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Silicone Oil for Retinal Detachments

Silicone oil is used for recurrent retinal detachments or complicated retinal detachments including PVR (proliferative vitreoretinopathy).  It can be a valuable tool to prevent blindness.

Most retinal detachments are caused by a retinal tear, or hole, in the retina.  In either case, this allows for communication between the vitreous cavity and the potential space underneath the retina.  Fluid may leave the vitreous and accumulate underneath the retina, causing a rhegmatogenous retinal detachment (rhegma = with a hole).

A vitrectomy with gas with or without a scleral buckle are common ways to surgically repair retinal detachments.

Recurrent Retinal Detachments

Occasionally, a retina can redetach and usually shortly after the first surgery.  Common reasons include an additional retinal tear, or, it is conceivable that an extra tear(s) was overlooked and not treated.

Options include repeating the vitrectomy with gas and possibly adding a scleral buckle if one is not present.  This usually does the trick.

Recurrent Detachments and PVR

Repeated retinal detachments due to additional tears usually persuades me to consider using silicone oil to fix the detachment.  In addition, a condition called proliferative vitreoretinopathy (PVR) often requires using silicone oil.

PVR can cause retinal detachments as membranes (scar tissue) form on the surface of the retina and start to pull.  This pulling can cause multiple retinal tears.

How Intraocular Gas Fixes Retinal Detachments

Intraocular gas works by “plugging” the retinal tears or retinal holes.  The gas bubble, when properly positioned against the tear/hole, prevents fluid from getting underneath the retina causing a recurrent detachment. As the gas is absorbed, the bubble will become so small that any untreated or new hole will be uncovered.  Thus, the retina can detach again.

How Silicone Oil Repairs Retinal Detachments

Think of silicone oil as a non-absorbable gas bubble.  Since the silicone oil is not absorbed, it stays large enough to always cover the holes.  This makes it highly unlikely that a redetachment can occur.

Is Intraocular Gas Better than Silicone Oil

Normally, intraocular gas is preferred as it eventually absorbs after reattaching the retina.  A separate procedure is not required to remove the gas.

Silicone oil does require removal and the vision is usually poor with the oil in the eye, however, when warranted, the oil is likely to prevent re-detachment.

What Does This Mean?

Silicone oil is a great tool to repair retinal detachments.  Repeated operations can be mentally straining and can be a hardship on the patient and family.  Also, with each new detachment, the likelihood of permanent vision loss increases, thus, the fewer detachments the better.

Too many retinal physicians, using silicone oil is a last resort to keeping the retina attached.  Often doctors wait until the retina has detached 3-4 times before considering oil (in fairness, I used to be one of them).

My belief is that oil should be used earlier to stop the vicious cycle of re-detachment and re-operation.  By preventing recurrent detachments, the vision can be better preserved in these complicated cases.

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Implantable Telescope is Available!

CentraSight Now Available, CMS to reimburse for implantable telescope to treat macular degeneration

CentraSight, the implantable telescope for macular degeneration, is now available! CMS (Centers for Medicare and Medicaid Services) has approved the telescope for those patients with macular degeneration meeting the eligibility criteria for the surgical procedure.

Medicare/Medicaid will cover the cost of the implant and the surgery in certain patients as October 1, 2011! For now, the procedure has a designation of a transitional pass-through payment, that is, CMS will approve the procedure for 2-3 years until enough payment data can be collected.

The Telescope Improves Vision

To achieve this milestone, Visioncare, the parent company, needed to show that the implantable telescope for macular degeneration met several criteria;

  • FDA Approval
  • CMS deems reasonable and necessary
  • Device offers Substantial Clinical Improvement

FDA Approval: VisionCare received FDA approval for their telescope last August.

Substantial Clinical Improvement may be difficult to attain as the device must surpass some steep challenges.  In order to achieve this status, one of the following situations must be true;

  1. the new device must be better than other available treatments
  2. the device improves the ability to diagnose a condition
  3. the device significantly improves the patient (i.e. clinical outcomes)

Availability of the CentraSight Telescope

For now, according to my contact at VisionCare, CentraSight will be offered at the locations where the original clinical trials were performed.  This has been their plan all along.  With time, as more physicians become trained, the availability will widen.

