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Patient Information

Patient Information

First visit to our clinic? Click here for resources and information to let you know what to expect.

Welcome! Your primary care physician, optometrist or ophthalmologist has referred you to our office. Whether you are referred for a retinal issue or a cataract consult, please take the time to read through the information below.

Prior to your appointment:

  • You will receive a confirmation email or text at least 2 business days prior to your appointment. The confirmation will include the date and time of your appointment as well as the doctor you will be seeing and the location. Please take a moment to read the parking instructions below for each location.
  • First time patients will need to complete our patient intake form. This can be done in our office when you arrive or online before your appointment. The instructions to complete are as follows:
      1. Go to the website: https://app.thrive.health/register
      2. Enter in the registration code: westcoast
  • Please bring your care card. If you have not completed the online questionnaire, you should also bring a list of your medical history, current medications, and any allergies that you may have.
  • Please bring your current prescription eyeglasses with you to your appointment, we do not recommend wearing contact lenses.
  • If English is not your first language, we ask that you bring a translator with you.
  • This appointment will require your eyes to be dilated, resulting in mild blurring and light sensitivity. Be sure to arrange transportation or bring someone with you who can drive after the appointment.
  • Please plan to be at our office for up to 2 hours.

During your appointment:

  • Upon arrival, if not completed online, you will be asked to complete our new patient intake form.
  • Both of your eyes will be dilated. The dilation drops we use are Mydfrin & Mydriacyl.
  • Our technicians will then preform some pre-testing. This can include the following:
    • Testing your visual acuity
    • Taking your eye pressure. We test eye pressure with a Tono-Pen. We use it to touch your eye and measure pressure. For your comfort, We use Alcaine to numb the eye.
    • Optical Coherence Tomography (OCT) - a non-invasive imaging test that uses light waves to take cross-section pictures of your retina.
    • Optos wide field images - high-resolution retinal imaging that captures 200˚ images of your retina.
  • Once both of your eyes are fully dilated and all the pre-testing is completed, you will be examined by one of our physicians.


After your appointment:

  • Dilation can last for up to 4 hours. This varies from individual to individual. It is not uncommon for dilation to last longer than 4 hours.
  • Your referring doctor, as well as those physicians you identified in your circle of care will receive a report of your visit.
  • If you require additional testing, treatment or surgery, our office staff will make those arrangements for you.
  • If you have any additional questions or concerns please call our office at 604-875-1661 between 8am and 5pm on regular business days.

 

How do I book an appointment with West Coast Retina Consultants?

New patients, and patients who have not been seen in the past 6 months, MSP requires a specialist referral from your primary care physician, or optometrist. Once we have obtained a referral we can book an appointment.

Current patients can call our office at 604-875-1661 between 8am and 5pm on regular business days. You can also email us at This email address is being protected from spambots. You need JavaScript enabled to view it.  for non-urgent requests.


Is my appointment covered by MSP?

MSP covers most procedures done in our office; however not all services and very few medications / drugs are covered under the provincial health plan (MSP).

If you are receiving a treatment of medication that is not covered, you will receive a bill.

We also charge if you request copies of your diagnostic imaging.

It’s also important to keep your MSP up to date, if you are behind on your MSP payments they will not pay for your service and you will receive a bill from our office.

You can pay your bill by cash, cheque, debit or credit at all of our offices; we will also process credit card payments over the phone.

I am a current patient with an eye emergency, what do I do?

We provide 24 hour a day, 7 days a week coverage for all our active patients with emergency issues that can not wait until regular business hours. Call our office at 604-875-1661 and press 1 when prompted.

Where can I park at your office?

We are tenants at all our locations, so unfortunately we have no control over parking. Please make sure you are following the parking rules posted at each lot. 

  • Eye Care Centre Location - limited pay parking under the building, pay parking at Fairmont Medical Building, meter parking along West 10th Ave.
  • 805 West Broadway Location - Pay parking under the building.
  • 5477 152nd St Location - Free 2 hour parking. This building is very strict with parking. You must be in a spot marked Visitors.
  • 5900 No 3 Rd Location - Free 2 hours parking in the parkade adjacent to the building. Spots are marked Visitors.

Are your locations wheelchair accessible?

All of our locations are wheelchair accessible, however we do not have loaner wheelchairs available for transfers at this time.

How long will my appointment take?

You should plan to be at our office for 2 hours. We make every effort to get you in and out of the clinic in a timely fashion. Our office deals with a wide variety of patients of diagnosis that add unpredictability to our schedule. 

