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Yearly Archives: 2015

Avastin is Safe | Study Shows No Link to Infection

Avastin is SafeAs reported this week in Jama Ophthalmology , the chance of contracting endophthalmitis from Avastin is no different than with the case of Lucentis.

Both are equally safe.

Several outbreaks of endophthalmitis (infection inside the eye) have occurred over the past few years questioning the safety of Avastin vs. the practices of compounding pharmacies.

What are Compounding Pharmacies?

A compounding pharmacy is NOT Walgreen’s, CVS or Rite Aid.

Compounding pharmacies can make, or “compound.” individualized specialty medications.  In the case of Avastin,  a compounding pharmacy will purchase large amounts of Avastin and divide them into smaller doses for use by retina specialists.

Both a compounding pharmacy and a pharmaceutical company are responsible for packaging and distributing drugs using approved sterile techniques.

Avastin is Repackaged

Avastin is only supplied in massive doses from the manufacturer.  As Avastin is an FDA approved anti-VEGF treatment for certain types of cancer, it is distributed only for chemotherapy treatments.  Genentech, the manufacturer, does not sell the smaller doses used for intravitreal injections (IVT).

Compounding pharmacies purchase the Avastin and re-package the drug in smaller doses for sale to the ophthalmologists.

Lucentis is Directly Shipped

In contrast, Lucentis is sold directly from Genentech to the practicing retina specialist.  As Lucentis is FDA approved for eye treatments, the Lucentis is manufactured, packaged and shipped directly to the ophthalmologist.

In 2011, an outbreak of endophthalmitis caused concern over the practices of compounding pharmacies.  Similar suspicions developed in 2012 over an outbreak of fungal meningitis – caused by contaminated steroid injections, but processed at a compounding pharmacy.

In 2013, the FDA released the Compounding Quality Act offering guidelines to reduce the chance of endophthalmitis.

Study Shows Avastin is Safe

The retrospective study just published in Jama Ophthalmology compared the rates of endophthalmitis between Avastin and Lucentis from 2005 to 2012, in essence, studying the two drugs BEFORE the Compounding Quality Act was created.

The authors found that there was no statistical differences in the rates of infection!  In other words, Avastin itself, does not cause infection.

What Does this Mean?

Historically, the threat of blinding infection (endophthalmitis) is the biggest concern with administering intravitreal injections (IVT).  It doesn’t matter if we are injecting Avastin, Lucentis, Ozurdex, etc.

In 2011, 12 cases of endophthalmitis were reported to have occurred in Florida.  Though all the injections emanated from the same compounding pharmacy, it questioned whether it was the Avastin versus the pharmacy itself.

Similar concerns were noted in cases of endophthalmitis from a compounding pharmacy in Tennessee.  Finally, an outbreak of meningitis, causing many fatalities, was linked to contamination from a single compounding pharmacy.

This study should alleviate concerns over use of Avastin causing blindness from endophthalmitis.  Concerns over the cause of endophthalmitis are limited to the  practices of the compounding pharmacies and not to the actual drugs.

Patients should find relief as Avastin continues to provide excellent treatment results from diseases such as macular degeneration and diabetic retinopathy.


Safety of Intraocular Injections | Infection

This is series of articles co-authored by John Sullivan, M.D., a retina specialist in Jacksonville, Florida. John and I trained together.

This is Part 2.
Part 1 – Intraocular Injections

Possible complications of intraocular injections (IVT) include Intravitreal Injections for Retinal Diseases, Randall Wong, M.D.cataract formation, increased eye pressure, inflammation, retinal detachment and endophthalmitis (blinding intraocular infection).

Of those listed, the most feared is infection inside the eye.  Infection inside the eye can cause blindness.

What is the Chance of Infection?

The chance of developing endophthalmitis after intraocular injection is somewhere around 1:2000.  No one knows the true chances.  This approximates the chances of infection from cataract surgery.

Why?  Because endophthalmitis does not occur very often.  Complications which are uncommon are difficult to measure.  Studying endophthalmitis has always been difficult due to the fact it occurs so infrequently.

There are several factors influencing the chances of getting an infection;  size of needle, volume of medication to be injected, the actual medication injected, etc.

