Fluorescein angiography

This test evaluates blood circulation inside the retina and choroid. After IV administering of the contrast called fluorescein – black and white images of the eye vascularity are taken.

The pigment flows through the eye like blood, so if somewhere fluorescein starts to leak, we know that in this location the blood vessels are damaged. The location of the leak is precisely shown on images.

Before starting the test, a qualified nurse takes the patient’s medical history. Eye drops are administered to cause mydriasis. The test consists in the nurse IV administering the contrast and later on in the ophthalmologist or radiation therapist performing a series of the fundus of the eye images.

The most common indications:

  • Evaluation of the retina vascular condition and its capillary permeability in order to detect vascular anomalies and pathologies arising in the course of retina diseases such as ophthalmological diabetes complications
  • Evaluation of the possible retina and partially choroid damages being the effect of degenerative or inflammatory changes
  • Eyeball tumors diagnostics
  • Evaluation of the treatment effectiveness after procedures such as laser photocoagulation or intraviteral injection
  • Patient’s qualification for the most adequate form of treatment

IMPORTANT: The test duration including the patient’s preparation time is about 1 hour.

Contraindications to perform the test:

  • Renal and hepatic failure
  • Heart diseases in the form of coronary insufficiency or arrhythmias, circulatory diseases, e.g. hypertension or diabetes, and circulatory insufficiency
  • Allergy to contrast with fluorescein sodium (possible after previous angiography procedure)

However, testing is avoided in pregnant women, especially in the first trimester, despite the fact that up to now there have been no cases of fetal damage due to fluorescein angiography during pregnancy.

How the patient should prepare for the fluorescein angiography test?

  1. On the day of the test, 3 hours before the test the patient should be fasting.
  2. Before and after the examination, the patient may take medications taken permanently prescribed by a physician.
  3. Eye drops are administered to cause mydriasis. For about 4 hours after the test deterioration of vision and photophobia occur.
  4. The patient is asked to bring along a complete medical history regarding eye diseases and accompanying diseases.
  5. In case of dialysis patients, it is necessary to obtain the nephrologist’s consent and arrange dialysis on the day of the AF examination.
  6. Before the test can be performed a written consent of the patient is required.
  7. After undergoing the test, the patient gets further instructions from a nurse.
  8. The patient obtains the medical records of the test.


The retina of the eye is a fiber of the brain that can turn the light into an electrical signal that reaches the brain through the optic nerve. Electrophysiology is a group of tests which allow to trace the electrical activity of both the retina and the optic nerve.

There are three types of electrophysiological tests:

  • Electroretinography that measures the electrical activity of the retina
  • Electrooculography measuring the effects of retinal pigmented epithelium and photoreceptors
  • visual-evoked potentials that reflect the power with which signals from the eye stimulate the visual cortex of the brain.

Visual evoked potentials (VEP, VER)

The test is done in a sitting position. The patient looks at the monitor screen, where the checkerboard pattern shows. On it, with the right frequency, white fields turn black. This vibration of black and white fields stimulates the retina, which sends the signal to the brain. The device measures both the signal strength i.e. amplitude, as well as the time it takes for the stimulation to pass to the brain.

Visual evoked potentials (VEP, VER – Visual Evoked Potentials, Visual Evoked Responses), arise in the visual cortex of the cerebral cortex. These are electrical responses to the light stimulus, providing information about the entire visual pathway, from the retina to the cortical structures. The pupils are not being dilated for this examination.

The examination is performed for each eye separately. The non-examined eye is covered with a black sash or, in case of patients with eye glasses, a shutter is being placed behind the eye glasses lens (VEP Pattern). For the examination three electrodes are used and placed in proper places on the patient’s head.

There are two types of the VEP examination:

Checkerboard stimulated VEP – VEP Pattern

A patient sits in front of a computer monitor at a distance of 80 cm. The monitor displays a black and white chessboard. During the examination the chessboard moves. There is a red cross in its center on which the patient should concentrate his sight. If the patient wears eye glasses, he doesn’t take it off for the test. Depending on the degree of the patient’s cooperation, the test lasts approx. 10-15 min.

