At Home Macular Degeneration Monitoring

Macular degeneration is the leading cause of blindness in the United States.  While dry macular degeneration has no treatment, wet macular degeneration can be treated with injection of medications into the eye. Unfortunately, may patients realize too late that their macular degeneration has converted from the dry form to the wet form.  We recommend Amsler grid usage at home, but often patients do not notice the early, subtle changes of newly converted macular degeneration.

Untreated wet macular degeneration can create scarring in the central vision that can be difficult, if not impossible for us to reverse.  Early detection seems to lead to improved vision outcomes in our patients. Until now, however, only the Amsler grid was available for detection.

A new device, called the ForeseeHome, monitors patients with macular degeneration by using preferential hyperacuity perimetry to detect early changes that can be associated with wet macular degeneration. The testing takes three minutes per eye and is done several times per week.  The device then transmits the data to a center that compares your results to previous results.  If there is a change, the device alerts your physician who can then contact you and recommend an evaluation.

Not every patient with macular degeneration qualifies for the use of the ForeseeHome.   We at NC Retina are prescribers of ForseeHome, so if you are interested in learning more about at home macular degeneration testing, your physician can discuss this with you at your next visit and write a prescription for the device if appropriate.




This is not intended to be medical advice.  Please consult your physician for medical advice.

Your first visit with us: What to expect

If you have been referred to us by another eye care or other health professional, you might be wondering what to expect on your first visit.  As retina specialists, we evaluate and treat diseases in the back part of the eye- the vitreous, retina, and choroid.  There are many such diseases that we evaluate and treat, but some of the most common include macular degeneration, diabetic eye disease, macular hole, epiretinal membrane, vitreous hemorrhage, retinal tears or holes, and retinal detachments.

On your first visit, you will first have your vision checked, you intraocular pressure measured, and your eyes dilated.  Often, people ask if it is necessary to dilate their pupils.  The answer is yes, it is necessary.  The way we see the retina is through the pupil, so it must be dilated for us to perform a complete exam.

Once your pupils are dilated, we will begin the testing process.  Most patients will have an OCT, a test that looks at the layers of your macula, or center of your vision.  And, most patients will have color photos taken of your retina.  These tests are usually very quick and easy for the patient.  Some patients will also require a fluorescein angiography.  This is a dye test that looks at the circulation and structures of the retina and choroid.  This dye is inserted into a vein in your arm or hand, and the photos are taken over a period of approximately 10 minutes.  Fluorescein angiography is usually very well tolerated by the patient but can leave your vision blurry for a few minutes.  Rarely, people have an allergic reaction to the dye, but before any test is done, the technician will discuss things that you should be aware of during the test.

After the testing is completed, you will then see the doctor.  He or she will perform an examination as well as go over all of your testing with you.  If treatment is necessary, you will receive a thorough description of the treatments available including risks, benefits, and alternatives to these treatments. Some of the various treatments that we perform include injections into the eye, lasers, and surgeries. Often, the first treatment is given or scheduled that day!

Overall, your first visit to any retina specialist will most likely be different than any eye examination you have had in the past due to the different tests that we perform.  The first visit can last anywhere from 1-3 hours depending on your eye disease and treatment requirements.

This blog is for informational purposes only and is not intended to be medical advice.  Please seek the advice of a health care professional.

How many injections will I get for macular degeneration?

One of the most common questions we get asked by patients receiving injections for exudative (wet) macular degeneration is how many injections that they will have to receive.  Understandably, most patients are anxious to decrease or even stop their injections all together.  The answer, however, is variable depending on the patient.

Exudative macular degeneration is a chronic disease where the blood vessels in the choroid (the back of the eye) grow through a barrier called Bruch's membrane and bleed.  This bleeding leads to fluid in the macula which is what leads to decreased vision.  Chronic fluid and blood can lead to scarring and eventually markedly decreased central vision. The primary driving force between these blood vessels is a protein called vascular endothelial growth factor (VEGF).  The medications that we currently use to treat macular degeneration-  including Avastin, Lucentis, and Eylea-block this protein (anti-VEGF medications).

When the anti-VEGF medications are injected into the eye they only have an effect for about 28 days. After the medications wear off, the VEGF proteins made in the eye rise again and cause the vessels to leak or grow.  That is why the medications have to be injected at regular intervals.  I often compare this to having to take your blood pressure medication every day to keep your pressure under control.  The medications aren't a cure, but a treatment.

In the initial trials for anti-VEGF medications, the injections were continued every 28 days for 2 years regardless of the patient's vision or amount of fluid in the retina.  The results were excellent- stabilization of vision in most patients and increased vision in many patients.  In the years since the initial trials, a few different approaches have been tried to decrease the number of injections including treating only as needed when fluid returns, and a treatment called treat and extend where we gradually increase the time between injections. One medication, Eylea, is often used very 8 weeks after a 3 to 6 month initiation with monthly injections with good success.

One recent trial, HORIZON, examined the use of as needed injections and revealed that patients lost some vision that they had initially gained when only receiving the injections as needed (when fluid returned in the macula) instead of on a strict schedule.  So, many retina physicians concluded that either monthly treatments or a slow treat and extend regimen is more beneficial to the patient.  And, we know that if we stop the injections all together, the blood often returns and leads to severe central vision loss.

