• YAG PI Laser: This type of laser is used to perform a peripheral iridotomy, which is a treatment for a specific type of glaucoma called narrow angle glaucoma. The surgeon uses the YAG laser to create a small hole at the edge of the iris (the colored part of your eye). This improves the flow of fluid (aqueous humor) through the eye’s internal drainage system. Sometimes this lowers IOP, but the primary goal of this procedure is to reduce the risk of narrow-angle glaucoma.
• Trabeculectomy: In Trabeculectomy, a small flap is made in the outer white coating of your eye. A reservoir, called a bleb, is created. The bleb looks like a bump or blister on the white part of the eye above the iris, but the upper eyelid usually covers it. The fluid (aqueous humor) can now drain through the flap made in the sclera and collect in the bleb, where the fluid will be absorbed into blood vessels around the eye. IOP is effectively controlled in three out of four people who have trabeculectomy. If the new drainage channel closes or too much fluid begins to drain from the eye, additional surgery may be needed.
• Tube Shunt Procedures: If trabeculectomy cannot be performed, tube shunt procedures usually are effective in lowering IOP. A shunt is a small plastic tube or valve connected on one end to a reservoir. The shunt is implanted in the eye through a tiny incision. The shunt redirects fluid to an area beneath your eye. The fluid is then absorbed into the blood vessels. When healed, the reservoir is not easily seen unless you look downward and lift your eyelid.
• iStent: The iStent Trabecular Micro-bypass, a revolution in glaucoma surgery, is implanted at the time of cataract surgery. The iStent is clinically proven to reduce eye pressure in adult patients with both cataracts and mild-to-moderate open-angle glaucoma. This device is the smallest medical implant known to be implanted in the human body. In U.S. trials, iStent was shown to be effective in decreasing IOP, with an excellent safety profile, few complications, fast recovery time, and has been implanted in over 100,000 eyes around the world.

Additional Eye Care

Laser Procedures

Laser procedures are usually performed in the doctor’s office. For comfort during the procedure, an anesthetic eye drop is often all that is necessary. The laser is a very bright, finely focused light. It can pass through certain parts of the eye without affecting them in any way, and have a specific effect on the targeted tissue.

Capsulotomy

In some cases, several months or years after cataract surgery, the part of the lens covering that supports the intraocular lens can become cloudy. If this occurs and blurs your vision, the doctor will use a laser to make an opening in the center of the cloudy capsule to allow light to pass through the lens properly again. This procedure takes less than five minutes and requires no recovery period.

Trabeculoplasty

This surgery is used to treat open-angle glaucoma. This is performed by Selective Laser Trabeculoplasty (SLT).

With SLT, a laser is used at different frequencies, allowing it to work at very low levels. SLT treats specific cells and leaves the mesh-like drainage canals surrounding the iris intact. SLT may be an alternative for those who have been treated unsuccessfully with traditional laser surgery or with pressure-lowering drops.

Even if laser trabeculoplasty is successful, patients can continue taking glaucoma medications after surgery. Many people who have had a successful laser trabeculoplasty may need a repeat treatment in the future.

Iridotomy

This procedure is recommended for people who have a type of glaucoma called closed-angle glaucoma. The doctor uses a laser to create a small hole about the size of a pinhead through the top part of the iris to improve the flow of aqueous fluid to the drainage angle. This hole is hidden from view by the upper eyelid.

Possible Eye Procedure Complications

As with any surgical procedure, there are risks associated with scatter laser treatment, and vitrectomy. Each eye in each situation is unique, and you should discuss the various options available to you to determine which of these options would be ideal for your situation.

Any and all surgical procedures should be taken seriously. Even after the doctor has answered any questions you might have, you should take some time and think it over before committing to surgery.

If you’re interested in having these kinds of surgeries and want to discuss your options with one of our highly-qualified ophthalmologists, get in touch with Chang Eye Group.