What Does This Mean? This is the first real step to helping patients with significant visual loss in both eyes.  The surgery to insert the “telesope” is similar to cataract implantation, yet the CentraSight will modify the images so more of the retina surrounding the macula is utilized for vision.

While patients with either form of the disease might be candidates, this is the first FDA sanctioned “therapy” for patients with severe loss of vision from dry ARMD.

This is not a cure or a “fix” for loss of central vision, however, the telescope does improve function for those that have no central vision from the disease and can lead to am improvement in the quality of life.

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Two Lasers for Diabetic Retinopathy

Laser Treatment for Diabetic Retinopathy

There are two different laser treatments to treat diabetic retinopathy.  One laser treatment is used to treat diabetic macular edema, the most common “complication” of diabetic retinopathy.  The second laser treatment is used to treat proliferative diabetic retinopathy (aka PDR), yet far fewer people develop this potentially blinding stage of the disease.

Same Laser Used for Both Treatments

Macular edema is treated with “focal” laser treatment.  The laser is used to treat/burn/cauterize those areas of blood vessels that are leaking near the macula.  The treatment is focused to treat certain specific areas, hence “focal” laser.

Proliferative diabetic retinopathy (PDR) is treated with “scatter” or “pan-retinal” photocoagulation (PRP).  The peripheral retina is “scattered” with laser burns.

Some Patients Need Both Laser Treatments

The timing of the treatment can be crucial.  Treating the PDR (proliferative diabetic retinopathy) before the macular swelling is controlled, or treated, can lead to progressive loss of vision because the PRP (used to treat PDR) can worse the macular edema.

I prefer treating and controlling the macular swelling first, before treating the neovascular disease (PDR).  Depending upon the situation, however, I don’t always have this luxury as sometimes the PDR is so advanced that we can not wait.

Remember, the neovascularization can cause blindness.

What Does This Mean? In most cases, patients need only one or the other treatment.  Macular edema is treated with focal laser and PDR is treated with PRP.  In the unlikely situation where patients need both…

When possible, I’ll treat the macular edema with focal and wait several weeks, or months, to treat with scatter laser.  I don’t want the macular edema to worsen.

Macular fluid causes decreased vision (patients can tell).  Worsening macular edema means lousy vision….and anxious patients.

Avastin, however, has improved my ability to treat those patients with both macular and proliferative disease.  Avastin (or Lucentis) allows me to treat both the PDR and macular edema…it buys me time!


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10 Facts About Diabetic Retinopathy

I will be speaking to a local patient group regarding the implications of diabetic retinopathy later this week.  These are my “Top Ten” factoids about the eye disease.

Patients With Diabetes Need Annual Eye Exams

Without exception and at a minimum, both the AAO and AOA recommend that every patient with diabetes receive an annual eye exam.  The pupils must be dilated to allow proper examination of the retina.

It doesn’t matter if you take insulin or not.  The disease has no bias.

Diabetes Mellitus Affects the Retina

The retina is the light sensitive tissue that lines the inside of the eye.  It is the principle tissue in the eye targeted by diabetes.  Without a healthy retina, you can not see.  It is perhaps the most important structure of the eye.

Diabetic Retinopathy May be Asymptomatic

Diabetic retinopathy is a slowly progressive disease.  The key to saving vision is early diagnosis and before there are any symptoms of blurred or decreased vision.  Don’t let good vision fool you into thinking there is nothing wrong with your eyes!

Good Sugar Control Does NOT Prevent the Disease

There is nothing to prevent the development of diabetic retinopathy.  While sugar control may slow the development of the disease, there is no proof that it will actually prevent the disease.  Most doctors and patients are unaware of this one fact.

Diabetic Retinopathy Can Cause Blindness

While diabetic retinopathy can cause a spectrum of vision loss, true blindness is quite rare.  In fact, fewer than 1% of patients with diabetes will sustain “significant” vision loss in their lifetime.

In other words, blindness may be prevented most of the time, but early detection and treatment is essential.

Ophthalmologist or Optometrist Doesn’t Matter

In my opinion, not shared by many of my colleagues, I don’t think it matters if you are examined by an ophthalmologist (M.D.) or optometrist (O.D.).  In my experience, most eye doctors are able to identify/recognize diabetic retinopathy.  You should then be referred to a retinal specialist.