Source of Infection

No one really knows the source of the bacteria which cause the infection.  The presumed source is from the patient’s own tears, conjunctiva and eyelids.  There is some strong evidence supporting this theory.

Other possible sources include spreading of infection from respiratory sources (i.e. droplets of saliva/secretions from speaking/sneezing).

Preventing Infection from IVT

Betadine is the best accepted antiseptic for cleaning the eye prior to IVT (injection).   It is used by most retina specialists just before the intraocular injection is given.

Betadine works rapidly and a few drops are often placed on the eye prior to IVT.

Topical antibiotic drops may also be recommended by many retina specialists starting a few days before the injection and continued shortly after the injection.

Many retina specialists will use gloves, masks or a lid speculum to aid in the prevention of infection.

John Sullivan, M.D.
Retina Speciallist
Jacksonville, FL 32256









Intravitreal Injections | Intraocular Drug Delivery Sytems

This is series of articles co-authored by John Sullivan, M.D., a retina specialist in Jacksonville, Florida.  John and I trained together.

This is Part 1.


Intravitreal Injections for Retinal Diseases, Randall Wong, M.D.Intravitreal injections (IVT) have become a very popular procedure used by retina specialists over the last decade.  Intravitreal injections have two unique advantages.  By directly injecting medications into the eye, systemic (exposure to the rest of the body) exposure to the drug is minimized.  Also, the eye’s natural barriers are bypassed and the amount of drug that reaches the eye surpasses the amount obtainable by topical drops or systemic administration (IV or drugs taken by mouth).

Retinal Diseases Treated by Injections

Intravitreal injections now allow retina specialists to treat a variety of diseases.

Wet macular degeneration is probably the most commonly retinal disease treated by anti-VEGF medications which are injected directly into the eye.  Examples of anti-VEGF medications include Avastin, Lucentis, Macugen and Eylea.

Retinal vascular occlusions (RVO) include branch retinal vein occlusions (BRVO) and central retinal vein occlusions (CRVO) used to be treated only with laser treatment.  Swelling of the macula (macular edema) is caused by loss of the normal blood supply of the retina.  Steroids (e.g. Kenalog, Triesence), sustained release steroids (Ozurdex) and anti-VEGF intravitreal injections are now the mainstay of treatment.

Diabetic macular edema (DME) is a common complication of diabetic retinopathy.   While laser treatment is still a valuable treatment option, intravitreal injections of steroids, Ozurdex, Iluvien and anti-VEGF are now saving the sight in many who can not have laser treatment.

Uveitis (intraocular inflammation, also called iritis) may be treated with injections of steroids or Ozurdex.  Vitreomacular traction (VMT) can be treated with Jetrea.  Cytomegalovirus (CMV) retinitis is treated with intravitreal Vitravene.

Intravitreal Injections are Increasing

The use intraocular injections has been rising from <3000 in 1999 to well over 1 million in 2008.

The rise in popularity can be attributed to efficacy (how well they work) and safety.  Cost may be an issue, but only when we have competing therapies which produce similar results.

John Sullivan, M.D.
Retina Speciallist
Jacksonville, FL 32256



Causes of Epiretinal Membrane (ERM)

Epiretinal Membrane, Randall Wong, M.D., Retina Specialist, Fairfax, VirginiaAn epiretinal membrane (ERM), also known as macular pucker, is caused by an overproduction of protein which accumulates on the surface of the macula.  An epiretinal membrane (ERM) occurs in normal eyes.

On a microscopic level, the ERM causes the underlying retina to wrinkle or “pucker,” hence the condition is also known as “macular pucker.”

PVD Usually Present

In my experience, something instigates the extraprotein production.  When I examine patients with an ERM, I specifically note the presence or absence of a posterior vitreous detachment (PVD).  There is usually a PVD present in most patients with an epiretinal membrane.

Other “causes” include a previous retinal tear, retinal detachment or a history of intraocular surgery, such as cataract surgery.

Symptoms of Epiretinal Membrane (ERM)

An epiretinal membrane can cause decreased vision and/or distortion.  Remember that the ERM causes the underlying macula to wrinkle.  This directly causes decreased vision and/or distortion.

Not all epiretinal membranes need surgery as either patients are asymptomatic (not aware of any vision loss) and the membrane is not progressing.

