Testing and Treatment Procedures

When you entrust your eyes to Illinois Retina Associates, the treatment you receive will combine not only the experience and expertise of our physicians - but also the latest in medical technology. The tests and treatments we employ range from simple - the Amsler grid - to highly specialized equipment, diagnostic procedures and treatment procedures. These include:

• Amsler grid testing
• Retinal laser treatment
• Intravitreal injections
• Fluorescein and ICG angiography
• Low Vision evaluation/therapy

Amsler Grid Testing

Amsler grid testing is often recommended for patients with macular diseases. The Amsler grid is an effective way for patients to monitor for changes in their central vision. Patients with significant macular disease are often advised to check the grid daily. The Amsler grid is simply a small square of graph paper with a dot in the center. Patients often stick the grid to their mirror, refrigerator, or some other prominent place in the house where they will see it and remember to check it daily.

Instructions

To check the grid, the patient should be wearing his or her reading glasses. The grid should be held at the normal distance and position in which the patient would hold a piece of paper he or she is reading. One eye is covered at a time, so that the grid is viewed with each eye alone for a few seconds. In checking the grid, it is very important to cover the other eye. Why? Because a healthy eye can compensate for an eye with vision changes. The healthy eye can mask the grid changes that would be seen with the other eye alone.

Several types of changes may occur on the grid. The straight lines may appear bent, curved or distorted. Sometimes an area of the grid may appear darker or disappear entirely. Or the central dot may disappear. Any of these changes can indicate progression of macular disease. If the grid appears changed, it should be checked again in a few hours. If the changes persist, the patient should call the office early on the next working day.

If you would like an Amsler grid please register. Please provide us your with your full name and mailing address and we will send you a magnetic grid. Or you can download the Amsler grid on this screen. Simply click on the icon labeled.

Retinal Laser Treatment

Laser treatment is commonly performed for many retinal conditions. Each type of laser treatment is different. However, there are several common features. Retinal laser treatments are usually performed as an outpatient procedure in the office. The actual laser treatment takes only about 15 minutes. However, the entire office visit may extend to over two hours due to the time necessary to prepare the patient for laser, as well as the post treatment care. A longer period may need to be allowed for the dilation of the eye. The eye must be more completely dilated for the laser treatment than for an eye examination.

There is only mild discomfort associated with most retinal laser treatments. Depending on the type of treatment, different anesthetics are used. Many treatments require only anesthetic eye drops. These drops numb the eye where the patient feels very little with the laser. Some laser treatments do involve greater discomfort, and occasionally an anesthetic injection is required. If the injection is required, the patient goes home with a patch over the eye. The injection is administered in the eyelid next to the eye - not into the eye itself. Your doctor’s decision about whether to use an anesthetic injection will depend on several factors including how extensive a treatment is planned.

During the laser treatment, there is a contact lens on the eye. The lens comes off at the end of the treatment. With the anesthetic medication, you do not feel the lens on the eye. During the laser treatment, the doctor is looking at the retina to see the area he or she is treating. Therefore, throughout the treatment, there is a very bright light, like the light used to examine the eye. Afterward, the vision is blurry for several hours from the bright light. Depending on the type of laser performed, it may take several hours to several days for the vision to return to its pre-laser level.

After the laser treatment, the eye may feel scratchy or irritated for several hours. There may also be some eye discomfort or a headache on that side. Usually people do not need anything stronger than Tylenol. You should check with your eye doctor to see what pain medications are acceptable after the laser treatment. It is usually recommended that the patient not plan on doing much for the rest of the day after laser treatment. With the vision blurry and the eye feeling uncomfortable, it is usually recommended that you do not drive or work that day. However, most patients are able to return to their normal activities the following day.

New laser treatments for macular degeneration are done with the infusion of a drug and the use of a cold laser. The drug is light sensitive and reacts to light. The laser used for this procedure has a special wave length, which only affects the drug and spares all surrounding tissue. The use of this laser is restricted to certain types of macular degeneration. Your physician at Illinois Retina Associates would let you know if you are eligible for the use of this laser.

Intravitreal Injections

In the past few years, there has been significant advancement in the use of pharmacologic agents or drugs to treat various retinal disorders. Research in this area has opened the door to brand new treatments, which may be more effective than traditional methods. There are many different drugs available, which would be used depending upon your condition.

Fluorescein and ICG Angiography

As part of their evaluation, many patients will undergo fundus photographs and fluorescein angiography. Fundus photographs are color photographs of the retina. A high magnification camera is used to photograph the back of the eye, its blood vessels and tissues. These photographs allow the doctor to study the back of the eye and – for patients with a chronic eye problem – to document the eye for future reference.

A fluorescein angiogram combines a fluorescent dye with rapid-sequence photography to study the blood flow, vessels and tissues of the retina. After the fluorescein dye is injected into an arm vein, 30 to 60 – photos are taken as the dye passes through the blood vessels of the retina. This allows the doctor to identify problem areas of the retina or retinal blood vessels. The entire test takes about 45 minutes.

Fluorescein is a relatively safe dye. As with any injected medicine, there is a small risk of an allergic reaction. A few patients may experience nausea. However, unlike the dye used for CT scans, heart angiograms and kidney studies, fluorescein dye contains no iodine. Therefore, the risk of allergic reactions or kidney problems from the injection is much lower. Patients who have allergies to iodine dyes can safely receive the fluorescein injection.

After the test, vision may be blurry for several hours due to the multiple bright flashes of light. The dye gives the skin an orange-brown tinge for several hours after treatment. The dye is cleared in the urine. The urine may appear bright green for the next 24 hours.

These are photographs, not x-rays. There is no exposure to radiation from this test. Because angiograms are much more effective than regular eye exams in showing the presence or absence of abnormal blood vessels, patients may often undergo repeat angiograms on return visits to evaluate the response to treatment and the need for additional treatments.

Occasionally, patients undergo a different type of angiography called Indocyanine Green Angiography (ICG). This test is similar to a fluorescein angiogram except that it uses a different dye called indocyanine green. In some situations, ICG may allow identification of an area of leakage not visible on the fluorescein angiogram.

Low Vision

Many patients with retinal problems will benefit from a low vision evaluation. Low vision rehabilitation includes a variety of programs and services to help people with visual limitations to function better. Low vision services include:

•  Occupational training to assist people whose vision interferes with their   work duties.
  
•  Magnifiers to assist in reading and other close visual tasks.
  
•  Mobility training for people whose vision loss interferes with their ability to   get around on their own.

Illinois Retina Associates does not provide low vision services. However, we do refer patients to an appropriate facility when indicated. If your vision loss is interfering with your ability to read, drive or perform other necessary activities, ask about whether a low vision referral would be appropriate for you.

While we hope that you would consider Illinois Retina Associates your first choice in treating low vision, we are not the only source of information on this eye problem. You are just a click away from finding more information on this subject at the following websites:

Foundation Fighting Blindness
http://blindness.org

Chicago Lighthouse for the Blind
http://www.thechicagolighthouse.org

Lighthouse International
http://lighthouse.org

Deicke Center for Visual Rehabilitation
http://www.deicke.org

Society for the Prevention of Blindness
http://www.preventblindness.org

Illinois Society for the Prevention of Blindness
http://eyehealthillinois.org

American Academy of Ophthalmology
http://eyenet.com