Office visit - Retina Evaluation

What do I need to tell the doctor (history)?

The determination of what is wrong with your eye and what is the appropriate treatment is based mostly on your history. Try to notice as much as you can about your vision problem so you can tell the doctor. Below are some guidelines that will help with the visit.

• Duration: How long has the vision been abnormal? If vision loss is intermittent, how long do episodes last and how frequently do they occur?
• Location: Which eye(s) is abnormal? Where is the vision abnormal, the center, side vision, all over?
• Situation: When is the vision abnormal? All the time? In the light or in the dark? Morning? Evening?
• Type of Loss: Is the vision dark, wavy, blurry, hazy, out of focus?

Systemic problems:

• Recent: Fevers, rashes, joint pain, diarrhea, headache, focal neurological problems.
• Ongoing: Diabetes, high blood pressure, stroke, rheumatic problem.
• Smoking?

New Patient Forms - Including Medical History

What is Visual Acuity?

Visual acuity is the cornerstone of the ophthalmic examination. It measures central, or foveal, vision. As retina specialists, we do not refract and prescribe glasses. It is important that you bring your best glasses for distance and near to every office visit so we can accurately assess your visual acuity. Visual acuity is used to determine the need for treatment in many patients with retinal diseases. In patients with macular disease it is not uncommon for vision to fluctuate. A sustained decrease in visual acuity or a sudden severe change in visual acuity is cause for concern.

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What is Intraocular Pressure?

The eye is one of the few parts of your body that maintains its own pressure (your brain is another). The eye produces aqueous fluid to nourish the avascular (without blood vessels) parts of the eye, like the cornea (clear part in the front) and lens. This aqueous needs to drain from the eye in a controlled manner. The fluid is made in the ciliary body, just behind the iris and drains from the eye through the trabecular meshwork which is in front to he iris. That way a flow of fluid is maintained that nourishes the eye structures. This also has the affect of keeping the eye inflated. If the eye did not have its own pressure, it would not properly maintain its shape and vision would decline. So, at each visit to the eye doctor, your intraocular pressure is measured to make sure the eye is healthy.

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What is Fundoscopy?

Eye drops & dilation

To see the retina we need to dilate your pupil. When we look at the retina, the macula, retinal vessels, optic nerve, and retinal periphery, we use a light and special lens system. Without pupillary dilation, your pupil constricts in response to the the light and blocks our view of your retina. The dilation usually lasts four hours and can make your eyes light sensitive and blurred. Bring sunglasses. If you don't have them, we have plastic sunglasses for you.

RETINA EXAMINATION

We carefully examine BOTH eyes. Even if only one eye is bothering you, we need to look at both eyes, since often the second eye can hold important clues about your eye disease. We look at the retina through a microscope, a headset and sometimes with a contact lens. We usually make a careful drawing of the retina during the initial visit.

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What is Optical Coherence Tomography (OCT)?

Optical coherence tomography uses a laser light to sweep the retina and produce a high resolution image of the retina. The device has revolutionized the care of retina patients. With OCT it is possible to detect small amounts of subretinal or intraretinal fluid and to evaluate treatment reponse. Since it is non-invasive and uses only a light beam it is very very safe. The light used is in the infra-red range and therefore is well tolerated because the human eye does not see intfrared. It can also be performed through an undilated pupil. The cross-sectional images OCT provides of the retina are analogous to histology slices, but in living tissue. These images, sometimes likened to a "virtual biopsy," are obtained in a noninvasive, noncontact office-based imaging procedure that has rapidly become an integral part of standard ophthalmic practice.

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What is Fundus Photography?

Our offices have several specialized cameras that are able to photograph the retina. These are useful for both diagnostic purposes and also to help evaluate and follow various retinal lesions. The photograph accompanying this text shows a choroidal nevus: a pigmented lesion in the back of the eye. A choroidal nevus needs to be carefully followed for growth because it can turn a choroidal melanoma. In addition to standard photography, we will sometimes photograph the retina with different wavelength lights to help diagnose retinal pathology: infra-red, blue, and green. We can also image the retina with fundus autofluorescence - an image that looks at the reflection of certain pigments in the back of the eye that can fluoresce when imaged with a blue light. These other types of fundus photography are described below.

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What is Flourescein Angiography?

Our offices have several specialized cameras that are able to photograph the retina. These are useful for both diagnostic purposes and also to help evaluate and follow various retinal lesions. A fluorescein angiogram involves photographs of the retina using special filters after receiving and intravenous injection of fluorescent dye. A fluorescein angiogram is useful to diagnose and manage a number of different retinal disease including diabetic retinopathy, age-related macular degeneration, retinal vein occlusion and macular edema.

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What is Indocyanine Green (ICG) Angiography?

Indocyanine Green angiography is an eye test that uses a special dye and camera to look at blood flow through the retinal vessels. ICG does not leak from normal retinal or from normal choroidal vessels. Fluorescein dye leaks from normal choroidal vessels but ICG dye does not. That is why it is sometimes used in conjunction with fluorescein to evaluate and manage disease of the choroid and retinal pigment epithelium. The test is usually performed with a dilated pupil. After the dye is injected in a vein, a photograph is taken using infra-red light which is absorbed by the ICG molecules. The molecules fluoresce and emit light with a longer wavelength. A barrier filter blocks any reflected light so that the images capture only light emitted from the ICG. Images are acquired immediately after injection and continue for ten minutes depending on the pathology being imaged. When the choroidal vessels leak, it can be seen as a white patch in the late frames of an ICG angiogram. One classic disease that causes the choroidal capillaries to leak more than they should is central serous retinopathy. The ICG of a patient with active CSR is shown along with this text.

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