Diabetic retinopathy has a characteristic appearance that can be recognized easily.

Retinal Specialists Treat Retinal Disease

Okay, no kidding, but my point is that there are many ways to treat diabetic retinopathy.  While you may not be examined regularly by a retina specialist, you should evaluated by a retinal specialist once the disease is diagnosed.

There are so many treatments available to you at this time to improve or stabilize your condition.

Every Patient With Diabetes Will Develop the Disease

I have seen very few patients with diabetes over 30 years that are lucky enough not to have developed the disease.  I think it is safe to say that most will develop the disease and I tell all my patients to expect the diabetic retinopathy to develop.

Why?  If you expect the disease to develop, you are most likely going to have regular exams.  If you expect the disease to develop, then you get rid of the “denial” and seek proper medical treatment.  Also, by expecting to develop the disease, you won’t feel disappointed in yourself for failing to take better care of your health.

Macular Edema and Proliferative Diabetic Retinopathy

There are only two “stages” that require treatment.  Swelling in the macular area is called macular edema.  Macular edema causes blurry vision.  Most diabetic patients get this form.

Proliferative diabetic retinopathy (PDR) affects fewer patients, but can lead to blindness if not treated.

Both macular edema and PDR may occur simultaneously.

anti-VEGF, Laser, Steroids and Vitrectomy for Diabetic Retinopathy

We now have an array of treatments depending on the stage and severity.  Regardless of the treatment, early detection gives you the best prognosis for maintaining your vision!

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How to Diagnose Macular Degeneration

Unlike the diagnosis of diabetic retinopathy, a patient with macular degeneration must have symptoms of the disease for the diagnosis to be made.  In most cases, the retina should have characteristic “damage,” and, most importantly, the patient must be having symptoms, i.e. decreased vision and/or distortion.

In Whom We Make the Diagnosis

Patients afflicted with macular degeneration are almost always greater than 55 years old, show signs of the disease, often of northern European ancestry and have decreased vision and/or distortion.

The disease is progressive and, in most cases, affects both eyes.

Symptoms of Macular Degeneration

As I wrote last week, a patient with diabetic retinopathy may not have anything wrong with their vision, that is, they may not  have symptoms.

A patient with macular degeneration must have visual symptoms.

What are Drusen?

Some of the hallmarks of macular degeneration include the presence or absence of pigmentary changes, fluid, blood and drusen.

Drusen are creamy white spots within the layers of the retina.  There are two types, hard and soft, but both can be associated with macular degeneration.  They are not diagnostic of the disease, but many non-retina physicians know this.

Drusen may be present in the retina without other evidence of degeneration.  Drusen may be normal.

Fluorescein Angiography is Diagnostic

As with any retinal disease, a good dilated pupil exam is necessary to look at the retina.  If there are no signs of the disease, the vision is good, no further testing is needed.

If there are signs of the disease, then a fluorescein angiogram should be performed.  This test involves injection of a dye into your arm.  The dye travels to the retina and pictures are taken.  A fluorescein angiogram is a great test for showing just how healthy, or unhealthy, the retina can be.

A fluorescein angiogram can diagnose macular degeneration.

What Does This Mean? In contrast to diabetes, where patients must be examined routinely due to the potential of a lack of symptoms, macular degeneration patients don’t benefit from routine examination if they have no symptoms.  (I am not saying don’t get an eye exam as many people are unaware of having vision loss!)

By definition, macular degeneration damages the macula.  Therefore, if present, there should be changes in the vision.

In cases of suspected macular degeneration, diagnostic tests are available.  At times, patients can look like they have ARMD, yet have normal vision.  As this is a progressive disease, those that are suspected of developing the disease should be followed regularly in years to come.

A normal fluorescein angiogram can also determine if drusen are normal, or associated with the disease.

As always, see your eye doctor if you develop any persistent decreased vision or distortion (symptoms continuously present for more than one day).

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Diabetes? 4 Things You Need to Know

I tell every new diabetic patient I meet 4 things: 

  1. they are going to develop diabetic retinopathy
  2. regular eye exams prevent vision loss
  3. good sugar control doesn’t save them
  4. and their other doctors are dead wrong. 

