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Retina

What is the Retina?

Your retina is the light sensitive lining in the back of your eye. It contains millions of special nerve cells that react to light. These photoreceptors send electrical impulses to your optic nerve, which your brain converts into the images you see.

Most people never give their eyes – let alone their retinas – a second thought until something goes wrong. Yet, retinal diseases are the leading causes of blindness in adults in the United States.

Why Choose Us?

Cleveland Clinic Cole Eye Institute retina specialists are internationally recognized for their expertise in diagnosing and treating the entire spectrum of retinal disorders, including age-related macular degeneration, diabetic retinopathy and retinal detachments. Cole Eye Institute is among the world’s most advanced eye centers, and ranked as one of “America’s Best” ophthalmology programs and No. 1 in Ohio by U.S. News & World Report. Our retina team has some of the best clinical outcomes in the field, and is passionate about leading the way in research and innovation for retinal diseases.

Our vitreoretinal surgeons have developed several state-of-the-art surgical procedures that are now used worldwide for retinal detachment, diabetic macular edema, diabetic traction detachments, macular holes and pediatric retinal surgery. Members of the team have also helped develop the next generation of vitreoretinal surgical devices.

Cole Eye Institute patients benefit from our access to a collaborative team of retina experts and the most advanced technology, including spectral domain optical coherence tomography (OCT) – the latest generation of retinal imaging devices that makes quicker and more accurate diagnoses possible. We can also help patients who qualify enroll in the latest, innovative clinical trials for early-stage retina diseases or when standard medical therapy has failed.

Fluorescein and Indocyanine Angiograms

If your ophthalmologist suspects an abnormality with your retina or choroid (the inside of the back of your eye), he or she may recommend special tests called fluorescein and/or indocyanine green (ICG) angiograms. What are fluorescein/ICG angiograms?

What are Fluorescein/ICG angiograms?

Fluorescein/ICG angiograms are diagnostic procedures that involve taking a rapid series of photographs (not X-rays) of your eye while a small amount of dye (fluorescein or indocyanine green) is injected into a vein in your arm. The dye is carried by your blood stream throughout the whole body, reaching your eye in about 10 seconds. Photographs are taken at different intervals up to 30 minutes after the injection.

The photographs show what changes have taken place in the retina and choroid and where the changes are located. The two dyes allow visualization of structures within the eye and may or may not be used together, depending on what abnormality your ophthalmologist suspects.

A fluorescein and/or ICG angiogram may be necessary to establish a diagnosis or if your doctor feels that you may benefit from treatment. If you are going to be treated with a laser, the photographs provide a kind of “map” for the doctor to use during the treatment.

Note: Fluorescein and/or ICG angiography is often performed several times after treatment to evaluate the effectiveness of your therapy.

The fluorescein dye may make your skin yellowish for several hours after the procedures. The dye also discolors your urine bright yellow for a day or so.

Unlike fluorescein dye, indocyanine green contains 5% iodine; therefore, patients with iodine allergies may have reactions to ICG dye.

Fortunately, allergic reactions to either dye are rare and are usually treated with antihistamine medications. Although severe allergic reactions (anaphylaxis) can occur, these are considered extremely rare.

Note: Fluorescein/ICG angiography is generally not performed on patients who are pregnant or who have liver disease.

Or call 216.444.2020 or 1.800.223.2273 ext. 4-2020 to schedule an appointment with a Cole Eye Institute ophthalmologist.

Other Diagnostic Tests

  • Intraoperative Optical Coherence Tomography (OCT)
  • Spectral Domain Optical Coherence Tomography (OCT)
  • Ultra Wide field Fundus Photography and Angiography

Treating Age-Related Macular Degeneration

What is age-related macular degeneration?

Age-related macular degeneration (AMD) is the leading cause of vision loss in people over the age of 50 in the United States. This eye disease affects the macula, the central part of the light-sensing nerve tissue in the eye known as the retina. The macula provides the sharp, straight-ahead vision that allows you to see small detail, read fine print, recognize faces and see street signs.

As we age, the macula (the small part of the retina at the back of the eye that provides sharpness of vision) begins to break down and produces small white particles called drusen, which are seen in a fundus photograph and in a cross-sectional diagram above. These can be an early sign of age-related macular degeneration, but they do not usually cause vision loss by themselves and not all patients who develop drusen go on to require macular surgery.

The dry or atrophic form of age-related macular degeneration, seen above in fundus photography and in a cross-sectional diagram, is the most common form of macular degeneration, accounting for about 90 percent of cases. Although this form of age-related macular degeneration does not usually cause severe vision loss, it can progress to the wet form, so patients who have it should see their ophthalmologist regularly.

The wet or exudative form of age-related macular degeneration, seen here in fundus photography and in a cross-sectional diagram, affects about 10 percent of AMD patients. It is caused by the growth of abnormal blood vessels at the back of the eye that can leak fluid and blood. The wet form of AMD typically causes significant vision problems in the affected eye and can progress very rapidly and cause permanent vision loss.