In addition, our retinal physicians are on-call for emergencies for the entire province (including the Yukon). Retinal problems are the most significant vision threatening ocular emergency and can be time sensitive. This means the clinic can receive a sudden influx of emergencies or that the physician may be called away to the operating room for emergency surgery.

We truly value your time and are constantly working on making our clinics run more efficiently. You can do your part by making sure we have your up to date contact information on file to reach you in a timely manner for schedule changes.

Do my eyes need to be dilated at every visit?

You are being seen at our office for a retinal problem. The retina is located at the back of the eye and can only be properly examined when the eyes are fully dilated. If you are new to our office, or haven't seen us in the past 6 months both of your eyes will be dilated. If you are being seen more regularly, we do try to limit dilation when it is clinically safe to do so.

We suggest that you plan for dilation at each visit. We recommend you bring dark sunglasses and have a driver arranged for every appointment.

Dilation can take 30-60 minutes.

Why do you test my visual acuity, eye pressure and take images every visit?

We are looking for any changes in your eye condition. Visual acuity, intraocular pressure and our imaging provide the physicians with objective information to help maximize patient care.

Why am I seeing a different doctor this appointment?

We run a group practice. This provides many benefits such as more flexible booking, 24 hour a day, 7 day a week emergency coverage and also 4 highly trained retina specialists who are always re-evaluating your care so that you are receiving the most up-to-date evidence based care.

If you would prefer to be followed by only one doctor, please let our reception staff know and we will make every effort to only book you with that specific doctor. Please keep in mind emergencies do come up.

Will someone call to remind me of my appointment?

We have moved to an email and SMS appointment confirmation system that is integrated into our Health Records Software. 

If you prefer not to be contacted by either email or SMS, you can easily opt of the service and continue to receive reminder phone calls. 

Please refer to our Terms and Conditions
 for Electronic Communication. More information on the collection, use and disclosure of personal information can be found in our privacy policy.

 

Fluorescein Angiography Information

What is Fluorescein Angiography?

Fluorescein angiography is a diagnostic procedure which uses a special camera to take a series of photographs of the retina, the light sensitive tissue in the back of the eye. A water-soluble dye (fluorescein) is injected into a vein in the arm. The dye then travels through  throughout the body reaching the eye. A special camera uses bright flashes of light to take a series of photographs in the rapid succession as the dye passes through the blood vessels supplying the back of the eye, providing information about the retina and nearby tissues.

Why is Fluorescein Angiography Done?

Fluorescein angiography is used to diagnose certain eye conditions, determine if treatment is possible, and plan or guide treatment. Common conditions requiring fluorescein angiography include diabetic retinopathy, macular degeneration, and retinal vascular diseases. In some cases, the angiogram may need to be repeated to monitor response to treatment or changes in your eye condition.

What are the Risks of Fluorescein Angiography?

Flourescein angiography is a safe and very helpful test. The chance of adverse effects is low, but as with any medical procedure, there are some risks involved. If the dye happens to leak out of the blood vessel at the time of injection, the patient may feel a localized burning sensation and yellow staining of the skin may occur.

Allergic reactions are rare. If they occur, they may cause a skin rash and itching. This reaction is treated with antihistamines. Severe allergic reactions are extremely rare.

Click here for more information.

Preparing for your Fluorescein Angiography Procedure

  • Arrive well hydrated, drinking extra water beforehand and avoiding caffeine.
  • Fasting is NOT required.
  • Take all prescription medications as normal.
  • This test is done with a nurse and technician, results are given by the doctor at your follow up visit.
  • Your eyes will be dilated. We do not recommend driving.
  • Bring an English translator if necessary.

During the Procedure

  • You are seated with your chin on a rest and head against the machine.
  • A nurse injects a small quantity of fluorescein dye into a vein in your arm or hand.
  • The camera flashes repeatedly to take the photographs.
  • It is important to follow the photographer’s instructions and not to move your head or eye unless you are told to do so.
  • The procedure lasts about 10-15 minutes, but please allow up to 2 hours for the whole appointment.

Additional Resources

 

Retinal Disease Information

Age-related Macular Degeneration (AMD)

AMD is a chronic, age-related, degenerative disease of the macula. The macula is a very small and specialized area in the centre of the retina. The macula allows you to see fine details directly in front of you such as words in a book or images on television. So while the entire retina lets you see that there is a book in front of you, the macula lets you see what is written in the book.

Risk Factors

There a number of factors both in and out of your control that can put you at increased risk for developing AMD.

  • Age: Risk increases with advancing age; from 8.5% for people 43-54 years of age to a high of 36.8% for people over 75.
  • Family History: Up to 3 times greater risk within families (parents and siblings)
  • Gender: Female are more susceptible.

