Retina & Vitreous Consultants of Virginia, P.C.

Products And Services

• Diabetic Retinal Disease

  Diabetic Retinopathy Diabetic retinopathy is the most common eye complication of diabetes and is a leading cause of blindness in adults. Diabetic retinopathy develops as a result of chronic elevation of blood sugars which then damages the internal lining of small retinal blood vessels. Damaged retinal blood vessels then are prone to leaking. This can lead to macular edema and vision loss. As blood vessels get progressively damaged from elevated blood sugars, these retinal vessels can also become blocked. This leads to a depletion of good blood flow to the retina. The retina then releases chemical signals to grow new blood vessels to feed itself (Proliferative Diabetic Retinopathy). However, these new blood vessels themselves are fragile and prone to breaking which can then cause vitreous hemorrhages and sometimes severe loss of vision. Tractional Retinal Detachments can also result from growth of these abnormal blood vessels. Patients who develop diabetic retinopathy may initially not notice any change in their vision. But in its advanced stages, the disease can cause blurred or cloudy vision, floaters and blind spots – and, eventually, blindness. This damage may become irreversible without treatment. Early stages of diabetic retinopathy do not usually require any treatment but patients must keep strict control of their blood sugar level to prevent the disease from progressing. If the disease does progress, treatment by a retinal specialist may be necessary to preserve your vision. The two most important causes of vision loss are now discussed below. Diabetic Macular Edema Treatment for diabetic macular edema typically involves one of the following options: observation alone with better control of blood sugars, ocular injections of medications, or the use of a laser. If a patient has significant macular edema, then injectable medications can slow or halt the release of fluid out of injured diabetic retinal blood vessels and thereby reduce macular fluid. Available anti-VEGF drugs that do exactly this include: Avastin™ (off-label), Lucentis™ , Eylea™ and intra-ocular steroid injections (Ozurdex™, Iluvien™). Avastin™ , Lucentis™ , and Eylea™ may require initial monthly injections to reduce diabetic macular edema and hence allow the macula to dry and see better. We are also pleased to offer the novel anti-VEGF and anti-Angiopoetin 2 drug, Vabysmo™ , for treatment of Diabetic Macular Edema. Because diabetes itself is a chronic disease, steady ongoing retinal therapy may be needed to prevent you from experiencing vision loss over time. Our retinal practice can discuss the risks and benefits of injectable therapies. Diabetic Macular Edema with Cholesterol Deposits Another category of treatment for diabetic macular edema is: LASER. During this procedure, small laser spots are placed in the macula to limit leakage from damaged capillaries and also stimulate the removal of fluid out of the retina. The reduction in macular fluid will improve the function of the retina and help prevent vision loss and, in certain patients, even improve vision. Focal laser treatment is performed in our office under topical anesthesia and repeat treatments may be necessary to stabilize your disease. Dr. Ilyas was one of the first retina surgeons in the region to offer a unique macular laser called "Micropulse Laser Therapy" (Iridex IQ 577 ™) for treatment of diabetic macular edema. Micropulse Laser can be useful to treat patients with Diabetic Macular Edema while preserving the health and well-being of the macular tissue. Micropulse laser works by chopping a continuous wave of laser into tiny low energy pulses with rest periods in between that spares the retina injury while treating the macular edema and reducing it. The idea of a "gentler" laser therapy for treating diabetic macular edema as opposed to conventional thermal laser has generated a lot of interest in exploring this as a unique therapy for some mild cases of diabetic macular edema or even as an adjunctive therapy that can be coupled with injections of medications (see above) for even greater benefit on treating diabetic macular edema. Micropulse Laser therapy is also utilized in the treatment of several other retinal diseases including Central Serous Retinopathy. Dr. Ilyas has extensive experience in the use of the Micropulse Laser from Iridex. Proliferative Diabetic Retinopathy Treatment of Proliferative Diabetic Retinopathy often involves use of injections of medications into the eye (see diabetic macular edema drugs) and also the application of laser surgery called Pan-retinal or Scatter Laser Treatment. The laser treatments are used to shrink the newly developed blood vessels by applying laser burns in the peripheral retina. Scatter laser treatment is most effective before newly grown blood vessels have started to bleed, and may slightly reduce patients' color and night vision, while preserving your central vision.