Flash stimulated VEP – VEP Flash

This is a special variation of the VEP examination, due to the type of stimulus used – flash. During the examination, the patient rests his chin on the chin rest of the chamber (in case of small children, the test can be performed when a child keeps his head at a short distance from the chamber). During the test, a shimmering light appears in the chamber – similar to the flash of the camera. During the examination the patient looks straight ahead and blinks normally as needed. Depending on the degree of the patient’s cooperation, the test lasts approx. 10-15 min.

Electroretinography (ERG)

The test consists in measuring the flow of electricity between the electrode placed on the cornea and the electrode placed on the forehead. The flow of electricity is shown in a graph called electroretinogram, resembling an ECG graph.

The retinal electrical function test is performed under conditions of adaptation of the eye to darkness and brightness. At the beginning the eye adapts to darkness for about 20 – 30 minutes. After this time the assessment is done. Then the eye is illuminated for about 10 minutes so that it adjusts to the light, and the measurements are made again. This allows to measure the function of photoreceptors responsible for vision in the dark, i.e. the rod cells and for vision in the light – the cone cells.

Pattern ERG

The traditional flash ERG does not present the activity of the innermost retinal layers, i.e. the ganglion layer. The electroretinogram in patients with glaucoma and optic nerve damage shows normal results. In order to understand the function of retinal ganglion cells, a special type of ERG – PERG (ERG) test is performed.

PERG is performed in conditions of typical room lighting, pupils are not being dilated. Just like in case of the ERG, after anesthetizing the cornea with eye drops, the electrodes are being places.

Electrooculography (EOG)

Electrooculography is used similarly as ERG in order to asses some of the macula lutea diseases. The determined functional potential is registered with the forced eye movements, and its amplitude depends on the position of the eyeball.

The examination is performed with the pupil dilated. The first stage is the preadaptation in a room light (bright room) about 30 minutes before the test. The electrodes are glued to the skin at the corners of the eyes, two for each eye and one grounding electrode in the middle of the forehead. The patient sits with his head rested on the chin rest and moves his eyes following the red diodes. For 15 seconds of each minute of the test, the patient, following the lights, makes alternating right-left eyes movements. The rest 30 seconds is a break. The test takes 30 minutes and consists of 2 phases. 15 minutes in brightness, 15 in the dark.

Cataract – surgeries and treatment in Warsaw

Also, a cloudy lens is removed and replaced with an artificial one.


Will cataract really happen to everyone? Yes, if you live long enough. Cataract, i.e. opacification of the lens, used to be the cause of blindness in the majority of elderly people. And now? Well, in the Retina Ophthalmological Clinic we deal with it in 15 minutes!

Initially your vision starts deteriorating and constant cleaning of glasses doesn’t help. Then on a sunny day you get an impression as if lightinings struck in front of your eyes. You see much better when the sun disappears behind clouds. Finally your eyesight deteriorates so much it’s difficult to do your daily tasks. What’s going on? Probably you suffer from cataract.


Cataract can’t be prevented with healthy lifestyle, a special diet or some eyedrops. It’s a natural symptom of getting older, such as wrinkles or grey hair. A course of the disease varies from patient to patient – sometimes it develops within several months, sometimes it takes years. The result is always the same: the deterioration of vision in the affected eye. It can appear simultaneously in both lenses. In 90% of cases cataract is a result of the aging of a body so it rarely starts before the age of 60 (and most commonly around the age of 80). Why do some people get cataract earlier than others? Different parts of a body age with a different speed.


Cataract is a progressive opacification of the lens. It can be treated by replacing the natural lens with an artificial one. It used to be believed that the opacification needs to be full in order for a surgery to be conducted. Now procedures are done in all stages of cataract
– the earlier the better, when the problem becomes disruptive in everyday life. This procedure is simple, effective and rarely results in complications.