It is a message I have developed to hammer home the idea that diabetic retinopathy can be blinding and most doctors don’t understand  how this disease affects the eyes.  There are many misconceptions about the disease.

1.  Every Diabetic Develops Diabetic Retinopathy

Diabetic retinopathy develops in most patients.  The average diabetic patient develops signs of the disease 7 years after the diagnosis of becoming diabetic.  In over 18 years of practice, I have seen fewer than 10 patients that do not have diabetic retinopathy, yet have been diabetic for over 30 years.

In my mind, this means that most, if not all, diabetic patients will get the disease.

2.  Regular Exams Prevent Vision Loss

Dilated eye exams are recommended at the time of diagnosis and then annually – even if there is no diabetic retinopathy.  Why? 

First, we don’t know when diabetes actually starts, so it is a good idea to look for disease at the time of diagnosis.  Second, diabetic retinopathy can develop while a patient is still 20/20.  The goal is to catch the disease and treat, while the vision is still perfect.  We don’t want to wait until there is decreased vision.  So, regular examination prevents vision loss.

3.  Good Sugar Control Does Not Prevent the Disease

This is the biggest myth.  While it is true that the severity of the disease is may be limited with sugar control, most people (and a lot of doctors) believe that good control of the blood sugar prevents diabetic retinopathy.

It does not.

4.  Doctors Really Don’t Know

I am constantly surprised that many doctors don’t know that every patient with diabetes, regardless of the vision (good and bad), need a dilated eye exam every year.

Many doctors don’t know that a patient with excellent vision and/or good sugar control can still develop diabetic retinopathy.

What Does This Mean?  If the development of diabetic retinopathy is inevitable, or at least highly likely, then the patient can’t be blamed for NOT taking good care of themselves. 

My message removes the blame.  Do you enjoy being contantly reminded when you are making mistakes?  Of course, not.  Would you keep going to the doctor if every time you were being told you were ugly?  Noone likes to be nagged or blamed.

My message also lets patients know that they can be rewarded by maintaining regular visits…we can prevent significant vision loss, and most cases are able to prevent any vision loss at all.

Have a great weekend.

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Sudden Vision Loss is Painless

True sudden vision loss can occur from a variety of reasons and are considered emergencies.  Most commonly retinal disease is the culprit.  Almost all causes of are painless.  While both macular degeneration and diabetic retinopathy can lead to blindness, they both usually do so slowly.  There are exceptions.

Vision Loss from Diabetes

Vision lost from diabetic retinopathy is usually due to macular edema and is very slowly progressive.  Diabetic retinal detachments can also blind, but these, too, occur slowly.

A vitreous hemorrhage can occur in minutes although the sight is only temporarily affected.

Wet Macular Degeneration

Compared to the dry form of the disease, wet macular degeneration is rapid, but does not usually cause abrupt loss of sight.  The vision loss can be rapid, say over a period of days or weeks.

Sometimes, the neovascular membrane (the “wet” abnormal blood vessels) can bleed within the retinal tissue and cause sudden loss of vision.

Vitreous Hemorrhage

One cause of bleeding into the vitreous is diabetic retinopathy as stated above.  Other causes can include a retinal tear.  There are a few other causes, but are very uncommon.

By the way, patients on blood thinners generally do NOT develop a vitreous hemorrhage.

Vascular Occlusions

Both retinal vein occlusions and retinal artery occlusions can cause instant loss of vision.

Retinal Detachments

Usually rapid loss of vision, but not sudden.  A retinal detachment can cause rather quick progressive loss of vision starting with the peripheral vision moving centrally.  This can occur over a day or two, but not minutes.

Corneal Abrasions

This may be the only exception to the painless statement.  The surface of the cornea is responsible for about 2/3 of the focusing power of the (that’s why laser vision correction is performed on the cornea).  If you scratch the cornea, you get sudden loss of vision and…pain!

Other Causes Related to the Brain

Injury to the optic nerve and stroke can also cause sudden loss of vision.  There are certain situations with the optie nerve where pain may be involved.  Strokes are usually painless, but other neurologic conditions may be associated.

What Does This Mean?  It is impossible to diagnose sudden vision loss over the phone.  We treat sudden vision loss as an emergency at our office.  Happily, most of the time there really is no emergency because every one’s definition of “sudden” and “vision loss” are different, but how would we know?