Surgery for ERM

Surgery to remove the ERM should occur when you are aware of the blurry vision caused by the macular pucker.  I recommend operating as early as possible due to the fact that usually there is not complete restoration of vision – there may always be some residual blurring or distortion.

Operating early should maximize your visual prognosis.

Timing of Vitrectomy for ERM

Unlike cataract surgery, the timing or indications for vitrectomy to remove the ERM are varied.

Many retina specialists consider the visual acuity as the sole indication for surgery, but this ignores the “distortion” caused by the epiretinal membrane.

Distortion is not measurable and we must rely on your perception of this symptom.




Anesthesia for Eye Surgery | Your Retina Surgery

Choosing Anesthesia for Retina Surgery, Randall Wong, M.D., Retina Specialist, Fairfax, VirginiaIf you require retina surgery; vitrectomy, removal of ERM, repair of macular hole, retinal detachment repair, etc., there are several choices of anesthesia for your eye surgery.

I operate almost exclusively at Woodburn Surgical Center at INOVA Fairfax Hospital.  Surgery is performed on an outpatient basis and go home soon after surgery is completed.

Let me also note that the choice of anesthesia is usually determined between YOU and the anesthesiologist.  While I may suggest a preference, the decision is really up to the anesthesiologist.

Local Anesthesia with Sedation

This is probably the most common choice of anesthesia.  This is also called “twilight” due to the sedation given through the intravenous line (I.V.).

Before numbing your eye with a “local” injection, you are given medication through the I.V. for sedation.  You will be sedated for a few minutes while I numb your eye with either a retrobulbar or parabulbar injection.  I usually prefer retrobulbar injections.

For a retrobulbar injection, I usually use 3-5 cc’s of numbing medicine such as Lidocaine.

The injection will both numb the eye and keep it still for surgery.  Once the sedation wears off, patients are usually awake, but very, very comfortable.

On occasion, additional sedation can be given during the operation.

General Anesthesia

General anesthesia using a laryngeal mask airway (LMA) can also be used.  General anesthesia is an option if the anesthesiologist feels it is safe enough for you.  Sometimes patients are not healthy enough for this method.

I like to use general anesthesia when placing a scleral buckle for repair of a retinal detachment.  The scleral buckle is placed on the outside of your eye and requires manipulation of your eye muscles.  This can be painful despite a successful retrobulbar block.

While it is possible to start a scleral buckle operation with local anesthesia and then “convert” to general, it’s more difficult once the operation has started.

Even with general anesthesia, I also use a retrobulbar block – it lasts several hours after surgery.

With modern operating techniques, this operation can often be completed in less than an hour requiring minimal amounts of anesthesia so that going home shortly after surgery is usual.  (Sometimes with long operations under general anesthesia, recovery from the anesthesia is prolonged.)

Some patients will want to go to sleep for the operation.

Local Anesthesia Only

On occasion, I have patients who do not want any sedation and request only the retrobulbar injection.

What Does This Mean?

No matter what technique is used for your retina surgery, the main goal is to keep you comfortable and without pain or discomfort.

It is also our job to keep you safe and healthy.  I want to operate knowing you will be comfortable and cooperative, too.  Sometimes this will impact our choice of anesthesia if patients are to fidgety, talkative or anxious.

Efficient operating times allow for reduced anesthesia.  This, in turn, allows you to recover from the anesthesia much quicker and avoid health concerns with longer operations.

Iluvien Treats Diabetic Macular Edema for 3 Years

US ILUVIEN LOGOIluvien is now available in the United States!  Finally receiving FDA approval in late 2014, the injectable sustained release intravitreal implant  is on the market.

Alimera Sciences states that Iluvien (sustained release of fluocinolone) will release its drug for up to 3 years.

Iluvien Treats Diabetic Macular Edema

Diabetic macular edema is the most common vision threatening complication of diabetic retinopathy.  In essence, normal blood vessels of the retina become leaky due to the diabetic retinopathy.

Fluid accumulation in or near the center of the macula is called diabetic macular edema (DME).  This is also known as clinically significant macular edema (CSME) if you are a doctor.

DME often causes blurry vision and in extreme cases can cause legal blindness.

Therapy is aimed at stopping the leakage.  With time, the macular edema may “dry up.”