The following are risk factors that you can do something about:

  • Smoking
  • Diet: A diet low in antioxidant vitamins and minerals is a significant risk factor
  • High blood pressure
  • Excessive weight/obesity

There are two types of AMD, dry AMD and wet AMD.

What is Dry AMD?

Most of the time, AMD will begin as the less severe dry type and, for approximately 80% of people, it will remain that way. Dry AMD can develop in one eye or both.

The early stage of dry AMD usually begins with the appearance of drusen. Drusen are small white or yellowish deposits that begin to accumulate in on of the deepest layers of the retina due to a breakdown in its normal function.

As the retinal layer continues to break down, an abnormal amount of drusen begins to build up. This build-up begins to disrupt the layers above it, eventually damaging the layer of photoreceptor cells (the cells that receive visual images from the lens), resulting in “blank” or blind spots in your central visual field.

As dry AMD progresses from early to late stage, more cells break down and begin to waste away. In the end stages, the entire central macula can be damaged leaving a blind spot.

As the disease continues to progress, the likelihood of it turning in to the more severe wet AMD significantly increases as well.

Diagnosis of Dry AMD

Since dry AMD develops quite slowly, it can affect the vision in your eye without you being aware of it. That’s because your eyes and brain are very good at compensating for weakness. So if dry AMD is compromising vision in one eye, the good eye will adjust, making up for the other’s deficiency. Regular visits to the eye doctor are critical for early detection.

Treatment of Dry AMD

Vitamin supplementation has been shown to slow down the progression of dry AMD and decrease the risk of conversion to wet AMD. This was shown in a large clinical trial called the AREDs trial. Your doctor may suggest you take a vitamin supplement that has the components studied in the AREDs trial.

What is Wet AMD?

Wet AMD is so named because of the involvement of blood in the deepest layers of the retina. In a process called choroidal neovascularization (CNV), new and abnormal blood vessels spontaneously begin to grow beneath the retina and push their way up through it. Imagine they’re like tree roots or weeds growing up through cracks in the pavement. Being weak and abnormal, these new vessels leak their contents of blood and fluid into the retina which separates and lifts up the other layers like a blister. The process finally disrupts the photoreceptors (the cells that receive visual images from the lens), leaving them unable to transmit visual signals to the brain. This results in “blank” or blind spots in the central visual field.

Left alone, this process eventually results in the growth of scar tissue which, in turn, causes severe and permanent central vision loss. Perhaps surprisingly, there is no pain associated with the entire process.

Although wet AMD can occur spontaneously, it’s usually preceded by dry AMD, which makes regular check-ups especially important.

Wet AMD is more aggressive than dry AMD and does not occur as frequently, accounting for approximately 20% of all AMD cases. It can cause rapid, severe and permanent central vision loss in a matter of months. Early detection is critical in order to start any treatments that might help preserve your vision.

What are the Symptoms of Wet AMD?

You will probably be the first person to detect the onset of wet AMD when you notice that your vision has suddenly changed. If you already have dry AMD, your vision might suddenly blur, you may see a blank spot in your visual field, or things that should be straight appear bent or wavy.

Will I Lose My Vision Completely?

Not likely. However the eventual outcome of untreated wet AMD can be severe and permanent central vision loss, with vision dropping to legal blindness or lower. In AMD, total blindness or darkness rarely occurs because the disease rarely affects the entire retina, just the central macula. So while someone with AMD may experience extremely poor vision in their central visual field, their peripheral vision is not impaired.

How Fast Does it Progress?

Unlike dry AMD which progresses relatively slowly and may go unnoticed for years, wet AMD is more aggressive and can cause severe vision loss in a matter of weeks or months. The speed at which wet AMD progresses is dependant on a variety of factors.

And once you have wet AMD in one eye, the chances of it developing in your other eye are significantly increased.

How is it Diagnosed?

Only an AMD specialist, such as a retinal specialist, can make a definitive diagnosis; however your regular eye doctor can usually detect the presence of wet AMD based on your symptoms, medical history and a basic eye exam including a dilated retinal exam.

How is wet AMD treated?

You and your retinal specialist will determine which treatment is best for you. The first line treatment for most patients is Anti-VEGF Therapy.

Anti-VEGF stands for Anti-Vascular Endothelial Growth Factor. VEGF triggers the growth of the abnormal blood vessels in the macula. Anti-VEGF drugs help prevent this from happening. The drugs currently available in Canada and covered by the provincial health plan are Avastin, Eylea and Lucentis. These drugs need to be injected into the eye on a regular basis for optimum effect.

Anti-VEGF therapy is NOT a cure. Most studies have shown that with regular treatment, 90% of patients can maintain their vision. 30 – 40 % of patients have seen an increase in vision with treatment.