In an eye doctor’s office, these unscheduled visits can kill an office schedule.  It happens quite often, as you can imagine, to a retinal specialist.

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Why Glasses Won't Help You See

“Will glasses help?”  We often wonder if “correction” will help decreased vision in the presence of retinal disease such as macular degeneration and diabetic retinopathy.  Spectacles can only help so much yet won’t “reverse” the loss of vision from the disease.  This is opposite to those people who claim they are “blind,” yet with glasses see quite well.

How do Glasses Work?

The goal of corrective lenses is to focus an image, sharply, on the surface of your retina (technically the macula).  If you are nearsighted (myopic), the image of what you see falls short, or in front, of the macula.

Nearsighted Image is "TOO SHORT" and Falls in Front of Retina

Glasses are used to refocus the image on the retina.  This is exactly like a projector focusing on a movie screen.

If you are farsighted (hyperopic), the image actually is focused behind, or past, the macular surface and glasses are used to move the image forward onto the retina.

Farsighted Image is "TOO FAR" and Falls Behind the Macula

What is the Macula?

The macula is the functional center of the retina.  It measures only about 1.5 mm X 1.5 mm, yet it gives us all of the attributes of our “sight.”  It provides us our best color vision, central sight for reading and watching TV and is the only part of the retina sensitive enough to “see” 20/20.

"JUST RIGHT" - Image Falls ON the Retina

Will Glasses Work?

If there is macular disease, such as diabetic retinopathy or macular degeneration, even properly measured glasses won’t work.

The vision is decreased due to the macular disease.  It simply isn’t capable of “seeing” 20/20.  The disease is preventing the retina from working to its full potential.

When glasses are working, the image is properly focused on the retina, but the retina is not working well.

Low Vision Aids

It may now make sense why “low vision” aids don’t simply correct for the disease.  Low vision aids may be useful by enlarging the image focused on the retina.  It may make the image easier to “see,” but the disease is still present.  Sometimes, images can be focused to the side of the diseased macula, but these “para-macular” areas are not as sensitive as the macula itself.

In all cases, vision is compromised.

What Does This Mean?

When we speak of decreased vision, implicit in our discussion is the assumption that the proper glasses, or contacts, are being used.  The eye is a pretty remarkable optical system, and in most cases, it is pretty routine to find the right lens to help correct myopia, hyperopia and astigmatism.

The optical system can’t correct for disease.  while the unit may be functioning properly, that is, focusing an image precisely on the retina, the disease will always win.

This is true of macular disease, glaucoma and some cataract.

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Legal Blindness and the IRS

Legally blind vision loss can result from either diabetic retinopathy or macular degeneration.  Complete blindness can result diabetic retinopathy, but not ARMD.  Legally blind, or partially sighted individuals, can still “see,” whereas completely blind patients see nothing.

Diabetic Blindness

Diabetic retinopathy can cause a spectrum of vision loss, from slightly blurry vision to complete blindness.  As we have discussed recently, one difference with diabetes as compared to macular degeneration is that diabetic retinopathy can affect the entire retina due to diabetic retinal detachment.

Proliferative diabetic retinopathy can also cause neovascular glaucoma which can completely destroy the optic nerve.

Both diabetic retinal detachment and neovascular glaucoma can blind completely.

Diabetes can also only affect the macula, thus, diabetic retinopathy can cause both legal and complete blindness.

Blindness from ARMD

In contrast, only the macular area of the retina is involved in macular degeneration.  Hence, central vision may be destroyed, yet the peripheral vision is spared.

Macular degeneration can NOT cause complete blindness.

Legal Blindness

Both eye diseases have the potential for causing legal blindness as both can affect the macula, or rather, both can affect central vision.

Legal blindness is defined as vision 20/200 or worse in both eyes despite use of corrective lenses.  There are also considerations of “blindness” for severely restricted visual fields.  Confirm this with your eye doctor.

Legal Blindness May Qualify for Tax Deduction

With tax day fast approaching, obtaining a qualifying statement from your eye doctor, may allow you a tax deduction. If you file jointly, your spouse may qualify, too.