  Link: Diabetic Retinal Disease

• Macular Degeneration

  Macular degeneration, also known as age-related macular degeneration (AMD) is a common condition in older adults and the leading cause of vision loss and blindness in people over the age of 65. Macular degeneration affects the macula, the part of the retina responsible for the crisp, detailed vision needed for reading or driving. As we age, the tissue in the eye responsible for central vision slowly begins to deteriorate which can significantly affect a patient's quality of life. Types Macular degeneration can be classified as either wet (neovascular) or dry (non-neovascular). Dry macular degeneration is the more common diagnosis, and is considered to be an early stage of the disease. This type of the disease usually develops as a result of aging and thinning of macular tissues and the depositing of pigment within the macula. Only about 10% of patients see their condition progress to the more advanced and damaging wet macular degeneration. In wet macular degeneration, new blood vessels develop beneath the retina and cause a leakage of blood and fluid. This leakage can lead to permanent damages in the central vision and the creation of blind spots. Although less common, wet macular degeneration accounts for 90% of the blindness caused by all cases of this condition. In addition, about 43 percent of people with wet AMD in one eye progress to wet AMD in both eyes within five years. A retina specialist can detect the earliest signs of Wet Macular Degeneration in the opposite eye and render treatment to save vision. Symptoms Patients with macular degeneration may notice gradual changes to their vision, including shadowy areas in the central vision, or fuzzy and distorted vision. These areas grow larger as the disease progresses, and can eventually turn into blind spots. Patients may also have difficulty seeing color and fine details. If the disease progresses to the wet form, patients may also see straight lines as wavy. With wet macular degeneration, central vision loss can occur rapidly, sometimes in as little as a few days or weeks. Example of Wet Macular Degeneration Your doctor may be able to detect early signs of macular degeneration, before any symptoms occur, through a regular eye exam. Any signs of this condition can be further confirmed by testing your central vision with an Amsler grid test. Regular eye exams are important in detecting macular degeneration and other serious eye conditions as early as possible, so that permanent side effects can be avoided. Causes And Risk Factors Many cases of macular degeneration are a result of aging and the natural deterioration of the eye tissue that is needed for clear vision. This disease can also be related to a genetic factor in patients who have a gene variant known as complement factor H. Nearly half of the blinding cases of macular degeneration are linked to this genetic deficiency. Macular degeneration is most common in females and whites, and the risk for all patients increases with age. This condition is the leading cause of blindness in the US for patients over the age of 65. Over 14% of adults between the ages of 70 and 79 have been diagnosed with advanced or intermediate age-related macular degeneration. Other factors that may increase your risk of macular degeneration include: Smoking Heredity High fat diet Prolonged sun exposure High blood pressure Early Menopause Patients can minimize their risk of macular degeneration by practicing a healthy, active life and getting regular eye exams. It is important for all patients to exercise regularly, avoid smoking, and eat a balanced diet that includes foods known to preserve vision and prevent eye diseases. Treatment While there is no cure for macular degeneration, there are several cutting edge treatments available to help patients manage the Wet (leaking) form of Macular Degeneration and help preserve their vision. At Retina & Vitreous Consultants, we carefully select a treatment regimen that is tailored to your disease. We then carefully follow your macula's response to treatment using state-of-the art OCT (Optical Coherence Tomography) imaging. In particular, our technology allows us to compare the exact same points in the macula from visit to visit so we can know that the fluid in your macula is truly disappearing. We use the latest therapies for wet macular degeneration. These injectable drugs work by stopping the abnormal blood vessel growth of wet macular degeneration and thereby halting the accumulation of fluid and blood under the retina which can lead to permanent scarring and vision loss. These medications are injected into the vitreous of the affected eye on a monthly basis to control the damaging effects of wet macular degeneration. Multiple treatments are often needed to stabilize the acute disease.