The cataract surgery can be provided to outpatients with a local anaesthetic. In our clinic it takes about a quarter of an hour. After a short rest the patient can go back home accompanied by someone. If cataract has affected both eyes, initially one eye is treated. The second one is operated several days later. The patient will see as well as before cataract and sometimes even better. How is it possible? It’s because the recent hit is a pseudo-accommodative lens replacing the natural cloudy one. When such lenses are implanted glasses become redundant as the patient sees from a short and a long distance equally well. We need to mention, however, that pseudo-accommodative lenses don’t provide good vision inbetween – for example while working on a computer.

  • Before the cataract removal procedure an ophthalmic surgeon locally anaesthetizes the eye. The patient is fully conscious during the procedure.
  • The surgeon makes a 2 mm cut in the cornea and divides the cloudy lens into smaller parts to remove them from the eye, using a procedure called phacoemulsification (the device used in this procedure can be compared to a vacuum cleaner which simultaneously grinds down and sucks out parts of the lens). The aim of this treatment is to remove the content, i.e. the cloudy lens, while retaining its packaging – the capsule.
  • A new synthetic rolled up lens is being implanted in the empty capsule and uncurled inside. Now a new content is placed in the old packaging.
  • All done! The new lens is equipped with a yellow filter which protects the retina from the harmful influence of UV rays./li>

The next day after the procedure a doctor removes the dressing. The patient can move normally, shake his or her head or bend down without a fear that the lens would fall out. But just in case for 2-3 weeks he or she should avoid a significant physical effort. After the treatment the eye can’t be touched or get wet to prevent infection.
Next appointments are arranged in 3 and 6 weeks time – during the second one glasses may be fitted, if necessary.


In our Clinic we implant lenses of the highest quality at no additional cost. They are customized to the needs of a particular eye:

  • Special lenses facilitating laser therapy for patients with lattice degeneration and diabetes.
  • Special lenses with additional UV filters in cases of age-related macular degeneration and retinal or choroidal nevi.

The procedure lasts approximately a quarter of an hour.
Attention! The cataract removal procedure is not the only eye surgery we do in the Retina Ophthalmological Clinic. We also perform retinal surgeries, we treat surgically AMD, i.e. age-related macular deterioration, we provide anti-glaucoma treatments and even plastic surgery procedures on eyelids and skin changes in the eye area.


Do you know that:

  • Cataract surgeries are the most common ophthalmic procedures performed around the world.
  • Cataract is the most common cause of blindness! 20 million people are blind due to cataract, which is a half of all blind people in the world. These are people who did not subject themselves to a cataract removal surgery.
  • The first cataract removal surgery was performed around 3000 years ago in India by a nomadic doctor Susruta. He used a knife topped with a little ball. He pushed a cloudy lens inside. It stayed on the retina for the rest of the patient’s life. Most people had an improved vision for a couple of days but then their eyes were getting infected and they were losing sight altogether.
  • It wasn’t until the 18th century, when a French physician, Jacques Daviel, performed the first successful cataract surgery. He developed his technique after a request from a young painter who lost his sight due to cataract. The technique involved cutting through the cornea, cutting off ciliary zonules that held the lens and removing the lens altogether. Daviel performed over 400 procedures – only 50 od them were unsuccessful. After the surgery his patients wore thick glasses which replaced the removed lens.
  • The first artificial lens was implanted in 1952. We owe the discovery of a material suitable for manufacturing artificial lenses to an English physician, Harold Ridley. He observed a lack of inflammatory reactions in an eye of a pilot who ended up with chips of acrylic glass in his eyeball after the Battle of Britain.

Glaucoma – anti-glaucoma surgeries, treatment


We explained it here.


On the stage of the disease and its character. If the disease is not yet advanced we start from a pharmacological treatment. In more advanced stages an anti-glaucoma surgery is required.


