Tests

Photography

Ultrasonography

Optical Coherence Tomography (OCT)

Test Results

 

Laser Treatment

Laser Photocoagulation

For Diabetic Macular Edema

For Proliferative Diabetic Retinopathy

 

Cryotherapy

For Retinal Tears and Detachment

 

Injections

Avastin

Lucentis

 

Photodynamic Therapy (PDT)

For Wet AMD

 

Surgery

Vitrectomy

Scleral Buckle

Pneumatic Retinopexy

 

Clinical Research

Ongoing medical research programs

 

 

Medical Procedures


Mark Hamel, our ophthalmic photographer, performs an OCT scan of this patient's retina.

Tests

Photography
Retinal photography is important in the diagnosis and treatment of eye diseases. Fluorescein angiography is a special photographic technique in which a dye is injected into a blood vessel in the arm and photographed as it passes through the eye.

Ultrasonography
Ultrasound is an examination technique which allows us to evaluate the retina and vitreous in eyes which have cataracts, hemorrhages or “scar” tissue. Sound waves reflected from the inside of the eye are displayed on a screen for interpretation by the doctor. The examination is painless and requires no anesthesia.

Optical Coherence Tomography (OCT)
Optical Coherence Tomography is a high resolution, non-invasive, non-contact scan of the retina. The scan gives a cross sectional picture that is capable of revealing leakage in the retina before it is visible on the doctor's examination. Your doctor will go over your OCT test results with you while you are in the office.

Dr. Woodcome reviews the results of an OCT test with a patient as part of a complete retina evaluation.

Test results
Your doctor will review all testing done in our office with you at the time of your office visit.

 


Laser Treatment

Laser surgery is used in the treatment of many different diseases. Your doctor will explain the procedure in detail and will discuss the indications for laser treatment and review your photographs with you and your family prior to treatment. Laser treatment is performed in this office.

Laser Photocoagulation
Nowhere in medicine has laser technology been more beneficial to patients than in the treatment of diabetic retinopathy. Lasers produce a light unique in nature. The light is of specific wavelengths and the light waves vibrate together without interference. This light can be microscopically focused, allowing for precise control in treatment. Patients who need laser surgery are seated at a slit lamp, just as during an examination, and the beam of laser light is focused through a special contact lens held on the patient's eye by the treating ophthalmologist. Both diabetic macular edema and proliferative diabetic retinopathy are treated by laser photocoagulation. While the machine used is the same, the type of treatment, risks and benefits are quite different.

Laser Treatment For Diabetic Macular Edema 
Patients with diabetic macular edema are at risk of losing moderate amounts of vision. Treatment of macular edema rarely improves vision but is successful in preventing visual loss and worsening of vision. The chance of moderate visual loss over two years is reduced from 24% in untreated eyes to 12% in eyes undergoing treatment. This treatment uses a small number (usually less than 100) of small, moderately powerful laser spots directed at the sites of leakage. Complications and side effects are rare. Treatments occur in our office, are without pain, take 20  to 30 minutes, and regular activities can be resumed after the treatment. Laser treatment is recommended only when the edema reaches well-defined levels of severity, as treatment before that time has been shown to be no better than deferral of treatment until or if the edema progresses to the more severe stage.

Laser Treatment For Proliferative Diabetic Retinopathy 
While diabetic macular edema is the most common cause of visual loss in diabetes, proliferative diabetic retinopathy is responsible for the most severe loss of vision. Eyes with these new blood vessels are at risk of blindness from bleeding into the vitreous and from retinal detachment. Laser photocoagulation greatly reduces this risk of severe visual loss. Laser treatment reduces severe visual loss in all stages of proliferative diabetic retinopathy, and even before proliferation develops. Because this type of laser uses larger and more powerful spots than for macular edema, and several thousand may be applied at several sessions, side effects are greater. Therefore, treatment is withheld until the risk of severe visual loss without treatment outweighs the risks and side effects of the treatment. Reduced side vision and impairment of night vision can occur with this treatment though most patients do not complain of these side effects.  The most serious side effect is mildly reduced visual acuity which treatment causes in about 10% of patients. However, when compared to a 50% chance of loss of all vision without treatment in severe proliferative retinopathy, the 10% risk of mild loss makes sense.

VITRECTOMYVITRECTOMY
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Laser for PDR

   

Cryotherapy (Cryopexy)

Cryotherapy for Retinal Tears and Detachment
Cryotherapy is a means of freezing the retina where a retinal tear has occurred. This keeps the retina stuck in its proper place inside of the eye. The cryo probe is placed on the outside of the eye over the area of the tear. The doctor uses a light mounted on his head and a lens held in his hand to check the position of the probe and make sure it is in the right place. The probe is turned on and a small area is frozen in a few seconds. You will notice a cold feeling in that area. Between 3 and 12 areas may need to be frozen to seal the tear. Cryotherapy is done on the front half of the eye where a laser cannot be used.

This treatment is usually done in the office. The vision in the eye is checked before the treatment and the eye is dilated. Numbing drops or an injection is placed into the tissue near the area of the treatment. The doctor may also put an antibiotic ointment in the eye after the treatment. This will make your vision blurry. No drops or ointment are needed after that. The eye takes about 10 days to heal. Please check with your doctor for physical restrictions. You can use TylenolŪ, 2 tablets every 4 hours, if needed.

Some people have a cold feeling or "ice cream headache" during or after the treatment. Your vision may be slightly blurry for several days, and the eye may look red for the next few weeks. Cryopexy's overall success rate in preventing retinal detachment is about 80%. You should remain alert for any new symptoms, such as new floaters or a shadow or cloud in your side vision. Please call the office at 401-274-5844 if you have any concerns.