  Link: Macular Degeneration

• Branch and Central Retinal Vein Occlusions

  Retinal Vein Occlusions Blood and nutrient circulation to and from the surface of the retina is mostly done through one vein and one artery. If these circulatory passages or any of the smaller branches connected to them are blocked, blood flow coming into or leaving from the retina can become seriously disrupted. Blockage of one of these passages is known as "occlusion", and can result in sudden vision loss. The retinal veins (either the Central Retinal Vein or one of its Branches) all carry blood away from the retina, and when blocked, will cause back-up of blood flow and damage to the feeding vessels behind them. Retinal vein occlusions cause: Intra-retinal Bleeding, Macular Swelling, and sometimes the growth of abnormal new blood vessels (Neovascularization) due to poor incoming blood flow (ischemia). These abnormal new blood vessels can in turn lead to: vitreous hemorrhages (floaters), tractional detachments of the retina, and forms of severe glaucoma. Retinal vein occlusions are the second most common cause of blood vessel-related vision loss (the first is diabetic retinopathy). The condition occurs most often in men and women over the age of 50, particularly those in their 60s and 70s. Risk factors include high blood pressure, high cholesterol, diabetes, smoking, glaucoma, and, rarely, blood clotting and inflammatory conditions. Although there is no cure for retinal vein occlusions, there are several treatment options that can address some of the eye complications that can arise from this disease. For macular swelling or edema, use of Lucentis™, focal laser treatment, and/or the off-label use of Avastin™ may help treat this complication and in certain cases improve vision but only in the right group of patients. Injectable treatments are often chronically needed and a regimen of every 4 week injections of Lucentis or Avastin may be needed to control the leakage of fluid into the macula. We are pleased to offer two novel FDA-approved therapies to treat vision-threatening macular edema from retinal vein occlusions. The first is Ozurdex™ , a dexamethasone steroid implant whose main benefit may be its prolonged duration of effect. The other is Eylea™ , which is approved for Central Retinal Vein Occlusion-related Macular Edema. At Retina & Vitreous Consultants, we pride ourselves on offering the latest cutting edge medical therapies for challenging retinal diseases such as this one. For new blood vessel growth, use of scatter laser photocoagulation can prove critical in treating neovascularization and preventing the most serious complications of Retinal Vein Occlusions. To learn more about retina and vitreous diseases and cutting-edge treatments available to you, please call 540-662-1810 today to schedule a consultation. Basic Anatomy The back of the eye is lined with a thin layer of nervous tissue containing millions of photoreceptor (light-sensitive) cells called rods and cones. This is the retina, where light rays are brought to a fine focus after travelling through the front parts of the eye. The retina, through a series of reactions, then converts the light it receives into an electrical signal that travels down the optic nerve to the back of the brain, where vision is ultimately formed. In the more posterior area of the retina lies the macula, responsible for giving us clear central vision. The macula is less than 1/4 of an inch in diameter and harbors a central depression called the fovea centralis, which gives us the most detailed and finest vision of objects or people. Lying in front of the retina rests the vitreous body or gel, a clear gel through which light is meant to pass through, undisturbed, on its way to the retina.