Such decision should be taken when eyes react badly to a pharmacological treatment or in cases when a treatment with eyedrops is impossible for some reason. If necessary, a planned cataract surgery (phacoemulsification) can be combined with a glaucoma treatment.


There are several types of them. An ophthalmic surgeon will choose the most appropriate one.
Trabeculectomy: a surgery aimed at creating an artificial fistula through which aqueous humour can escape from the anterior chamber of the eyeball. This surgery is very effective but unfortunately involves a risk of complications, including cataract – that’s why cataract is often operated together with glaucoma.
Trabulectomy with an ExPress draining implant: an improved version of trabulectomy. During this procedure a surgeon, using a very thin needle, places a microscopic implant made of stainless steel in a patient’s eye. Unfortunately, due to the use of a very precise implant, the cost of this procedure is higher than in case of traditional trabulectomy.
Canaloplasty: the newest, non-invasive method of treating glaucoma. During this procedure a surgeon clears existing tracts of passage of aqueous humour by reinforcing the canal with special prolene threads.
Laser iridectomy: a minimal opening in the iris is made using a very precise laser. This opening improves the exchange between the anterior and the posterior chambers of the eyeball. The surgery very often successfully stops the progress of glaucoma. We need to remember, however, that after such procedure the eye should be regularly assessed by a specialist – the opening is so tiny that it sometimes spontaneously heals and the surgery needs to be repeated.
Surgical iridectomy: very similar to laser iridectomy, as far as its course and results are concerned, but performed surgically. It is recommended to patients with contraindications for the laser procedure.
Cryotherapy of the ciliary body: applying low temperatures to the ciliary body (a part of the eye surrounding the retina). It is used in cases of advanced glaucoma when there is pain and very high intraocular pressure. If cryotherapy is repeated within 3-6 months, the pressure can be stabilized – the patient, however, needs to remain under doctor’s care.
Endoscopic cyclophotocoagulation: an incredibly modern method of reducing the production of aqueous humour. It consists of lasering ciliary processes which produce aqueous humour.

OCT test of both eyes

MD PhD Piotr Tesla

Fundus examination – fundus is in every body the only place where the condition of blood vessels can be assessed without opening any of the body cavities. Therefore, it is believed that the condition of the blood vessels in other organs is analogical to those from the fundus. All the vascular diseases such as hypertension, diabetes or arteriosclerosis evoke pathological changes in the eye’s blood vessels. It is assumed that the condition of the blood vessels in the whole body is analogical to the one in the eyes. Therefore, the stage of the general disease can be judged basing on the stage of the eye condition. Funduscopy is an examination for which the ophthalmologist needs to enlarge the pupil of the eye in order to assess the blood vessels’ condition on the largest possible area. The assessment of the blood vessels’ condition is being made for the needs of other specialists such as diabetologists, general physicians, cardiologists. For ophthalmologists from the Retina Ophthalmological Hospital who deal with posterior section of the eye diseases it is a very basic examination before planned retina surgeries, OCT macula lutea test, Avastin injection or other medication into the eye administration.

Funduscopy, examination of the retina, choroid and vitreous

Retina, choroid and vitreous tests are possible only after administering, often several times, drops dilating the pupil. Remember that after administering the drops, it will be more difficult for you to read because the droplets “turn off” the accommodation (the ability of the eye to see things from a distance and from close) and the sun will be hurting your eyes. Due to dilating the pupil the retina can be fully assessed from the beginning to the end i.e. up to the optic nerve. The vitreous can also be assessed and its relations with the retina. Dilatation also enables us to examine the layer under the retina, i.e. the choroid.

Removal of the foreign body from the cornea – essential when a foreign body thrusted into the cornea. The eye is anesthetized with drops, then the foreign body is removed and a dressing with neomycin ointment is put on.

Histopathological eye examination

Eye histopathological test is performed in case of doubts about the structures of the removed change. The whole or small portion of the change is preserved with a formalin solution and sent for the microscope examination.