As cumbersome as monthly injections seem to you as a patient, it is important to realize the benefit you are likely receiving from your injections.  The anti-VEGF medications have revolutionized the treatment of this blinding disease and have given hope to many patients who did not have a good visual prognosis in the past.

Researchers are working to develop longer acting medications and other methods that could help avoid these monthly or ever other month injections, so some day in the future you may be able to decrease your visits to the retina physician for macular degeneration treatment.

Each patient is different and is evaluated by his or her physician to determine the best course of treatment.

This blog is for informational purposes only and is not intended to be medical advice.  Please consult your physician for any medical advice.

Examining the AREDS2 data

Macular degeneration is the most common cause of vision loss in the United States.  2 million people have advanced AMD and 8 million people are at a risk for advanced AMD.  Many more patients have earlier stages of AMD that can lead to vision loss as they age.

In 2001, the National Eye Institute (NEI) concluded the original AREDS study (Age-Related Eye Disease Study).  In this study, participants were given either a placebo or the AREDS formula- a combination of Vitamins C, E, beta-carotene and minerals zinc and copper.  After 5 years, patients who took the AREDS combination had a 25%  reduced risk of progressing to advanced AMD.  Since the release of those results, many eye physicians have recommended patients with AMD begin taking these vitamins.

In 2006, the NEI began another study, the AREDS2.  This compared patients taking the original AREDS formula to patients taking various versions of AREDS with or without additional supplements.  The additional supplements studied were omega-3 fatty acids, lutein, and zeaxanthin.  The trial also looked at reducing the level of zinc from the original formula and excluding beta carotene from the formula.  (Studies have suggested that beta-carotene increases the risk of lung cancer in former smokers.)

The results of AREDS2 were released earlier this month. Let's review:

1. Omega-3 fatty acids- The study showed no benefit to adding omega-3 to the formula
2. Lutein-Zeaxanthin- There was no benefit of adding the Lutein and Zeaxanthin by themselves.  But, adding them did negate the removal of beta-carotene.  Also, patients who had diets low in these nutrients did gain benefit from having them in the formula.
3. Reducing zinc- there was no increased risk of progression to advanced AMD in patients receiving the reduced level of zinc.

So, what formula should you be taking? In light of the new results, we suggest discussing this with your eye care professional because the answer could depend on your stage of AMD, your smoking status, and your dietary habits.

This blog is for informational purposes only and is not intended to be medical advice.  Please seek the advice of a qualified medical professional.

Retinal tears

Retinal tears are a common diagnosis that we see in our practice.  Patients often wonder when they have flashes and floaters whether they have a retinal tear or detachment.  Many have researched these symptoms on the internet and see the words "retinal tear" and "retinal detachment" and, understandably, become concerned.

The retina is the inner lining of the back wall of the eye.  It is a 9 layered structure that "takes the picture" and sends it to the brain by way of the optic nerve.  The vitreous is a gel layer made up of collagen and other proteins as well as water that is between the lens, the focusing system of the eye, and the retina.  The vitreous is attached at the optic nerve, the macula, and the entire peripheral retina.  As we age, our vitreous becomes less gel-like and more liquid.  When this occurs, it begins to separate from the retina in stages.  When it separates from the peripheral retina, it can cause a retinal tear or hole.

Retinal holes and tears can have many symptoms.  Flashes and floaters are common with a benign vitreous detachment as well as a more serious retinal tear.  That is why we recommend patients with new flashes and floaters be evaluated by an eye care professional.  Some retinal tears have no symptoms and are discovered on routine exam.

A retinal tear is a serious condition because it can lead to a retinal detachment.  A retinal detachment occurs when the fluid of the vitreous tracks underneath the layers of the retina through the tear.

If a retinal tear is discovered, often it can be treated before it leads to a detachment.  The treatment involves a "welding" process where either laser or freezing is placed around the tear to "glue" it in place.  This is not a guaranteed fix because the tear can sometimes pull through the treatment and evolve into a detachment, but is often very successful.

If you have symptoms of a retinal tear please consult an eye care professional.

This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional for medical advice.

What does it feel like to get an injection in my eye?

As retinal specialists, we give hundreds of intraocular injections (injections into the eye) each month.  Patients with macular degeneration, diabetes, vein occlusions, and now macular holes receive injections to treat their disease, often monthly.

When we first tell a patient he or she will be receiving an injection into his or her eye, there is always a degree of fear that the patient feels.  After all, an injection in the arm hurts bad enough, how much pain does an injection into the eye cause?  The answer, more often than not, surprises the patient- not much.  In fact, many patients report not even feeling the injection or feeling only a small amount of pressure.

To prepare for the injection, we numb the eye.  Then, we use a very small (30 gauge) needle to inject the medication.  Between the numbing and the small needle, the procedure is usually over before the patient knows it.

The day of the injection, patients often report mild stinging or burning in the eye. This is due to a combination of the numbing medicine and the betadine, the medicine we use to kill the bacteria in the eye.  The stinging is usually gone by the next day.

If  the patient continues to have pain the day after or increasing pain and swelling around the eye, we encourage them to call us immediately to discuss this as it could be a sign of an infection.

So, if you are having an intraocular injection, you can rest easy knowing that most patients experience only mild, if any, discomfort, from the process.

This is for informational purposes only and is not intended to be medical advice.  Please consult your physician for medical advice.