  Link: Branch and Central Retinal Vein Occlusions

• Floaters and Flashes of Light

  Floaters and flashes are symptoms of the eye that commonly occur as a result of age-related changes to the vitreous gel. When we are born, the vitreous is firmly attached to the retina and is a thick, gelatinous substance without much movement. But as we age, the vitreous becomes thinner and more watery, and tissue debris that was once secure in the firm gel can now move around inside the eye, casting shadows on the retina or floaters. These changes are generally well-tolerated. In some patients, however, flashes and floaters are a more ominous sign and can appear as the vitreous suddenly pulls loose from the retina and tears the retina. Thus, anyone presenting with sudden onset of floaters and flashes of light may in fact have a retinal detachment, retinal tear, or simply a posterior vitreous detachment (PVD). A Retina specialist through a detailed exam can pick up on these problems and render emergency treatment of these problems before vision is lost. What Are Eye Floaters? Floaters in the vision can represent clumps of cells in the vitreous cavity (blood, inflammation) or more commonly they represent normal age-related degeneration of the vitreous gel inside the eye causing clumps of collagen to form. These clumps of collagen cast shadows on the retina which appear as small dark spots, strings, or clouds in the vision that typically move around. Vitreous degeneration by itself is benign. However, if the vitreous pulls on the retina, this could then represent an emergency. For example, new floaters especially in middle age or upper age may be a sign of a posterior vitreous detachment and should be examined by an eye professional to ensure that no retinal tear or retinal detachment has resulted from vitreous detachment. Trauma to the eye or cataract surgery can cause floaters in the vision and this too needs prompt evaluation by an eye professional to ensure the retina has not been harmed. Treatment of floaters depends on the cause. Most floaters related to degeneration of the vitreous gel can be observed and often times the brain neuro-adapts to these and ignores them. However, some patients with floaters can experience significant debilitation of their activities of daily life including reading, driving, watching TV, performing computer work, and other specific tasks. There are 2 current therapies performed for floaters from vitreous degeneration and vitreous detachment. One therapy is Yag Laser Vitreolysis with limited clinical trial data available and the other is Vitrectomy surgery. Both have specific risks and benefits and case selection for each procedure is critical. At Retina & Vitreous Consultants of Virginia, Dr. Ilyas performs both procedures and has significant experience in their use for floaters. However, it must be born in mind that in most situations, floaters can be safely observed and rarely require treatment. If you feel like floaters are severely affecting your quality of vision and your life activities, we are happy to evaluate your eyes and begin by excluding any serious retinal problems that could coexist with floaters like retinal tear or detachment. What Causes Flashes Of Light Or Flickers Of Light In The Vision? Flashes of light can be an indication of the vitreous gel pulling on the retina and inducing a mechanical light flash. The main issue is that the retina may be undergoing a retinal tear or retinal detachment which are vision-threatening conditions that, if not caught early, can lead to irreversible vision loss. Always report flashes of light to your eye professional or go to your nearest emergency room since this may be a sign of a serious retinal condition. Flashes of light which are more central or colored associated with blurred vision or headache can be a sign of migraine. Consult with your primary care physician if you think you may be suffering from a Migraine condition or simply see your eye care professional for an exam. What Does A Dark Shadow Or Curtain In The Vision Represent? Always report this emergency to your eye care professional or go straight to the emergency room. This could be a sign of a retinal detachment, severe bleeding inside the eye, or a vascular blockage in the retina or optic nerve (stroke). To learn more about retina and vitreous diseases and cutting-edge treatments available to you, please call 540-662-1810 today to schedule a consultation.

  Link: Floaters and Flashes of Light

• Macular Hole

  A macular hole is exactly what it sounds like: a hole in the macula, the center of the retina responsible for central and reading vision. Specifically, the hole or defect occurs in the fovea, the center of the macula and the most delicate part of the entire retina. Macular holes almost always develop during the natural aging process, when the vitreous (the gel that fills most of the eye) thins and separates from the macula. This can pull on the macula and cause a hole to form. Less commonly, macular holes are caused by eye injury, intraocular inflammation, retinal detachment and other diseases. Most cases occur in people over the age of 60. At first, a macular hole may only cause a small blurry or distorted area in the center of vision. As the hole grows over several weeks or months, central vision progressively worsens. Peripheral vision is not affected. Surgery is over 95% effective for the treatment of macular holes. The procedure is done as an outpatient (no hospital stay required) and performed under local anesthesia. A vitrectomy is performed to remove the vitreous gel. Then, any scar tissue on the macular surface is peeled and removed. Finally, a gas bubble is injected into the eye to help the hole close. As the eye heals, the gas bubble will naturally be removed and replaced by fluid. There is no treatment outside of surgery for macular holes. To learn more about retina and vitreous diseases and cutting-edge treatments available to you, please call 540-662-1810 today to schedule a consultation.