You and your retinal doctor will try to develop a treatment plan to best suit your specific condition. All patients respond differently to treatment and require different treatment frequency and duration.

On average, most patients require ANTI-VEGF treatment every 1-2 months to maintain their vision. In some patients, the treatments can be spread apart further or discontinued – but there is always a risk of recurrence with subsequent loss of vision. This balance should be discussed with your retinal doctor.

AMD Information Sheet - Chinese

 

Diabetic Retinopathy

The retina is a thin layer of light-sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see. The macula is a very small area at the center of the retina. It is the macula that is responsible for your pinpoint vision, allowing you to read, sew or recognize a face. The surrounding part of the retina, called the peripheral retina, is responsible for your side—or peripheral—vision.

Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina are damaged. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.

Diabetic retinopathy usually affects both eyes. People who have diabetic retinopathy often don't notice changes in their vision in the disease's early stages. But as it progresses, diabetic retinopathy usually causes vision loss that in many cases cannot be reversed.

There are two types of diabetic retinopathy:

Background or nonproliferative diabetic retinopathy (NPDR)

Nonproliferative diabetic retinopathy (NPDR) is the earliest stage of diabetic retinopathy. With this condition, damaged blood vessels in the retina begin to leak extra fluid and small amounts of blood into the eye. Sometimes, deposits of cholesterol or other fats from the blood may leak into the retina. NPDR can cause changes in the eye, including:

  • Microaneurysms: small bulges in blood vessels of the retina that often leak fluid.
  • Retinal hemorrhages: tiny spots of blood that leak into the retina.
  • Hard exudates: deposits of cholesterol or other fats from the blood that have leaked into the retina.
  • Macular edema: swelling or thickening of the macula caused by fluid leaking from the retina's blood vessels. The macula doesn't function properly when it is swollen. Macular edema is the most common cause of vision loss in diabetes.
  • Macular ischemia: small blood vessels (capillaries) close. Your vision blurs because the macula no longer receives enough blood to work properly.

Many people with diabetes have mild NPDR, which usually does not affect their vision. However, if their vision is affected, it is the result of macular edema and macular ischemia.

Proliferative diabetic retinopathy (PDR)

Proliferative diabetic retinopathy (PDR) occurs when many of the blood vessels in the retina close, preventing enough blood flow. In an attempt to supply blood to the area where the original vessels closed, the retina responds by growing new blood vessels. This is called neovascularization. However, these new blood vessels are abnormal and do not supply the retina with proper blood flow. These new blood vessels can leak and bleed into the eye. The new vessels are also often accompanied by scar tissue that may cause the retina to wrinkle or detach.

PDR may cause more severe vision loss than NPDR because it can affect both central and peripheral vision. PDR affects vision in the following ways:

Vitreous hemorrhage: delicate new blood vessels bleed into the vitreous — the gel in the center of the eye — preventing light rays from reaching the retina. If the vitreous hemorrhage is small, you may see a few new, dark floaters. A very large hemorrhage might block out all vision, allowing you to perceive only light and dark. Vitreous hemorrhage alone does not cause permanent vision loss. When the blood clears, your vision may return to its former level unless the macula has been damaged.

Traction retinal detachment: scar tissue from neovascularization shrinks, causing the retina to wrinkle and pull from its normal position. Macular wrinkling can distort your vision. Severe vision loss can occur if the macula or large areas of the retina are detached.

Neovascular glaucoma: if a number of retinal vessels are closed, neovascularization can occur in the iris (the colored part of the eye). In this condition, the new blood vessels may block the normal flow of fluid out of the eye. Pressure builds up in the eye, a particularly severe condition that causes damage to the optic nerve.

Maintaining strict control of blood sugar and blood pressure, as well as having regular eye examinations, are the keys to preventing diabetic retinopathy and vision loss.

Diabetic Retinopathy Risk Factors

Several factors can influence the development and severity of diabetic retinopathy, including:

  • Blood sugar levels: Controlling your blood sugar is the key risk factor that you can affect. Lower blood sugar levels can delay the onset and slow the progression of diabetic retinopathy. 
  • Blood pressure: A major clinical trial demonstrated that effectively controlling blood pressure reduces the risk of retinopathy progression and visual acuity deterioration. High blood pressure damages your blood vessels, raising the chances for eye problems. 
  • Duration of diabetes: The risk of developing diabetic retinopathy or having your disease progress increases over time. After 15 years, 80 percent of Type 1 patients will have diabetic retinopathy. After 19 years, up to 84 percent of patients with Type 2 diabetes will have diabetic retinopathy. 
  • Blood lipid levels (cholesterol and triglycerides): Elevated blood lipid levels can lead to greater accumulation of exudates, protein deposits that leak into the retina. This condition is associated with a higher risk of moderate visual loss. 
  • Ethnicity: While diabetic retinopathy can happen to anyone with diabetes, certain ethnic groups are at higher risk because they are more likely to have diabetes. These include African Americans, Latinos and Native Americans.
  • Pregnancy: Being pregnant can cause changes to your eyes. If you have diabetes and become pregnant, your risk for diabetic retinopathy increases. If you already have diabetic retinopathy, it may progress. However, some studies have suggested that with treatment these changes are reversed after you give birth and that there is no increase in long-term progression of the disease. 

The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won't cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.

What Treatments are Available For Diabetic Retinopathy?

Laser surgery

The laser is a very bright, finely focused light. It passes through the clear cornea, lens and vitreous without affecting them in any way. Laser surgery shrinks abnormal new vessels and reduces macular swelling. Treatment is often recommended for people with macular edema (swelling) or neovascularization (new blood vessels in PDR)

Laser surgery is performed in an office setting. For comfort during the procedure, an anesthetic eye drop is often all that is necessary, although an anesthetic injection is sometimes given next to the eye. The patient sits at an instrument called a slit-lamp microscope or sits in a chair that can be reclined. At the slit lamp, a contact lens is temporarily placed on the eye in order to focus the laser light on the retina with pinpoint accuracy. Occasionally, the laser is performed with the doctor wearing a head lamp to direct the laser.

With laser surgery for macular edema, tiny laser burns are applied near the macula to reduce fluid leakage. The main goal of treatment is to prevent further loss of vision by reducing the swelling of the macula. It is uncommon for people who have blurred vision from macular edema to recover normal vision, although some may experience partial improvement.

A few people may see laser spots near the center of their vision following treatment. They usually fade with time, but may not disappear completely.

In PDR, the laser is applied to all parts of the retina except the macula (called PRP, or panretinal photocoagulation). This treatment causes abnormal new vessels to shrink and often prevents them from growing in the future. It also decreases the chance that vitreous bleeding or retinal distortion will occur. Panretinal laser has proven to be very effective for preventing severe vision loss from vitreous hemorrhage and traction retinal detachment.

Multiple laser treatments over time may be necessary. Laser surgery does not cure diabetic retinopathy and does not always prevent further loss of vision.

Vitrectomy surgery

Vitrectomy is a surgical procedure performed in a hospital or ambulatory surgery center operating room. It is performed on an outpatient basis.

During vitrectomy surgery, an operating microscope and small surgical instruments are used to remove blood and scar tissue that accompany abnormal vessels in the eye. Removing the vitreous hemorrhage allows light rays to focus on the retina again.

Vitrectomy often prevents further vitreous hemorrhage by removing the abnormal vessels that caused the bleeding. Removal of the scar tissue helps the retina return to its normal location. Laser surgery may be performed during vitrectomy surgery.

To help the retina heal in place, your ophthalmologist may place a gas or oil bubble in the vitreous space. You may be told to keep your head in certain positions while the bubble helps to heal the retina. It is important to follow your ophthalmologist's instructions so your eye will heal properly.

Medication injections

More and more often, injections of medication are being used to help treat diabetic retinopathy. Sometimes a steroid medication is used. In other cases, you may be given an anti-VEGF medication called Avastin, Eylea or Lucentis. This medication works by blocking a substance known as vascular endothelial growth factor, or VEGF. This substance contributes to abnormal blood vessel growth in the eye that can affect your vision. An anti-VEGF drug can help reduce the growth of abnormal blood vessels, decrease macular edema.

After your pupil is dilated and your eye is numbed with anesthesia, the medication is injected into the vitreous, or jelly-like substance in the back chamber of the eye. The medication reduces the swelling, leakage, and growth of unwanted blood vessel growth in the retina, and may improve how well you see.

Medication treatments may be given once or as a series of injections at regular intervals, usually around every four to six weeks or as determined by your doctor.

The main risk of intra-vitreal injections is infection. This risk is around 1 in 4000. If your eye becomes painful and you have a loss of vision after your injection you need to contact our office immediately. 

Retinal Vein Occlusion

What is a retinal vein occlusion?

The retina is nourished by tiny blood vessels that bring blood into (arteries) and out of (veins) the eye. Occasionally an artery will compress the underlying vein, making it difficult for blood to exit the eye. This blockage, called a branch retinal vein occlusion (BRVO), causes the vein to dilate and leak fluid and blood. The main vein exiting the eye can also become blocked within the optic nerve, causing a central retinal vein occlusion (CRVO). Retinal vein occlusions are more common in older individuals as well as persons with hypertension, diabetes, or glaucoma but can occur in young healthy individuals.

