Intraocular pressure measurement, visual acuity test and possible lenses selection.

Visual field test resembles a computer game: the patient looks at one point and presses the joystick when “out of the corner of the eye” sees a flash of light. It requires concentration and a proper technique, therefore only a second or a third try is considered probable.

The visual field determines the optic nerve function – the better it is working, the better is the visual field.  This test is in use in cases of all optic nerve diseases, that is in cases of glaucoma, brain or retina damages.

Electroretinography (ERG) and electrooculography (EOG) allowing to obtain information on individual layers of the retina functioning.

It allows assessment of the visual pathway functioning from the macula through the optic nerve, the visual pathway to the visual cortex in the brain.

Cornea is an external transparent lens with the eye’s highest optical strength (over 40 diopters).

This test evaluates blood circulation inside the retina and the choroid. After IV administering of the contrast – yellow-orange pigment called fluorescein – black and white images of 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.

The most up-to-date retina testing method. 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 – macula lutea.

The macula lutea allows a person to see details, colors, to read and to write. If the macula lutea is damaged the patient can see only the outline of objects, does not recognize faces or bus numbers. The most common disease of the macula lutea is age-related degeneration (AMD).

DRI OCT Triton – up-to-date device for macula lutea and optic nerve computed tomography (OCT, GDX) and angiography.

As the second in Poland and the only one in Mazovia, we are holders of the eye testing equipment in Swept Source technology – DRI OCT Triton. The device allows much better penetration of the eye structures – up to the sclera and choroid, also in eyes with high refractive deffect (allows examination of eyes with defect from -33D to +40D) and worsened translucency. Triton allows a good quality examination in cases of corneal spots, cataract, as well as of minor bleeding to the vitreous. All this made it difficult – and often impossible – to test with conventional OCT devices.

If you had problems with this type of test, you were referred to as a “difficult to diagnose patient” or if a substantial vision defect makes it impossible to perform the examination – come to us!

The properties of our new equipment are particularly useful for diagnosing age-related macular degeneration, central serous retinopathy, macular hole, choroidal nevus and others.

The most up-to-date retina testing method. 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 – macula lutea.

The macula lutea allows a person to see details, colors, to read and to write. If the macula lutea is damaged the patient can see only the outline of objects, does not recognize faces or bus numbers. The most common disease of the macula lutea is age-related degeneration (AMD).

DRI OCT Triton – up-to-date device for macula lutea and optic nerve computed tomography (OCT, GDX) and angiography.

As the second in Poland and the only one in Mazovia, we are holders of the eye testing equipment in Swept Source technology – DRI OCT Triton. The device allows much better penetration of the eye structures – up to the sclera and choroid, also in eyes with high refractive deffect (allows examination of eyes with defect from -33D to +40D) and worsened translucency. Triton allows a good quality examination in cases of corneal spots, cataract, as well as of minor bleeding to the vitreous. All this made it difficult – and often impossible – to test with conventional OCT devices.

If you had problems with this type of test, you were referred to as a “difficult to diagnose patient” or if a substantial vision defect makes it impossible to perform the examination – come to us!

The properties of our new equipment are particularly useful for diagnosing age-related macular degeneration, central serous retinopathy, macular hole, choroidal nevus and others.

The most up-to-date retina testing method. 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 – macula lutea.

The macula lutea allows a person to see details, colors, to read and to write. If the macula lutea is damaged the patient can see only the outline of objects, does not recognize faces or bus numbers. The most common disease of the macula lutea is age-related degeneration (AMD).

DRI OCT Triton – up-to-date device for macula lutea and optic nerve computed tomography (OCT, GDX) and angiography.

As the second in Poland and the only one in Mazovia, we are holders of the eye testing equipment in Swept Source technology – DRI OCT Triton. The device allows much better penetration of the eye structures – up to the sclera and choroid, also in eyes with high refractive deffect (allows examination of eyes with defect from -33D to +40D) and worsened translucency. Triton allows a good quality examination in cases of corneal spots, cataract, as well as of minor bleeding to the vitreous. All this made it difficult – and often impossible – to test with conventional OCT devices.

If you had problems with this type of test, you were referred to as a “difficult to diagnose patient” or if a substantial vision defect makes it impossible to perform the examination – come to us!

The properties of our new equipment are particularly useful for diagnosing age-related macular degeneration, central serous retinopathy, macular hole, choroidal nevus and others.

The most up-to-date retina testing method. 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 – macula lutea.

The macula lutea allows a person to see details, colors, to read and to write. If the macula lutea is damaged the patient can see only the outline of objects, does not recognize faces or bus numbers. The most common disease of the macula lutea is age-related degeneration (AMD).

DRI OCT Triton – up-to-date device for macula lutea and optic nerve computed tomography (OCT, GDX) and angiography.

As the second in Poland and the only one in Mazovia, we are holders of the eye testing equipment in Swept Source technology – DRI OCT Triton. The device allows much better penetration of the eye structures – up to the sclera and choroid, also in eyes with high refractive deffect (allows examination of eyes with defect from -33D to +40D) and worsened translucency. Triton allows a good quality examination in cases of corneal spots, cataract, as well as of minor bleeding to the vitreous. All this made it difficult – and often impossible – to test with conventional OCT devices.