What causes AMD?

There are two types of AMD - the dry (atrophic) form and the wet (exudative) form. The dry form of AMD affects about 90 percent of AMD patients and usually begins with the formation of tiny yellow deposits called drusen in the macula. Drusen usually do not cause serious loss of vision, but can cause distortion of vision. However, for reasons that are not yet understood, sometimes drusen will cause the macula to thin and break down, slowly leading to vision loss.

The wet form of age-related macular degeneration occurs in about 10 percent of patients. It is caused by the growth of abnormal blood vessels beneath the macula that can leak fluid and blood. Wet AMD typically causes significant vision loss. Age-related macular degeneration is the leading cause of vision problems in the affected eye and can progress very rapidly, causing permanent central vision loss.

The exact cause of AMD is not known. AMD may be hereditary. If someone in your family has or had AMD, you may be at higher risk for developing the disease.

What are the symptoms of AMD?

A primary symptom of AMD is a distortion in vision that makes straight lines appear wavy or irregular. Patients also may notice blurriness and dimming of vision, a dark or blank spot in the center of their vision, or that the size or color of something looks different when viewed through different eyes.

How is AMD diagnosed?

Your ophthalmologist will perform a complete clinical examination to diagnose AMD. He or she may order a fluorescein or indocyanine green angiogram to look for the abnormal blood vessels within or under the retina. During each of these procedures, dye is injected in the arm, and photographs (not X-rays) are taken from a special camera to track the movement of the dye as it reaches the eye and to show any changes in the retina. These photographs will serve as a guide for treatment.

What treatments are available for AMD?

Many national eye centers, including The Cleveland Clinic Cole Eye Institute, are investigating new medications and other ways to treat AMD. Although there currently is no medical or surgical treatment for the dry form of AMD, eyesight may be helped with low-vision aids that use special lenses or electronic systems to produce enlarged images of nearby objects. Patients also can be trained to use their peripheral (side) vision to help them see more clearly. One recent study found that taking high levels of antioxidants can reduce some patients' chances of developing AMD. Ask your eye doctor if this type of therapy is right for you.

Because the dry form of AMD can change into the wet form, it is very important for patients to monitor their eyesight carefully and see their ophthalmologist on a regular basis.

For patients with the wet form of AMD, early diagnosis and treatment are critical to save as much vision as possible. Early diagnosis can help expand treatment options and increase the likelihood of preserving eyesight.

Several options are available to treat the wet form of AMD, but not all are appropriate or successful for all patients. These treatments include:

  • Photodynamic therapy - combining the use of a cold laser with a light-sensitive drug to destroy abnormal blood vessels. The drug is injected into the arm and travels to the unwanted vessels in the eye. This helps avoid damage to healthy retinal tissue.
  • Laser therapy - the use of high-energy lights to destroy actively growing abnormal blood vessels.

Cole Eye Institute is also testing several experimental treatments for AMD for patients who qualify for these studies:

  • Anti-angiogenesis medications - There are several drugs that prevent the growth of abnormal blood vessels currently being tested.
  • Surgery to remove abnormal blood vessels and blood - The surgeon may use a genetically engineered enzyme called tissue plasminogen activator (t-PA) to dissolve any blood clots under the macula.
  • Macular translocation - This new procedure may be performed if there are abnormal blood vessels directly under the center of the macula, where a laser beam cannot be placed safely. Here, the surgeon rotates the retina away from the abnormal blood vessels to an area that is healthy, thus preventing the formation of scar tissue and further damage to the retina. Then, laser therapy is used to treat the abnormal blood vessels.
What can I expect after macular surgery?

After the surgeon removes the abnormal blood vessels or moves the retina, an air bubble is placed in the eye so the retina can heal properly. The patient must remain in certain positions (e.g. upright, laying down or sitting to one side) for several days following macular surgery, until the body has absorbed the air bubble.

Once the doctor can examine the eye after macular surgery, they may order another angiogram to make sure there are no additional areas of blood leakage. If any problem areas are observed, the doctor may perform additional laser treatment.

As the eye continues to heal over the next three to six weeks following macular surgery, you are treated with eye drops to reduce inflammation, keep the eye comfortable and prevent infection. Once the eye has healed, you are fitted for glasses and any necessary low-vision aids.

Can surgery help if I'm legally blind?

Depending upon the cause of legal blindness, it is possible that surgery may help. If recent bleeding or leakage under the retina has resulted in legal blindness, surgery can be considered.

Can I have surgery if lasers were used as a prior treatment?

Because bleeding or leakage may occur beneath the retina even following the laser treatment, it is possible that surgery can help.

Are there any side effects?

Rare complications may include infection, elevation of pressure in the eye (glaucoma) or damage to structures in the eye including the acceleration of clouding of the lens (cataract). In very rare instances, retinal detachment or severe loss of vision may occur.

I have other medical conditions. Can I still have surgery?