Macular edema (swelling) develops when the occlusion involves the macula, causing it to swell with fluid and blood. Central vision can become blurred, just as a water droplet placed on a photograph will cause the picture to blister and become distorted. Macular edema develops in 60% of branch retinal vein occlusions and virtually all central retinal vein occlusions.

Retinal vein occlusions can also decrease the overall retinal blood supply. Some eyes will develop tiny new blood vessels along the retinal surface in an attempt to increase the retinal blood supply (retinal neovascularization). These new vessels do not help the eye, however. They are fragile and can cause blindness by hemorrhaging or retinal detachment. Retinal neovascularization develops in about 25% of eyes with branch retinal vein occlusions and rarely in eyes with central retinal vein occlusion.

Eyes with central retinal vein occlusion are classified into the non-ischemic (good retinal arterial circulation) and ischemic (poor circulation) types. Up to two-thirds of eyes with ischemic central retinal vein occlusion (compared with virtually none of the non-ischemic occlusions) develop new blood vessels on the surface of the pupil (iris neovascularization). These vessels can block the outflow of fluid from the eye, causing pain with very high pressures inside the eye (neovascular glaucoma).

What are the symptoms of a retinal vein occlusion?

Retinal vein occlusions can cause blurring of the central and peripheral vision. Central retinal vein occlusions generally cause more severe loss when compared to branch retinal vein occlusions. Patients may be completely asymptomatic, especially when the other eye sees normally. Neovascular glaucoma can cause severe eye pain, redness, nausea, and total blindness if left untreated.

How is a retinal vein occlusion diagnosed?

You can't diagnose a retinal vein occlusion by looking in the mirror since your eye will usually look and feel normal. The diagnosis is made with a thorough retinal examination through a dilated pupil. Additional testing, including OCT scanning and fluorescein angiography, may be performed to better diagnose and assess the need for treatment.

What treatments are available for retinal vein occlusions?

Laser

Macular grid laser photocoagulation is considered if macular edema explains the visual loss in Branch vein occlusions. The Branch Vein Occlusion Study found that laser improved the visual prognosis at the 3-year follow-up visit. The average vision was 20/40 to 20/50 in the treated eyes compared to 20/70 in the untreated eyes. This treatment is currently fully covered by the provincial MSP program.

Intraocular steroids

Although laser photocoagulation was the only treatment available for branch retinal vein occlusion-related macular edema since the 1970's, the recent advent of intraocular steroids has added another successful treatment for this disease. Injection of anti-inflammatory steroid medication (Triessence) into the eye (a painless in-office procedure) can rapidly improve macular edema and vision loss, often more successfully than laser in some patients. Ozurdex, a sustained released steroid (dexamethasone) implant, can also improve vision and lasts longer than the triessence injection (3-6 months). These medications are currently not covered by the provincial MSP plan but are covered by most extended insurance plans.

Anti-VEGF Drugs

VEGF-inhibitors (Eylea, Lucentis and Avastin) have been shown to rapidly improve macular edema and vision loss in both branch and central retinal vein occlusion. These medications are the first choice for treatment for macular edema and for neovascularization. These injections are usually performed on a monthly basis as an outpatient office procedure. These medications are currently covered by the provincial MSP plan.

Flashes and Floaters: Posterior Vitreous Detachment

Vitreous is the clear gel that fills the central cavity of the eye. It occupies approximately 80% of the volume of the eyeball. The formed vitreous gel liquefies with age and eventually falls away or separates from the retina, which is the neuro-sensory tissue that lines the back wall of the eye. The retina is the structure in the eye that allows for vision.

This event is called a posterior vitreous detachment (PVD) and is a normal event occurring in most people sometime between 40–70 years of age.

As the gel separates and falls away from the retina one will often see floaters. These appear as dots, spots, or curly lines that appear suspended in front of you and move with your eye. People often think these floaters are flying bugs. Flashes of light are also a common symptom of a vitreous detachment. These are due to pulling on the retina as the gel separates. This pulling stimulates the retina resulting in a flash of light. If a retinal blood vessel is broken from the pulling, a vitreous hemorrhage (bleed) can occur. A small amount of blood may be seen as a shower of spots. Larger hemorrhages can cause large dark blobs in the visual field or an overall decrease in vision.