If you had problems with this type of test, you were referred to as a “difficult to diagnose patient” or if a substantial vision defect makes it impossible to perform the examination – come to us!

The properties of our new equipment are particularly useful for diagnosing age-related macular degeneration, central serous retinopathy, macular hole, choroidal nevus and others.

The eyeball pressure value is evaluated with a special device called tonometer. A disadvantage of this device is that it needs to touch the patient’s eye. Therefore the patient needs to be under the local anesthesia and the tonometer’s probe needs to be sterilized. That is why non-contact tonometry is becoming increasingly popular. During this test the pressure is measured with an air-puff and therefore the patient does not require anesthesia. In Retina Ophthalmological Hospital we use the most modern non-contact tonometer.

The correct value for intraocular pressure in adults should not exceed 21-22 mm Hg, although it is also important to know that some people suffer from ocular hypertension – elevated intraocular pressure, which is not synonymous with glaucoma. Moreover, the following factors may affect the test results: cardiovascular diseases (hypertension, hypotension, stroke, diabetes), blood diseases and respiratory diseases. Nonetheless, elevated intraocular pressure urges the ophthalmologist to carry out further diagnostic tests for glaucoma.
Assessment of the anterior and posterior segment of the eye. Although the eye is just the size of a ping pong ball, its internal structure is more complicated than the one of 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 dilatate pupils. The test performed after pupil dilatation is called funduscopy.

In the process of examining fundus, blood vessel can be assessed. This test is also used in assessment of the general condition in diseases like diabetes or hypertension. We are concerned with the fact that the blood vessels condition is the same in the whole body.

If applicable, additional test are performed:

• visual field test (perimetry)
• corneal topography and keratometry
• OCT that is optical coherence tomography
• ultrasound
• fluorescein angiography

AVASTIN AND LUCENTIS

WHAT IS INTRAVITREAL INJECTION, WHICH IS MEANT FOR TREATING THE “WET” FORM OF AGE-RELATED MACULAR DEGENERATION (AMD)?

A layman would call it an “injection into the eye” and it reality is an injection into the carefully selected spot in the eyeball. The injection is performed under local anesthesia so it does not hurt. Not including the time needed for pupil dilatation, the intravitreal injection takes only two minutes.

HOW IS THE TREATMENT WITH SUCH INJECTIONS BEING PERFORMED?

In case of AMD a series of injections is being administered, once a month. Then the progress of treatment is being checked with the OCT test and the future treatment is planned. OCT test (Optical Coherence Tomography) is a ultra-modern and non-invasive method of examining tissues inside the eye. Often this will end the series of injections. After that periodic medical supervision and perhaps additional injections will be necessary. At times, the patient needs to continue to receive the injections but usually at larger intervals.

IS IT TRUE THAT AVASTIN – THE MEDICINE USED FOR OPHTHALMOLOGICAL INJECTIONS IS IN FACT A CANCER DRUG?

Yes, and it is still an effective drug used in oncology. And since its effectiveness in cancer treatment was proven to be high, other possibilities for its use have been sought. American ophthalmologists started to use it 6 years ago and practice has shown that it has been effective. Ophthalmologists from various countries note its high efficiency both in treating the “wet” form of AMD, the diabetic retinopathy, some forms of glaucoma and diabetic macular edema. It has similar effect to a much more expensive drug – Lucentis.

WHAT IS THE DIFFERENCE BETWEEN THOSE TWO DRUGS?

Both have similar chemical composition and eventually similar effect. Lucentis is a smaller molecule obtained from a bigger Avastin. The effect of both Avastin and Lucentis is based on sealing and blocking the growth of abnormal blood vessels. Lucentis was approved in the USA in 2006 and Avastin has been used there off-label already since 2004.

The research results from the Queen’s University Belfast published in 2013 in a prestigious surgical journal “Lancet” (two-years trial) confirmed the results of previous American studies stating that the effect of both these drugs is very similar. Click here to view more tu and tu.

WHEN AVASTIN AND WHEN LUCENTIS SHOULD BE USED?

There is no easy answer to this question. The depth of once pocket plays a big part here. Some people believe that if one of the drugs does not work, applying the other one can bring the desired result. Due to the very similar composition of both drugs, their effectiveness is similar. Every person responds differently to drugs. Hence the need for different measures for the same disease. There is a lot of hope placed in new, alternative drugs such as Eylea (which we also have been using in Retina since June 2013).

WHAT IS CHALAZION?

Chalazion is a type of abscess inside the eyelid – palpable change; as if a pea inside the eyelid. Sometimes it’s painful.

WHERE DOES THE CHALAZION COME FROM?

The sebaceous glands on the inner side of the eyelid get bunged up, they accumulate secretion in which infection may develop.

Chalazion is often a result of recurring stye but unlike stye the chalazion does not heal itself. Do not wait! You need to see a doctor.

HOW DOES THE MEDICAL INTERVENTION LOOK LIKE?