What Does This Mean? Obviously, as one who deals with partially sighted patients, I attest to a patient’s “blindness” all the time.  A letter from your doctor is all you need to confirm your legal blindness.

I have also included a link to a  “Confirmation of Blindness”  form that can be used by your doc, but I don’t know for a fact if this grid is indeed acceptable by the IRS, but it is provided by the National Federation of the Blind.

NOTE:  There are many reasons a person may become legally blind, not just from retinal disease.  As always, feel free to share any of these articles with friends, family or doctors.

Disclaimer: The information contained in this posting should only be used as a reference. Should you have additional questions contact your tax attorney or local IRS office.

U.S. Treasury Circular 230 Notice: Any tax information contained in this communication (including any attachments) was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding penalties that may be imposed under the Internal Revenue Code or by any other applicable tax authority; or (2) promoting, marketing or recommending to another party any tax-related matter addressed herein.

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Prevent Vision Loss from Macular Degeneration

Vision loss from macular degeneration increases as we age.  This means that more and more people may lose vision as the population (baby boomers) get older due to ARMD (Age Related Macular Degeneration).  There are lots of recommendations on the Internet that just don’t make sense.  Here are a few practical recommendations and tips about ARMD, prevent vision loss and preserve your retina.

There are Two Types of ARMD

There are two classifications of macular degeneration, so-called “dry” and “wet.”.  They have many similarities, yet differ, principally, in two ways.  First, the “wet” ARMD is defined by the presence of leaky, abnormal blood vessels.  The presence of “neovascularization” (aka choroidal neovascularization) causes a more rapid change, or decrease, in vision.

Most cases of macular degeneration affect both eyes and are of the “dry” type.  The dry form changes vision loss much more slowly than the more aggressive “wet” form and accounts for about 90% of patients.

Both types can cause blurring of the central vision, formation of dark/grey areas in the vision and distortion.  Neither affects the peripheral, or side, vision.

There is No Cure for Macular Degeneration

Unfortunately, despite what you read, there is no cure for either type of ARMD (Age Related Macular Degeneration).  Intraocular injections are a treatment only for the “wet” form of the disease.  It is only a treatment and not a cure.

At present, there is nothing to do for dry ARMD, although you will hear the contrary with regard to vitamins and other supplements.

Only one NIH study has confirmed evidence that vitamins have a role in macular degeneration.  That role, is NOT curative, but may prevent patients with high and intermediate risk factors from experiencing severe vision loss from macular degeneration. The AREDS 1 study was completed over ten years ago.  AREDS 2 is underway.

There is no other indication, or reason, to take vitamins or other supplements.

Most ARMD is NOT Inherited

The term macular degeneration is probably a huge “waste basket” of terms, that is, we will probably learn that ARMD is a collection of different diseases that have similar characteristics and behaviors.   While there are cases of disease that have been found to run in certain areas or families, for the most part, macular degeneration is not passed on.

Regular Examination Prevents Vision Loss

The best way to look for macular degeneration is to have your pupils dilated by your doctor.  This will allow direct examination of the retina.  He or she does not have to be a retina specialist, but you should be referred to one if your exam raises any concerns or suspicions.

A retina specialist, with the aid of a fluorescein angiogram and OCT, may be able to confirm the diagnosis.  Remember, there can be several causes for whatever symptoms that concern you.

Monitor Your Own Vision

Self-monitoring of your vision is probably the best thing you can do for yourself.  Once diagnosed with ARMD, daily use of an Amsler grid or similar device, can help identify any changes that may need to be treated early.

The idea of self-monitoring is to catch any sudden, sustained, change in vision, including distortion, as early as possible.  You should alert your doctor of any changes.

What Does This Mean? There is a lot of “misinformation” regarding macular degeneration.  There are many ways that patients can help themselves including early examination and understanding that there are few, if any, supplements to help with the disease.

Don’t get hung up on seeing a retina specialist off the bat.  If there are concerns regarding your vision, see your eye doctor for a complete examination of your retina for macular degeneration.  There are many reasons you may have changes in your vision.

Just because a family member does have macular degeneration does not mean that you, too, have the disease.  Get examined and have your eye doctor, or retina specialist, confirm the presence, or absence, of the disease.

Lastly, sustained changes in your vision usually don’t go away by themselves.  Get tested!

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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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