Treatment options include laser, anti-VEGF (e.g. Avastin, Lucentis, Eylea), intravitreal steroids (Kenalog) or sustained release intravitreal implants (Ozurdex, Iluvien).Size comparison of Iluvien to Pencil Tip | Randall Wong, M.D., Retina Specialist, Fairfax, Virginia

Iluvien is Injected Painlessly

Iluvien is injected directly into the vitreous.  The sustained release system will release fluocinolone for 3 years.  The actual “pellet” is small enough to fit inside a 25 gauge needle.  It is smaller and thinner than a grain of rice.  You may click on the image to enlarge.

By injecting directly into the eye, as with all intravitreal injections, only small amounts of drug are needed to treat the retina.

The steroid will chemically stop the retinal vessels, affected by the diabetic retinopathy, from leaking.

36 month Delivery

While intravitreal drug delivery is not novel, the duration of the product is unique.

Constant treatment for 36 months may have huge practical advantages; namely fewer offices visits and less testing.

The economics of this are intriguing.  The practical consequences are even more staggering.  In short, this could mean far fewer trips to the retina specialist for the patient AND the family.  Fewer office visits translates into fewer examinations and testing.

We’ll see.





Vitreous Hemorrhage | A Dilemma

Vitreous Hemorrhage presents dilemma in treatment | Randall Wong, M.D., Retina Specialist, Fairfax, VirginiaOn Thursday morning, I met a 75 YOM (year old male) who had lost vision just the day before.  He was referred to me for evaluation of a dense vitreous hemorrhage in his left eye.  He is healthy and never had any eye problems before.

This is one of the more difficult patient situations for me to manage.  This is a case of a dense vitreous hemorrhage in a patient without diabetes.

The situation is challenging for several reasons.  The hemorrhage happens suddenly and without warning.  A vitreous hemorrhage is painless, yet can produce profound vision loss depending upon the amount of bleeding.   Up to this moment, most patients have enjoyed excellent vision.   I don’t blame patients for being anxious.

The situation is more complex because I can’t make a definitive diagnosis as to the actual cause of the vitreous bleeding.  Blood in the vitreous causes immediate loss of vision because it blocks the light from hitting the retina.

Patients can’t see “out” and I can’t see “in.”

Causes of Vitreous Hemorrhage

There are only 2 likely causes of the vitreous hemorrhage in this scenario.   Bleeding with a retinal tear or bleeding without a retinal tear.

Remember that retinal tears can cause retinal detachments.  Retinal detachments are potentially blinding and will require surgery to repair.

Therefore, an undiagnosed retinal tear has the potential for developing a retinal detachment at any time.

Appropriate treatment for a retinal tear with vitreous hemorrhage might be to operate (vitrectomy) and remove the blood.  Removal of the blood allows excellent visualization of the retina and the tear.

Appropriate treatment for a vitreous hemorrhage without a tear is to wait – do nothing.

After performing an ultrasound (B-Scan ultrasound), I was able to determine that the retina was not detached.  Therefore,  there was no immediate cause for concern.

Vitrectomy for Vitreous Hemorrhage, or NOT?

Again, the dilemma is that I don’t know for sure if there is a retinal tear.  I only know that there is no retinal detachment and there may or may not be a retinal tear.

The might absorb over the next few weeks allowing better and more definitive examination, or it might not.  There’s about a 50/50 chance the blood will absorb.  It may take weeks to go away if at all.

Meanwhile, a retinal detachment could ensue.

Advantages of waiting are avoidance of an operation and its possible complications.

Disadvantages of waiting:

  • retinal detachment develops (potential for permanent loss of vision)
  • possibility of emergency surgery (never ideal)
  • surgery may be needed anyway (blood doesn’t absorb)
  • frequent return office visits

Advantage to Vitrectomy

  • definitive treatment
  • faster restoration of vision
  •  likely avoid retinal detachment

Risks of Vitrectomy

  • blinding infection (endophthalmitis – chance is less than cataract surgery)
  • creating a retinal detachment (about 2% chance)

After balancing all his options, my patient chose to operate.

Scleral Buckle and Vitrectomy to Fix Retinal Detachments

Vitrectomy for repair of retinal detachmentThere are several ways to fix retinal detachments.  The most popular operations include vitrectomy and scleral buckle.  These two procedures may be used singly, or in combination.