If the vitreous is abnormally adherent to the retina or the retina is weak in a certain area, a retinal tear can occur as the gel separates and pulls on the retina. Once a retinal tear develops there is a significant risk of the liquid vitreous going through the break and detaching the retina from the back wall of the eye, a retinal detachment. A retinal detachment can result in permanent visual loss if not corrected surgically. This is why a posterior vitreous detachment is a significant event. A posterior vitreous detachment is the initiating event of most retinal detachments although only 10% of posterior vitreous detachments will develop a retinal tear.

Awareness of the symptoms of a PVD is the critical first step in preventing a retinal detachment. If you have new symptoms of a PVD (floaters, flashes, shower of spots), or a significant increase in your current floaters after an initial evaluation, it is important to have a prompt and thorough examination of the retina to search for any retinal breaks. Please call our office in this situation or go to the nearest emergency room.

If a retinal break can be discovered before a retinal detachment develops it can be treated with the laser to seal the break and prevent a retinal detachment.

Fortunately the great majority of vitreous detachments do not cause a retinal tear and not all retinal breaks will lead to a detachment.

Central Serous Retinopathy

Central serous retinopathy (CSR), also called central serous chorioretinopathy (CSCR), is an eye condition where fluid builds up under the retina causing changes in vision. The retina is the light-sensing tissue at the back of the eye that sends image information to the brain, and works best when it is flat without fluid underneath.

CSR usually occurs in one eye, but occasionally in both. Your doctor may find evidence of previous resolved fluid that you did not notice. This can happen if the fluid was outside the macula, which is responsible for your sharpest central vision.

Who gets CSR?
  • Usually men in their 20s-50s, although it can occur outside this agerange.
  • Women can also have CSR at a ratio of 1 woman to every 5-7 men. 
What are the symptoms?
  • Painless blurred vision
  • Images appearing smaller
  • Dark spots in vision 
  • Changes in colours
  • Changes in glasses prescription
What are the risk factors?

Studies suggest that males, people with high blood pressure, high levels of stress, type “A” personalities, corticosteroid use, Cushing’s disease/syndrome, pregnancy, smoking, sleep apnea, H. pylori infection (bacteria occasionally involved with gastritis/stomach ulcers), or a family history of CSR may have higher risk of either developing CSR or having it for longer periods. About 50% of people have at least one of these risk factors, while the rest may not.

What tests will my doctor do?

In addition to examining your eyes, you will have scans and photos of the back of your eyes to document exactly where the fluid is.

To confirm the diagnosis and determine where the fluid is coming from, most patients will have a Fluorescein Angiogram arranged. In this test, a yellow dye is used in the arm vein, making it possible for special cameras to examine the retina and find exactly where the leaking fluid is coming from.

Less commonly, an Indocyanine Green Angiogram will be required, where a green dye is used, allowing cameras to image the layers underneath the retina.

Rarely, in very severe or chronic cases despite treatment, your family doctor or internist will be asked to arrange a special test to measure how much cortisol hormone your body naturally produces.

What are the treatments?

About 90% of cases resolve on their own within 3-6 months, so careful monitoring is usually the first step. If it does not resolve, or other factors prompt early treatment, your doctor will discuss a number of treatment options depending on your eye examination, general health, and testing results. These can include:
  • Focal “hot” laser
  • Photodynamic therapy (PDT), or “cold” laser
  • Oral medications
  • Ocular injections
CSR treatment does not directly affect vision, but helps resolve the fluid under the retina, giving the retina its best chance to recover. Once the fluid resolves, about two-thirds of patients will regain their vision to previous levels, although small visual quality differences are often noticeable. Permanent reductions in vision can occur based on chronicity of fluid, fluid location, and other ocular factors. About 25-50% of people can have recurrent episodes of CSR fluid.

What can you do to help your eye?

Use of corticosteroid medications have been shown to either trigger or prolong episodes of CSR. These include:
  • oral medications (ie. Prednisone)
  • asthma inhalers with corticosteroid ingredients
  • nasal/sinus sprays with corticosteroid ingredients
  • corticosteroid skin creams
  • corticosteroid joint injections
  • corticosteroid skin injections
Ideally, these would be stopped, but only with permission of your prescribing physician – stopping some of these medications abruptly without supervision can be very dangerous.

Other helpful factors include stopping smoking, maintaining a healthy blood pressure, and reducing stress.

Epiretinal membrane

An epiretinal membrane is a layer of scar tissue that grows on the surface of the retina, particularly the macula, which is the part of your eye responsible for detailed, central vision.

The macula is the small area at the center of the eye’s retina that allows you to see fine details clearly. The retina is a layer of light-sensing cells lining the back of your eye. As light rays enter your eye, the retina converts the rays into signals, which are sent through the optic nerve to your brain where they are recognized as images. Damage to your macula causes blurred central vision, making it difficult to perform tasks such as reading or threading a needle.