As long as you can maintain a face-down position for several days following the surgery and you are not prone to excessive bleeding during surgery, other medical conditions or age should not be a factor if you are considered an appropriate candidate for surgery. Your Cole Eye Institute vitreoretinal specialist will work closely with your other doctors to be certain that your other medical conditions are treated and controlled as best as possible before, during and after surgery.

You can also call 216.444.2020 or 1.800.223.2273 Ext. 4-2020 to schedule an appointment with a Cole Eye Institute ophthalmologist.

Macular Translocation

What is macular translocation?

The eye is often compared to a camera. The front of the eye contains a lens that focuses images on the inside of the back of the eye. The back of the eye, called the retina, is covered with special nerve cells that react to light. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. This small middle section, called the macula, is essential to clarity and sharpness of vision. Sometimes the retina is damaged by unwanted new blood vessels growing on it. This damages the macula and causes vision loss.

In macular translocation, the macula is moved away from abnormal new blood vessel growth (choroidal neovascular membrane) to an area of healthier retinal tissue to preserve as much vision as possible.

Can macular translocation be performed if the patient has either the dry (atrophic) or the wet (exudative) form of age-related macular degeneration?

This procedure is only for patients who have the wet (exudative) form of age-related macular degeneration. This translocation is used only for patients whose abnormal blood vessels are located in the very center of the macula and are not associated with a scar. Better results are achieved in patients who have small abnormal blood vessels of more recent onset.

Will the patient need tests before the procedure?

The patient will require a comprehensive ophthalmological evaluation as well as fluorescein angiogram. Sometimes an indocyanine green angiogram is also needed.

How is the procedure performed?

This is a vitreoretinal surgical procedure - a bubble of air is placed in the eye and the patient is required to maintain a sitting up or leaning to one side position for a few days following the surgery.

Is more than one treatment needed?

In about 10% of the cases, a secondary macular translocation treatment is required.

What results can the patient expect?

The treatment is still experimental. So far, about 20 percent of the patients treated have had improvement in the vision. There continues to be improvement up to six months after the procedure.

Is age a factor for macular translocation surgery?

No.

If the patient has been diagnosed as legally blind, can this procedure still be performed?

Yes.

If a doctor told a patient that nothing else can be done for them, can macular translocation surgery still be performed?

The patient needs to be evaluated at the Cole Eye Institute to determine whether they are eligible to undergo the procedure here.

If lasers were used as a prior treatment, can this procedure still be performed?

Yes.

Are there any risks or side effects the patient should be concerned about?

The risks will be discussed when the patient is evaluated.

If the patient has other medical disorders, can this procedure still be performed?

Yes.

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Amy Babiuch, MD
 

Amy Babiuch, MD

Babiuch, Amy, MD
419.289.6466

Location(s): Ashland Ophthalmology, Lakewood Hospital Professional Building, Elyria Family Health Center

Department: Ophthalmology

Treats: Adults Only

Surgeon: Yes

Education: University of Toledo College of Medicine

 
Ryan Deasy, MD
 

Ryan Deasy, MD

Deasy, Ryan, MD
440.695.4010

Location(s): Richard E. Jacobs Health Center, Mansfield

Department: Ophthalmology

Specialties: Acquired Vitreoretinal Diseases, Age-Related Macular Degeneration, Diabetic Retinopathy, Diseases of the Retina, Endophthalmitis, Eye Injuries, Floaters And Flashes more

Treats: Adults Only

Surgeon: Yes

Education: The Ohio State University College of Medicine and Public Health

 
Justis P. Ehlers, MD
 

Justis P. Ehlers, MD

Ehlers, Justis P., MD
216.444.2020

Location(s): Cleveland Clinic Main Campus

Department: Ophthalmology

Specialties: Acquired Vitreoretinal Diseases, Cystoid Macular Edema, Diabetic Retinopathy, Endophthalmitis, Eye Injuries, Histoplasmosis, Macroglobulinemia more

Treats: Adults Only

Surgeon: Yes

Education: Washington University School of Medicine

 
Peter Kaiser, MD
 

Peter Kaiser, MD

Kaiser, Peter, MD
216.444.2030

Location(s): Cleveland Clinic Main Campus

Department: Ophthalmology

Specialties: Age-Related Macular Degeneration, Diabetic Retinopathy, Diseases of the Retina, Diseases of the Vitreous, Age-Related Macular Degeneration, Macular Hole, Macular Pucker more

Treats: Adults Only

Surgeon: Yes

Education: Harvard Medical School

 
Daniel Martin, MD
 

Daniel Martin, MD

Martin, Daniel, MD
216.444.0430

Location(s): Cleveland Clinic Main Campus

Department: Ophthalmology

Specialties: Diabetic Retinopathy, Infectious Diseases of the Retina, Macular Hole, Macular Pucker, Retinal Detachment, Management Of Age Related Macular Degeneration (Amd), Ophthalmology more

Treats: Adults Only

Surgeon: Yes

Education: Johns Hopkins University School of Medicine

 
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