The use of antivegf inhibitor medicines has also been tried in the treatment of diabetic retinopathy. Vegf (vascular endothelial growth factor) is an natural occurring agent that is present in the eye, which helps vessels to proliferate. In the case of diabetes it is theorized that it can exacerbate abnormal vessel growth and abnormalities in diabetic retinopathy. For this reason, antivegf drugs have been used in trials to determine if they would be helpful in these patients. In the early phase two randomized trials indicate that Pegaptanib is superior to control shame injections in treating diabetic retinopathy. Both groups had laser treatments as well but the group with Pegaptanib demonstrated fewer laser treatments needed and improved vision and decrease in retinal thickness. However, the benefits at thirty-six weeks decreased after the injections were discontinued and any benefit present disappeared by fifty-four weeks. In other words, onc

  Laser has always been the gold standard for diabetic macular edema.   This standard is a product of the early treatment diabetic retinopathy study, which gave convincing data that laser definitively helps this group of patients. However, there is a group of patients that even with laser do not have significant stabilization in their diabetic retinopathy. A number of studies as a result have been investigating alternative therapies. Intravitreal Triamcinolone, also known as Kenalog, has been evaluated in conjunction with laser therapy. A study by the Diabetic Retinopathy Clinical Research Network looked at 1 mg. and 4 mg. of intravitreal Traimcinolone in comparison with standard focal laser alone. This was a large multicenter study. It showed best corrected visual acuity was superior at four months in the 4 mg. group but the difference disappeared compared to the laser group at two years. Patients who have Triamcinolone in this higher

  Ocular coherence tomography (OCT) is a noninvasive technique to evaluate the retina and back of the eye. The technique is noncontact and is able to evaluate the retina with extraordinary resolution. The OCT produces a two dimensional image using scattered light. The OCT uses a priniciple called low coherence interferometry and unlike an ultrasound, it measures optical rather than acoustic wave reflectivity. Because the technique used is light instead of sound, the resolution is significantly higher. The technology is very helpful in measuring the thickness of the retina, looking for macular holes, looking for traction from the vitreous pulling on the retina and looking for pockets of fluid in the retina. This is particularly helpful technology to follow the course of the disease and to evaluate the success of treatments. This is particularly used for macular degeneration, diabetic retinopathy and central serous retinopathy.   If you hav

  When you go to the ophthalmologist’s office for a retinal exam, you can expect vision testing. In addition, your eyes will be dilated and the pressures are checked. In particular when one is dilating the retina, a slit-lamp will be used to look at the macula. Typically the patient will put their chin on a machine that allows visualization with a biomicroscope and specialized lenses. These lenses will allow the doctor to examine the retina with good illumination and high magnification. Occasionally a contact lens will be placed on the eye to increase stereopsis (depth perception).    Another technique that allows the retina to be evaluated involves indirect ophthalmoscopy. In this technique the ophthalmologist will place an instrument on his head that allows excellent illumination of the retina.  In addition, a specialized lens allows the ophthalmologist to examine the more peripheral aspects of the retina. Occasionally a

  Fluorescein angiography is a specialized test that ophthalmologists will perform that helps evaluate the blood circulation of the retina and the choroid. This is particularly helpful in diseases of the eye that have vascular problems, such as macular degeneration and diabetes. There are many other diseases that may benefit from evaluation with this test but diabetes and macular degeneration are probably the most common reason to have a fluorescein angiogram done. The patient typically will have their pupil dilated with anyone of a number of eye drops. These drops will last for several hours and even longer. Photographs are taken. It should be noted these are not x-rays. A dye then consistenting of Sodium Fluorescein, which is an orange/red is injected into a blood vessel, typically in the mid to lower arm. This dye then circulates through the eye and eventually is eliminated through the liver and kidneys. Right after the injection is

  There is some evidence that diabetic retinopathy may increase after cataract surgery. If the patient is about to have cataract surgery and there is evidence of either diabetic macular edema or proliferative diabetic retinopathy, one should consider adding some laser before the cataract removal, if it is possible to do so. Occasionally the cataract is so dense that it is not possible to add laser. If in fact this is the case, laser treatment shortly after removal of the cataract should be considered. As a rule, any patient who has diabetes should be have the retina carefully evaluated before cataract surgery.   If you have diabetes, please have your eyes checked for diabetic retinopathy.   We have offices in Arlington, Burlington, Wilmington, Winchester and Woburn, as well as serving the surrounding towns of Tewksbury, Chelmsford, Lowell, Concord, Reading, Acton, as well as Bedford, Lexington, Lynnfield, , Waltham, Cambridge, Andover, and others

  While the idea of having laser done in your eye may sound scary, it is a routine procedure that has been done since the 1970s and is surprisingly straight forward. Typically you will be brought into a laser suite where drops will be placed in your eyes to dilate the eye. Blood pressure and pulse will be checked to be sure that you are in good systemic order. Consent forms will already have been explained and signed, of course, before the procedure. The eye is typically re-examined to make sure that the clinical findings are still consistent with the previous testing, which usually includes fluorescein angiography and ocular coherence tomography. The patient then places their chin on a machine which is very similar to the slit-lamp which most patients have been examined with in the ophthalmologist’s office. A contact lens is placed in the eye at this point. The lens provides two benefits: #1. It prevents the patient from blinking so

  The Early Treatment Diabetic Retinopathy Study (ETDRS) and other clinical studies demonstrate that many eyes with diabetic retinopathy will benefit from laser. However, there are some eyes that are more inclined to have limited outcomes even with expertly applied laser. Particular risk factors include: #1. Diffuse swelling of the macula, particularly involving the center. #2. Diffuse leakage that is shown on a fluorescein angiogram. #3. Diffuse ischemia (poor blood flow in the macula). #4. Hard exudates (fatty material) deposit in the center of the macula. #5. Marked cystic changes in the macula.    However, despite some of these risk factors, in general those patients that have laser treatment overall do significantly better than those that do not if they have appropriate indications for therapy.    If you have diabetes, please have your eyes checked for diabetic retinopathy.   We have offices in Arlington, Burl

  The first step is always to prevent proliferative diabetic retinopathy by controlling blood sugars, high blood pressure and other factors noted in earlier blog entries. However, if despite all these efforts proliferative diabetic retinopathy develops, in most cases a laser photocoagulation is indicated.   For patients who are at risk for proliferative diabetic retinopathy, laser therapy is almost always recommended. The goal of pan-retinal photocoagulation, also known as laser, is to cause regression of existing new vessel growth and to prevent further progression. The amount of laser we apply to some extent depends on what type of response we get after the initial laser application. Typically 1200 spots of laser are applied. Each spot is only a tenth of a second in duration and this initial treatment may be applied in either one or two sessions.    After the initial application of laser, the patient is watched very closely to determi