Nowadays, most retina specialists choose to repair retinal detachments using vitrectomy (and gas) alone.  While the scleral buckle has been around for several generations, I rarely use it alone to fix a retinal detachment.

Most often I use just vitrectomy, but when do I use BOTH vitrectomy and scleral buckle for repair of retinal detachments?

First of all, there is no dogma.  I’ve developed my own indications for using both procedures.  Hence, the elegance of “the practice of medicine.”

No Retinal Tear

All rhegmatoneous retinal detachments, by definition, are caused by a retinal tear or retinal hole.  This the more common type of retinal detachment.

One of the keys to successful surgery is find the retinal tear or retinal hole causing the retinal detachment.

Sometimes, despite my best efforts, I can’t locate the tear causing the retinal detachment.

Placing a scleral buckle increases the likelihood of successful reattachment AND the likelihood the retina remains attached.

Scleral Buckle to repair retinal detachment.  Randall Wong, M.D., Retina Specialist, Fairfax, VA 22031

Multiple Retinal Tears

Only one retinal tear is “required” to cause a complete retinal detachment.  In most cases, I find only one or two tears.  There are occasions where multiple retinal tears are found and in these cases, I am more than likely to use both vitrectomy and scleral buckle.

Also, in cases where the retina detaches again…I’ll choose to add the scleral buckle.

Old Inferior Retinal Detachments

In my opinion the most difficult situation to repair is a chronic (been there a long time, e.g. several months) retinal detachment located in the inferior portion of the retina (i.e. bottom).

Fluid underneath the retina tends to get thicker with time.  Usually the “subretinal” fluid is very watery (because it is basically water).  With time, however, this fluid accumulates protein and starts to thicken.

This thicker fluid is more difficult to remove.  Patients must keep a strict “face down” head position, but the chance of re-detachment increases due to these two factors.

Again, scleral buckles improve the initial success rate!

Scleral Buckle Has Side Effects

There are several side effects of scleral buckle;

1.  Increased myopia (nearsightedness) – by placing a buckle around the eye, the eye elongates, thus causing an increase in myopia.  Sometimes this can be dramatic and is difficult to correct with glasses or contacts.

If the refractive error is too different between the two eyes, your brain won’t tolerate this situation and you may see double.

2.  Possible Double Vision – the scleral buckle involves manipulation of the extraocular muscles – the muscles attached to the outside of the eye which are responsible for eye movements.  In theory, this could cause damage to one of the muscles.  It doesn’t happen very often, but it can.  I’ve found it to be surgeon related.

3.  Healing – the post-operative period is a little more complicated than when just performing a vitrectomy alone.  There is more swelling due to the surgery performed on the outside of the eye.  There may be additional discomfort (shouldn’t be frank pain).

4.   Time – while not really a side effect, the extra time required by your retina specialist to install a scleral buckle varies greatly.  This can add as little as 10 minutes to the procedure or increase the operating time to hours.

What Does this Mean?

These are my basic considerations when deciding to repair a retinal detachment with BOTH scleral buckle and vitrectomy.

While the success rate (in my opinion) is higher, we need to consider the risks and benefits overall.

I hope this was somewhat helpful in explaining a very complex and curious situation.

I look forward to hearing from you!

What is the Vitreous?

Vitrectomy is performed by retina specialists to repair various retinal diseases.  Randall Wong, M.D.As a retina specialist, my specialty niche is disease pertaining to the retina and vitreous.   The retina is the light sensitive tissue which lines the inside of the eye.

The vitreous is the gel like substance which fills most of the eye in the posterior chamber (that portion of the eye behind the iris and lens).

What Does the Vitreous Do?

The vitreous is critical to embryonic development, that is, it’s part of the development of the eye.

The vitreous should be optically clear.  You should not be able to see your own vitreous although your eye doctor should be able to see all of your vitreous!

Once we are born, there is no practical function of the vitreous.  Because it is 2-3 times thicker than water, it potentially could “plug” cuts or holes into the eye…kind of like putting a finger in a dike.

Vitreous Causes Retinal Detachments

Many of the diseases I treat as a retina specialist stem from the vitreous.  If it weren’t for the vitreous, there would not be a retinal surgical sub-specialty – there wouldn’t be any diseases upon which to operate!