As we grow older, the thick vitreous gel in the middle of our eyes begins to shrink and pull away from the macula. As the vitreous pulls away, scar tissue may develop on the macula. Sometimes the scar tissue can warp and contract, causing the retina to wrinkle or become swollen or distorted.

The macula normally lies flat against the back of the eye. When wrinkles, creases or swelling affect the macula, vision can become blurry and distorted and you may even have a blind spot in your central vision.

With an epiretinal membrane, you may notice that your central vision is blurry or mildly distorted, and straight lines can appear wavy. You may have difficulty seeing fine detail and reading small print. There may be a gray or cloudy area in the center of your vision, or perhaps even a blind spot.

Symptoms of an epiretinal membrane range from mild to severe. Usually epiretinal membranes affect only one eye, although it may affect the other eye later. Vision loss can vary from none to severe vision loss, although severe vision loss is uncommon. An epiretinal membrane does not affect your side (peripheral) vision.

A test called optical coherence tomography (OCT) is helpful in making an accurate epiretinal membrane diagnosis. With OCT, a special camera is used to scan your retina. It measures the thickness of the retina and is also very sensitive at detecting swelling and fluid.

A surgery called vitrectomy and membrane peel is the treatment for this condition. The surgery is performed as an outpatient procedure in an operating room. During surgery, your retinal surgeon uses microsurgery instruments to remove the wrinkled tissue on your macula and to remove the vitreous gel that may be pulling on the macula. The vitreous gel is not required for sight and is not replaced at the end of surgery. An air or gas bubble is placed in the eye at the end of surgery. As the gas or air bubble diminishes, your eye fills with a natural fluid called aqueous humor.

After the tissue is gone, the macula flattens and vision slowly improves, though it usually does not return all the way to normal. After the operation, you may need to do some particular head positioning if an air or gas bubble was placed in your eye during surgery. You will also need to use medicated eye drops to help the eye heal.

In most cases, while vision improves after epiretinal membrane surgery, it generally does not return to perfect. It can take up to six months for vision to fully recover. On average, about half of the vision lost from an epiretinal membrane is restored; some people have significantly more vision restored, some less. In most cases, the visual distortion of an epiretinal membrane is significantly reduced.

Macular Hole

A macular hole is a small break in the macula, the part of your eye responsible for detailed, central vision. The macula is a very small area at the center of the retina — a thin layer of light-sensitive tissue that lines the back of the eye. Light rays are focused onto the retina, where they are transmitted to the brain and interpreted as the images you see. It is the macula that is responsible for your pinpoint vision, allowing you to read, sew or recognize a face.

As we grow older, the thick vitreous gel in the middle of our eyes shrinks and pulls away from the macula. If the gel sticks to the macula and doesn't pull away, the macular tissue stretches and eventually tears, forming a hole.

Macular holes are associated with aging and usually occur in people over the age of 60. Less common causes of macular holes include injury to the eye and long-term swelling of the macula.

In the early stages of macular hole formation, symptoms may not be completely obvious. Your central vision becomes blurred and distorted. If the hole progresses, a blind spot develops in your central vision and impairs the ability to see at both distant and close range.

Macular hole symptoms include:
  • Decreased ability to see fine details when looking directly at something at any
  • Vision distortion similar to looking through thick fog or wavy glass.
  • A dark or blind spot in the center of the field of vision.
It is important to note that if the macula is damaged, you will not lose your vision entirely. You will still have peripheral, or side, vision.

Vitrectomy surgery is the treatment to repair a macular hole and possibly improve your vision.

Macular hole surgery involves using tiny instruments to remove the vitreous gel that is pulling on the macula. The eye is then filled with a special gas or oil bubble to help flatten the macular hole and hold the retinal tissue in place while it heals.

If you have vitrectomy surgery, you should maintain a face-down position after surgery to keep the bubble in contact with the macula to allow effective healing for three days. We suggest patients maintain a face down position 90% of the time. This allows for your activities of daily living such as bathroom breaks eating etc. A successful result often depends on how well this position is maintained. The bubble will then slowly dissolve on its own.

If you have a gas bubble, you cannot fly in an airplane until the gas bubble has dissolved, as a rapid increase in altitude can cause a dangerous rise in eye pressure. You must also not undergo general anesthesia using nitrous gas, though it is generally safe to have general anesthesia without using nitrous gas.

As the macular hole closes, the eye usually regains some of the lost sight. How much vision is restored generally depends on the size of the hole and how long it was present before surgery. Most patients regain a significant portion of their vision that was lost.

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