Retinal Disease Diagnosis

People with retinal diseases may experience an array of symptoms, from specks floating in their vision to blurred or lost vision. These diseases can be isolated, genetic or associated with other systemic conditions such as diabetes.

The retina may be affected by diseases exclusive to it alone, and is also frequently affected by systemic disorders such as diabetes, high blood pressure, cardiovascular disease (“narrowing of the arteries”), autoimmune diseases, metabolic disorders, blood infections, and certain types of cancers. Some disorders of the retina cause symptoms such as blurred vision, floaters (usually fine objects that appear as debris obscuring the visual image), and flashes of light. However, many conditions affecting the retina do not cause noticeable symptoms in the early stages, but may lead to irreversible and sometimes severe loss of vision. If you have diabetes or certain other medical or eye conditions, your primary medical doctor or comprehensive ophthalmologist can help you to determine when and how often to see a retina specialist.

The diagnosis and monitoring of retinal diseases requires a complete eye examination with dilation of the pupils by instillation of eye drops. You may experience a temporary change in vision and sensitivity to light, so you may wish to bring a pair of sunglasses to wear after the visit. One or several types of tests may need to be performed to help your treating physician to assess the retina and macula (the central portion of the retina).

Diagnostic Tools: 

The most common cause of vision loss in older Americans is age related macular degeneration (AMD). At Mass. Eye and Ear, our retina specialists utilize the most advanced tools and techniques in its treatment, such as:

• Fundus Photography and Angiography 
• Optical Coherence Tomography 
• Ultrasound Examination and Ultrasound Biomicroscopy

Digital fundus photography is often used to photograph any abnormalities in order to carefully study any change in the appearance of a patient’s retina and macula over time. An angiogram is a type of photograph that allows your treating physician to visualize more clearly the blood vessels in the back of your eye as well as associated abnormalities, such as the growth of abnormal new blood vessels (neovascularization), the most common cause of vision loss in AMD. An angiogram is performed by taking photographs of the macula and retina after the injection of a food dye called fluorescein into a peripheral vein, generally in the patient’s arm or hand. The dye circulates through the blood vessels, including the eye, and is eliminated from the body over a few days through the urine. You should expect that your urine will appear yellow/orange over the course of several days, as the dye is eliminated. It is regarded as a safe test; however, as with the administration of any medication or drug, a small percentage of patients may have allergic symptoms such as itching and rash. More severe allergy occurs very rarely. Indocyanine green (ICG) angiography is a less frequently used technique that may supplement standard fluorescein angiography (FA).

Optical Coherence Tomography (OCT) is a relatively new imaging technique that was developed as a collaborative effort between The Massachusetts Institute of Technology, Mass. Eye and Ear, and Harvard University. It is now used by ophthalmologists throughout the world to create cross-sectional images of the front or back of a patient’s eye, similar to the images created by computed tomography (‘CAT’ or ‘CT scan’), to allow detailed examination of ocular structures by your treating physician. OCT imaging may be performed in the office setting by your retina specialist at the time of your visit. It is a rapid, non-invasive test, similar to the experience of having a photograph of the retina. OCT is invaluable in the diagnosis and monitoring of neovascular AMD over time, and your retina specialist will likely perform repeated measurements in order to follow the progress of your treatment.

Ultrasound is non-invasive test and is not associated with pain or side effects. It is most often used to diagnose eye pathology including tumors, especially when visualization to the interior structures is poor due to media opacities. Mass. Eye and Ear/ Harvard Department of Ophthalmology is equipped with state-of-the-art technology for ophthalmic ultrasound. We are among few places in North America that have ultrasound biomicroscopy (UBM) and a dedicated certified technician. UBM has a very high resolution (2 to -60 microns) compared to conventional ultrasound (300 to 600 microns). This allows your physician to study anterior eye structures as if looking at a pathological specimen through a low power microscope.

The Mass. Eye and Ear Retina Service has immense experience and has performed tens of thousands of ultrasound procedures. Our specialists are involved in teaching the intricacies of his technology throughout the country.