 


Injections

Avastin (Bevacitzumab)

The purpose of this medication is to treat abnormal blood vessels growing in the back of your eye from age-related macular degeneration (AMD) and other eye conditions that cause loss of vision due to abnormal growth of blood vessels. These can occur even in young patients, and include, but are not limited to, conditions such as high myopia (nearsightedness), histoplasmosis, angioid streaks, and eye injury. Sometimes there is no known reason for the abnormal blood vessels.

Refractory macular edema, or swelling around the macula, is edema that affects vision but does not respond adequately to the usual treatment methods. It can occur with conditions such as central retinal vein occlusion and diabetic retinopathy.

Without effective treatment, vision loss could progress and become permanent.

Avastin offers an excellent chance of stabilizing and, in some cases, improving your vision. Some mild discomfort, redness and irritation in the eye are not uncommon after the injection.

Possible benefits and “off-label” status
Avastin was not initially developed to treat conditions of the eye. Based upon the results of clinical trials that demonstrated its safety and effectiveness, Avastin was approved by the Food and Drug Administration (FDA) for the treatment of metastatic colorectal cancer. As a condition of approval, the manufacturer produced a “label” explaining the indications, risks, and benefits. The label explains that Avastin works by blocking a substance known as vascular endothelial growth factor or VEGF. Blocking or inhibiting VEGF helps prevent further growth of the blood vessels that the cancer needs to continue growing.

Once a device or medication is approved by the FDA, physicians may use it “off-label” for other purposes if they are well-informed about the product, base its use on firm scientific method and sound medical evidence, and maintain records of its use and effects. Ophthalmologists are using Avastin “off-label” to treat AMD and similar conditions since research indicates that VEGF is one of the causes for the growth of the abnormal vessels that cause these conditions. Some patients treated with Avastin had less fluid and more normal-appearing maculas, and their vision improved. Avastin is also used, therefore, to treat macular edema, or swelling of the macula.

Lucentis (Ranibizumab)

Patients diagnosed with wet age-related macular degeneration (wet AMD) may benefit from the injection of Lucentis into the eye in the vitreous cavity. The purpose of this medication is to treat abnormal blood vessels growing in the back of your eye. Lucentis offers an excellent chance of stabilizing and, in some cases, improving your vision. Some mild discomfort, redness and irritation in the eye is not uncommon after the injection.

 

Photodynamic Therapy (PDT)

PDT is a combined drug and laser treatment
Visudyne (verteporfin) was the first drug therapy for treatment of the wet form of macular degeneration. We now recommend that most patients with the wet form of macular degeneration be treated with Lucentis or Avastin injection therapy as these drugs produce better results.


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Photodynamic Therapy (PDT) for Wet AMD

Visudyne was designed for patients with new blood vessel growth (neovascularization) under the retina. It is not used in patients with the "dry type" of macular degeneration

Visudyne is a medicine that is activated by light but has no effect on its own. In the presence of light and oxygen, it reacts with oxygen to produce a cell-killing (cytotoxic) effect. The cells we are trying to kill are the abnormal blood vessels under the retina.



During treatment, the doctor injects Visudyne into a vein in your arm. After waiting a few minutes, the doctor activates the drug so it will stick to the abnormal blood vessels. This is done by shining a non-thermal laser (cold laser) into your eye. The Visudyne is activated and destroys the abnormal blood vessels. The procedure is painless.

To destroy abnormal blood vessels in the retina, our doctors use this "cold laser" in patients who have received Visudyne. >>

 


Surgery

When necessary, surgery is performed at the Rhode Island Hospital Ambulatory Surgical Center. The Center has a state-of-the-art operating room and a superb staff dedicated to retinal surgery. Pre-admission testing and a preliminary physical exam may need to be arranged. Our surgical coordinator will schedule surgery with you. She will fill out the necessary paperwork and let you know what to bring with you on the day of surgery. You should neither eat nor drink after midnight on the evening before your surgery.

Vitrectomy

Vitrectomy is a surgical procedure in which instruments are introduced into the eye for repair of various diseases and conditions of the retina and vitreous. It is usually performed under local anesthesia and in an ambulatory or outpatient operating room. Surgery usually takes an hour or two, but, in complicated cases, may take hours longer.  


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Vitrectomy

In patients with diabetes, reduced vision because of vitreous hemorrhage is a common indication for surgery and the results are generally good. The blood stained vitreous is removed as an enhanced saline solution is infused as replacement. Diabetic retinal detachment is another indication for surgery.

Various instruments and techniques are employed to remove the vitreous gel and to separate it from the retina to which it is intimately attached. Proliferative neovascular tissue is also removed and laser photocoagulation is often applied. An inert gas is sometimes placed in the eye to help hold the retina in place. This gas is slowly absorbed from the eye and does not need to be surgically removed. Visual recovery after vitrectomy may be limited by the degree of previous retinal damage from the diabetes. Complications include cataract and recurrent hemorrhage. This surgery has been of great benefit to patients who may have received laser therapy too late, and for the small number who have not responded to laser treatments.

Scleral Buckle

Retinal detachments are sometimes fixed using a scleral buckling procedure either alone or in combination with vitrectomy. In this procedure, a piece of plastic is sewn onto the eye wall (the sclera) and this pushes the wall of the eye in against the retinal break that is causing the retinal detachment. This closes the break and allows the retina to reattach.

Pneumatic Retinopexy

Some retinal detachments may be repaired with an office procedure called pneumatic retinopexy. A small bubble of gas is injected into the eye and the patient is positioned so that the causative retinal break is upper most. Since the gas bubble rises to the top in the eye, the bubble comes in contact with the break and prevents fluid from passing through the break.
Fluid already beneath the retina is absorbed usually within a day. Cryopexy or laser is added to seal the retina tightly around the break.