The vitreous causes;

Retinal Tears – the vitreous is adherent to the retina.  Forces tugging on the retina can cause a retinal tear.  This may happen during a PVD (posterior vitreous detachment) or trauma.
Retinal Detachments – There are two basic types of retinal detachments.   The vitreous is implicated in both.

Rhegmatogenous retinal detachment – these are the most common types of retinal detachments emanating from a retinal tear.  Fluid migrates through the tear and underneath the retina…causing a retinal detachment.

Certain diseases, such as advance diabetic retinopathy can lead to a “traction” retinal detachment.   These detachments occur when sheets of protein/scar tissue grow on the surface of the retina and start to detach the retina by “pulling” or causing traction.

These sheets of protein develop in between the vitreous and retina.

Epiretinal membranes are microscopic types of traction retinal detachments as are macular holes.

Diabetic macular edema improves if a PVD develops or a vitrectomy is performed.

Floaters are a common annoyance and for some impair the vision by causing spots in the vision, glare or blurriness.

What Does this Mean?

This is a vestigial tissue, the vitreous is important in our development.   Once born, we don’t really need the vitreous.

A vitrectomy, the core operation performed by a retinal specialist, removes the vitreous and is performed a part of the procedure to fix a variety of the problems noted above.

The vitreous does not need to be replaced – we simply don’t need it.  During the operation, artificial saline is pumped into the eye.  After the vitrectomy, the artificial saline is replaced by our own.

Using Intraocular Gas in Retina Surgery

Gas Bubble Used in Vitrectomy to repair retinal detachment or macular hole.  Randall Wong, M.D., Retina Specialist, Fairfax, VirginiaInjecting a “gas bubble” into the eye is commonplace for certain types of retinal surgery.  Not all retina surgery requires use of intraocular gas or air.

Vitrectomy is the basic operation performed by retina specialists.  The vitrectomy is the removal of the vitreous, the watery-gel that fills most of the inside of the eye.

Removing the vitreous allows me to work on the retina;  to repair macular holes, remove epiretinal membranes, fix retinal detachments, remove vitreous hemorrhage, etc.

Intraocular Gas – Long Acting

It is my practice to use intraocular gas for repair of macular holes and retinal detachments.  Almost without exception, these are the only two operations where I’ll use a gas as a tool to help me repair the retina.

Most retina specialists use a gas called  C3F8.   This is a very long acting gas and may remain in the eye for over a month.  When used, most patients must assume a particular head position for several weeks to ensure that the “bubble” is correctly positioned inside the eye.

This is the origin of the famous “face down positioning.”

Shorter Acting Gas

I prefer to use SF6.  This is a smaller molecule and, depending upon the concentration used, will be absorbed by the eye much faster than its counterpart C3F8.

It is my observation over 23 years, that in most cases, the gas is needed for only a few days…not weeks.  Not only is excessive head positioning avoided, but complications decrease, too.

I usually use SF6 for retinal detachments.  Sometimes, too, just plain air.

Intraocular Air

Air is composed mainly of nitrogen and oxygen.  These are much smaller molecules than either of the gases noted above; C3F8 or SF6.  Hence, it makes sense that the smaller molecules are absorbed faster by the retina.

Many times, simply injecting air in the eye will give me a “gas bubble” that will help repair the retina, yet will be absorbed faster to reduce complications.  The longer a gas stays in the eye, the higher the chance of complications such as causing retinal tears.

Benefits of Air in the Eye

The faster absorption rate also means that while head positioning after surgery may be important, keeping your head in a fixed position for WEEKS is not necessary.

The chance of glaucoma developing with air is almost non-existent.  Both C3F8 and SF6 have the capability of expanding in the eye when the gas is pure (i.e. not mixed with air).  Most retina surgeons choose a gas mixture which expands very little or none at all.  Thus, at times, very high eye pressure can develop when using these gases.

Air is non-expanding.

It is also possible that cataract formation after intraocular air may be reduced…this is just my observation, not gospel.

What Does this Mean?

Using simple air instead of the other gases in selected cases of retinal detachment and macular holes may prove to be just as effective, yet have fewer complications and without the agony of prolonged (unnecessary?) head positioning.







Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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