  Link: Macular Hole

• Macular Pucker

  An Epiretinal Membrane, also known as a Macular Pucker, is a thin layer of scar tissue that forms over the macula, the area of the retina that gives us clear central vision. An epiretinal membrane most often develops with age, as the vitreous gel that makes up most of the eye's volume thins and pulls away from the retina inducing microtrauma to the retinal surface. Other causes of epiretinal membranes can include: diabetic retinopathy and vascular occlusive diseases, uveitis, retinal detachments, and eye trauma among others. The damage caused to the retina by any of the above entities then leads to the formation of scar tissue on the macula. When the scar tissue contracts, the retina wrinkles or puckers and macular swelling can ensue, which then causes blurry or distorted central vision. Patients with an epiretinal membrane may experience difficulty seeing fine details and reading small print and may also see straight lines appearing as wavy ones. There may also be a gray area or blind spot in the center of your vision. Most cases of epiretinal membranes do not progress and do not require treatment. The symptoms of distortion and blurriness are usually mild and patients are able to adjust to the vision changes without much impact on their daily lives. Noninvasive treatments such as eye drops or medications will not improve vision that is reduced from an epiretinal membrane. If vision distortion or blur is severe enough, a vitrectomy with delicate peeling of the membrane may be performed to repair this condition. Dr. Ilyas can further discuss the impact of your macular scar tissue on your vision and whether surgery is truly indicated for you. Diagnostic Tests Fluorescein Angiography Fluorescein angiography is the practice of taking photographs of blood vessels inside the eye (an angiogram) with the help of a intravenous injectable 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, and macular swelling, among many other diseases. Initially, some pre-injection photos of the retina are taken with the camera (fundus Auto-Fluorescence images). The contrast dye is then injected in a small vein, usually in the patient's arm. The dye travels up to the eye within seconds and "lights up" the blood vessels of the retina which allows the camera to capture the retinal circulation. Once the dye is injected, multiple photographs will be taken over the ensuing 10 minutes or so. The procedure is very well-tolerated in most patients and a discussion of the benefits and risks of the procedure will be shared with you on the date of your test. OCT Imaging Optical coherence tomography (OCT) is an advanced diagnostic tool used to produce cross-sectional images of the retina and in particular the macula. These images can then help with the detection and follow-up of serious retinal conditions such as macular holes, macular edema, Wet Macular Degeneration, macular scar, and central serous retinopathy. OCT uses light rays to image the retinal layers in detail and does NOT involve any radiation exposure. B-Scan Ultrasound of Eye Ultrasound is a test that uses sound waves to assess the overall structural appearance of the vitreous and retina. If your doctor cannot view the retina because of something in the patient's eye blocking the view (severe cataract or vitreous blood), then they can use ultrasound to determine the general status of the retina (e.g.- is there a Retinal Detachment back there?). B-scan US is also helpful for evaluating, measuring, and following tumors of the eye. To learn more about retina and vitreous diseases and cutting-edge treatments available to you, please call 540-662-1810 today to schedule a consultation.