Eye test

Although the eye is just the size of a ping pong ball, its internal structure is more complicated than the Swiss watch. Each eye structure is examined in a slightly different way, and the ophthalmologist selects a test method adapted to the problem. The test is carried out using biomicroscopes and magnifying lenses. Without pupil dilatation the outer half of the eyeball, professionally called the anterior section can be examined. Whereas, to examine the deeper half, drops should be administered in order to dilate the pupils. The test performed after pupil dilatation is called funduscopy.{ut1}In the process of examining fundus, blood vessel can be assessed. This test is also used in the assessment of the general condition in diseases like diabetes or hypertension. It is believed that the blood vessels condition is similar in the whole body.

Cornea test

Cornea is an external transparent lens with the eye’s highest optical strength (over 40 diopters). Its assessment is done before every eye surgery and especially before the cataract surgical removal. In the Retina Ophthalmological Hospital we perform the endothelial cells number test of the cornea. We measure the cornea’s thickness before every surgical procedure.

Eye diseases involving the cornea are characterized by high pain and severe tearing. In case of suspected corneal disease, the ophthalmologist uses fluorescein, a special yellow-orange substance for corneal coloration. If you suspect a dry eye, then after the coloration of the cornea the color does not persist on its surface only “bursts” leaving dry spots. In case of corneal inflammatory conditions or traumatic eye diseases, stained are the corneal lesions.

Measurement of the cornea thickness i.e. pachymetry is important in the treatment of glaucoma. Normal cornea is about 540 micrometers thick, about half a millimeter. In case of an augmentative cornea intraocular pressure measurement is understated and vice versa if the cornea is very thin the measurement is overestimated. Therefore, in order to determine the real pressure special tables are used to correct the cornea thickness.


Gonioscopy – is an irideocorneal angle test. It is taken after desensitizing the eye with drops and putting on the eye a ganioscope or a Goldmann indirect goniolens, a small glass-like device containing several mirrors set at different angles. With this mirror setting, the angle of occlusion can be examined, its closure is one of the symptoms of glaucoma. In case of danger of closing the irideocorneal angle, treatment should be started in the ophthalmologist’s office or hospital. It consists of laser or surgical iridectomy.


OCT i.e. ophthalmological coherent tomography – is the most modern method of examining the retina.
Due to exceptional accuracy of 3 micrometers, it is possible to view and evaluate all layers of the retina as if we were looking at them under the microscope.
The test evaluates the most important part of the retina – the macula lutea.
Macula lutea allows us to see details, colors as well as to read and to write.
If the macula lutea is damaged the patient can see only the outline of objects, can walk around but does not recognize faces or bus numbers.
The most common macula lutea disease is age-related degeneration also called AMD.
Research results show that in developed countries about 30% of population above 70 years of age suffers from the age-related macular degeneration (AMD).
In the Retina Ophthalmological Hospital since 2008 we have been treating the macula lutea diseases with injections administered into the eye. One of them is Avastin injection.


Vitrectomy is a surgical procedure of removing the vitreous that is the gel filling the inside of the eye.
It is being performed in case of the blood effusion into the vitreous, retinal detachment, macular holes or preretinal membranes. The silicone oil, gas or fluid replaces the removed vitreous.

Retina Ophthalmological Outpatient Clinic and Hospital in Warsaw is a modern medical facility with an excellent and experienced team of specialized physicians – including pediatric ophthalmologists. Retina opened in 2004. Since that time we have performed over 10,000 eye surgeries, hundreds of angiographic tests and ultrasounds, and have had over 15,000 patients.

The name of our hospital comes from Greek. Retina is an inner coat of the eyeball responsible for vision. A Patients’ ability to see is the most important for us, ophthalmologists. Knowledge and many years of experience help our team to achieve that goal.

We are unique in our non-standard approach to eye diseases, innovative solutions and patient-friendly approach. Knowledge and experience are not enough and need to be supported by tests, which we perform on the most up-to-date equipment.

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