Retinal Disease Treatments
The Retina Service at Mass. Eye and Ear not only offers the latest treatments for retinal diseases, but also has been instrumental in developing them. Our surgeons are actively involved in the pursuit of new therapeutic discoveries.
The goal of many retinal treatments is to stop disease progression and reverse or prevent vision loss. Early detection is very important for vision preservation because many retinal diseases can cause irreversible damage.
Advanced 3D Retina Surgery with NGENUITY
Mass. Eye and Ear is the first medical center in New England to offer retinal surgery with a state-of-the-art visualization system, called NGENUITY. This novel technology allows surgeons to operate while looking at a large, high-definition, 3D screen instead of through a small microscope.
Exceptional Visualization: Surgeons can now see the eye with more detail and clarity than ever before. The new system allows surgeons to magnify an image while maintaining a wide field of view and provides exceptional resolution, color contrast, and depth perception that is ideal for precise surgical maneuvers.
Improved Teamwork in the Operating Room: With immersive, panoramic video, everyone in the operating room can watch surgery in real time. “This helps surgeons work more smoothly as a team to provide the best possible patient care,” says John B. Miller, MD, an adult retina surgeon and Director of Retinal Imaging at Mass. Eye and Ear.
Reduced Fatigue for Surgeons: With retina surgeries lasting anywhere from 30 minutes to three hours, the ergonomic “heads-up” design of NGENUITY reduces fatigue and degenerative back and neck disease in surgeons. "This may translate to safer surgeries and improved outcomes for patients,” says Yoshi Yonekawa, MD, a pediatric and adult retina surgeon at Mass. Eye and Ear and Boston Children’s Hospital.
Minimized Light Exposure for Patients: Retina surgeries can be completed at lower light levels, potentially minimizing toxic light exposure to patients' eyes.
Through your retinal specialist at Mass. Eye and Ear, you will have access to the full complement of treatment options shown to be beneficial in the treatment of retinal diseases. In addition, you may qualify to take part in clinical trials that are investigating new agents or refinements to existing therapies. If you are interested in enrolling in one of these clinical trials, please make an appointment with one of our retina specialists to learn more about the process.
Our retina specialists have performed thousands of treatment procedures on patients with various retinal diseases. Depending on the particular disease affecting your eyes, your doctor may recommend one of the following treatment options:
In photocoagulation, the physician uses a laser to create small burns in the retina. Depending on the disease process, the laser may be applied around a retinal tear to seal it, or applied in diabetic macular swelling to help reduce leakage of fluid from vessels. Panretinal photocoagulation is used for severe diabetic retinopathy, which is characterized by abnormal vessel proliferation. In this situation, the goal is to reverse the growth of the abnormal vessels and reduce the chance of severe vision loss. Laser burns targeted on the peripheral retina will protect the central vision, but may sacrifice some peripheral vision.
In cryopexy, intense cold is applied at the area of a retinal tear or hole. This freezing treatment causes scarring, which seals the tear/hole. This usually prevents detachment of the retina.
Pneumatic retinopexy is an office treatment for some cases of retinal detachment. During this process, cryopexy is first performed around the retinal tear to seal it. This is followed by the injection of a special gas bubble. The bubble will slowly expand over the next few days, sealing the retinal tear, and facilitating retinal reattachment. The patient is instructed to hold his/her head in a special position so that the bubble can effectively seal the tear. Patients should avoid lying or sleeping on their backs to guard against a sudden increase in eye pressure. Air travel is not recommended for 2 to 4 weeks, which is the time it takes for the body to absorb the gas bubble.
Scleral buckling is one of the most common surgeries for repairing retinal detachment and was first pioneered at our institution by Dr. Charles L. Schepens almost 40 years ago. During this process, the surgeon uses a special silicon band to buckle the eye wall, which results in improved contact between the eye wall and the retina. This procedure successfully repairs retinal detachment in more than 80 to 90 percent of cases. Recovery of vision depends on several factors, such as duration and extent of retinal detachment. A minority of the patients may need more than one surgery to successfully reattach the retina.
Vitrectomy is a specialized surgical procedure where tiny incisions are made in the eye to remove vitreous gel. This is followed by additional surgical steps, as dictated by the particular disease. This surgery may be performed instead of buckling in order to repair a retinal detachment, or may be used for complex diabetic retinopathy treatment or for the removal of scar tissue.
Injections of medications inside the eye are most often used for age related macular degeneration (AMD). These medications include pegaptanib (Macugen™), the first anti-VEGF agent approved specifically for the treatment of neovascular AMD; the newer and more effective ranibizumab (Lucentis™); and bevacizumab (Avastin™). These medications are delivered by injection into the eye harboring neovascular AMD. Injections are generally performed monthly or at a varying interval. Your retinal specialist will explain the dosing schedule and rationale. Injections of anti-VEGF agents are performed in an outpatient office setting and are generally well-tolerated – most patients are able to resume their daily activities immediately. You will be instructed to use antibiotic eye drops for several days following your injection. While anti-VEGF agents are relatively safe, there are associated risks. You will have the opportunity to discuss the risks and benefits of anti-VEGF treatment with a retinal specialist. If you experience worsening vision, pain, or progressive eye irritation and redness following an injection, contact your retinal specialist immediately.
Please see the AMD Treatments section for more information on approaches for this disease.
Referral to Vision Rehabilitation
It is fortunate that patients with lost vision can be referred to and benefit from evaluation by the Vision Rehabilitation Service of Mass. Eye and Ear. The Vision Rehabilitation Service has offered services for more than 25 years to patients with eye conditions that restrict daily activities, mobility, productivity or independence. The goal of vision rehabilitation is to assist patients to effectively use all of their remaining vision. It is part of the continuum of ophthalmic care, just as stroke rehabilitation or cardiac rehabilitation is part of the continuum of health care. Patients continue to receive treatment from a retinal specialist while participating in rehabilitation.