  Link: Macular Pucker

• Diagnostic Tests

  Fluorescein Angiography Fluorescein angiography is the practice of taking photographs of blood vessels inside the eye (an angiogram) with the help of a intravenous injectable 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, and macular swelling, among many other diseases. Initially, some pre-injection photos of the retina are taken with the camera (fundus Auto-Fluorescence images). The contrast dye is then injected in a small vein, usually in the patient's arm. The dye travels up to the eye within seconds and "lights up" the blood vessels of the retina which allows the camera to capture the retinal circulation. Once the dye is injected, multiple photographs will be taken over the ensuing 10 minutes or so. The procedure is very well-tolerated in most patients and a discussion of the benefits and risks of the procedure will be shared with you on the date of your test. OCT Imaging Optical coherence tomography (OCT) is an advanced diagnostic tool used to produce cross-sectional images of the retina and in particular the macula. These images can then help with the detection and follow-up of serious retinal conditions such as macular holes, macular edema, Wet Macular Degeneration, macular scar, and central serous retinopathy. OCT uses light rays to image the retinal layers in detail and does NOT involve any radiation exposure. B-Scan Ultrasound of Eye Ultrasound is a test that uses sound waves to assess the overall structural appearance of the vitreous and retina. If your doctor cannot view the retina because of something in the patient's eye blocking the view (severe cataract or vitreous blood), then they can use ultrasound to determine the general status of the retina (e.g.- is there a Retinal Detachment back there?). B-scan US is also helpful for evaluating, measuring, and following tumors of the eye. To learn more about retina and vitreous diseases and cutting-edge treatments available to you, please call 540-662-1810 today to schedule a consultation.

  Link: Diagnostic Tests

• Vitrectomy Surgery

  A Vitrectomy is a procedure performed by a retinal surgeon to address specific diseases of the vitreous and retina. Small wounds are created through the eye wall to gain access into the back of the eye. A tiny instrument called a vitreous cutter is used to cut and remove the vitreous gel. Any floaters, debris, or blood lying within the vitreous gel are removed at this time. Saline is continuously infused into the eye to replace the gel and pressurize the eye. Attention is then turned to retinal issues including the peeling of macular scar tissue for example. Sometimes removal of a foreign body from the back of the eye is required during a vitrectomy. This could include a piece of cataract left behind after cataract surgery or a lens implant that has slipped to the back of the eye or a metallic foreign body that has pierced the eye. Adjunctive treatments needed at the time of a vitrectomy might include: Laser treatment or placement of a Gas bubble into the eye. The vitrectomy procedure is generally well-tolerated with only mild pain in most cases afterwards. A patch will be placed on the operated eye and kept in place till the next morning. Dr. Ilyas will remove this and assess the eye the next day after surgery, at which point several drops will be started on the operated eye. If a Gas bubble has been placed in the eye, you may be asked to position your head in a specific way so as to promote retinal healing and success of the surgery. Risks of Vitrectomy surgery include: Bleeding, Infection, Loss of Vision, Retinal Detachment, Cataract worsening, and too High or too Low of an Eye Pressure. At Retina & Vitreous Consultants, we perform vitrectomy surgery for many diseases including: Macular Hole, Retinal Detachment, Macular Pucker or Scar, Diabetes with eye complications such as Vitreous Hemorrhage and Tractional Retinal Detachments, Infections inside the eye, and complications after Cataract removal such as a dropped lens, and for many other indications. Schedule a consultation to learn more about vitrectomy surgery and whether it is right for you. Scleral Buckle An encircling scleral buckle is an ophthalmologic procedure in which a thin silicone band is wrapped around the external eye and indents the eye in order to correct retinal detachment. The band is attached to the whites of the eyes (sclera) and the pressure exerted helps relieve the pull of the vitreous on the retina and heal a detached retina. The silicone buckle remains in place usually for a lifetime and is only removed if it becomes infected or exposed. This surgery is usually performed as an outpatient procedure under local or general anesthesia and may be preformed in conjunction with vitrectomy, cryotherapy, or laser photocoagulation. These additional procedures can facilitate success of the surgery.

  Link: Vitrectomy Surgery