If the chalazion is still small, antibiotic therapy, including ointment and drops, should be enough. If the above should be not be enough the doctor may decide about antibiotic injections being administered around the infected area. If that won’t work the chalazion needs to be surgically removed.

HOW THE PROCEDURE OF CHALAZION REMOVAL LOOKS LIKE?

It is being performed under local anesthesia. First the surgeon unfolds the eyelid (the Chalazion is present on its inner side), then he incises infected area and evacuates the accumulated fluid content. After the procedure, for the time recommended by the doctor, the patient should locally apply ointment or drops with antibiotic.

Learn more.

WHAT IS VITRECTOMY?

Some call it the “last chance-surgery” – and that seems to be true. Due to advances in medicine, the introduction of modern surgical techniques and the latest medical devices, vitrectomy can cure or ward off diseases that several decades ago would lead to vision loss.
Vitrectomy is the pathological changes removal from the vitreous and the retina. Vitreous is a gelatinous substance that fills the posterior (the largest) chamber of the eyeball. A specialist qualifies the patient for vitrectomy when there are no other ways of treating the retina or the vitreous. In cases of retina diseases indications for vitrectomy are macular hole, epiretinal membrane, retinal detachment, retinal vein thrombosis or diabetic retinopathy. The indications for vitrectomy in case of the vitreous disease are hemorrhages or vitreous opacities.

HOW IS THE VITERECTOMY PERFORMED?

The surgeon performs the procedure using a specialist microscope which allows three precise incisions in the retina. The incisions are small (from half to one millimeter long). Through the incisions the surgeon removes the vitreous and injects other substance to the eye – gas, sterile air, infusion fluid or silicone oil. The type of filling depends on the decision of the surgeon who intraoperatively makes the eye condition assessment. Gases and fluids are absorbed, silicone oil, after some time, needs to be removed or exchanged by a surgeon. Vitrectomy may be accompanied by other surgical procedures – that depends on the ailments which caused the bad eye condition. Vitrectomy is often combined with the replacement of the opaque lens of the eye (that is with the cataract removal) – such procedure is called phaco-vitrectomy.

IS VITERECTOMY PAINFUL?

It is being performed under local anesthesia. The procedure takes about an hour. This is ambulatory surgery – immediately after it the patient may be discharged. The pain may persist for several days after the operation – then conventional over-the-counter pain killers help to relieve it.

HOW LONG WILL THE CONVALESCENCE TAKE? WILL THE OPERATED EYE BE ABLE TO SEE AS PREVIOUSLY? HOW TO TAKE CARE OF THE OPERATED EYE?/h5>
After the surgery together with your physician you will plan the dates of the postoperative appointments – specialist care after the surgery is essential since the vitrectomy carries a risk of complications (the most common ones are cataract, retinal detachment and hemorrhage to the eye). For a few days after the surgery the vision may be worse – it is natural after such a serious intervention. But the vision will gradually return to normal. It is worth remembering that in case of filling with silicone oil the effect of vision worsening can last longer and be serious enough that it will be necessary for the time being (until the oil is released) to replace the corrective lenses in your glasses.

During the convalescence period it is recommended to maintain a specific positions – face down; sitting and walking in a slight incline, sleeping on the stomach. For a few weeks the patient should avoid traveling by plane (especially if the eye was filled with gas). At night the patient can occlude the operated eye with a cover – this way one will avoid accidental eye irritation while sleeping. The bathing time should also be limited. The patient may not use sauna – long contact with very hot air is not advisable for the operated eye.

WHAT IS THE REFRACTIVE SURGERY?

It’s a procedure aimed to correct eye defects. It is done with a laser.

WHAT DEFECTS CAN BE CORRECTED WITH THE REFRACTIVE SURGERY?

• myopia of up to 8 diopters
• hyperopia of up to 2.5 diopters
• astigmatism of up to 2.5 diopters

There are contradictions for the treatment if the patient:

• is under 21 and over 60 years old
• is pregnant or nursing
• is treated with steroids
• suffers from connective tissue diseases
• diabetes
• autoimmune diseases, immunodeficiency, allergies
• active infections
• has a peacemaker
• if the vision defect is increasing
• suffers from degenerative myopia
• non-operated cataract
• glaucoma
• retina diseases
• keratoconus
• nystagmus
• dry eye syndrome (DES)
• vascular eye diseases

QUALIFYING APPOINTMENT

For four weeks prior to the appointment please do not wear your contact lenses.

The following test will be performed during the appointment:

• vision defect test before and after pupil dilatation
• keratometry
• retinal topography
• measuring of the pupil size and reactivity (pupillometry)
• measuring the thickness of the cornea (corneal pachymetry)
• evaluation of the quality and composition of the tears
• eyeballs USG
• assessment of the anterior and posterior segments of the eye
• measuring the intraocular pressure (ocular tonometry)
• assessment of the irideocorneal angle (ganioscopy)
• a visual field test (perimetry)
• optical coherence tomography (OCT)

All the tests are performed during one visit to our hospital. Their cost is included in the general cost of the qualifying appointment (400 zlotys). Note! The qualification takes about 2-3 hours.

SURGERY DESCRIPTION

After administering anesthetic drops a metal retractor is put on the eyelids. The laser arm is positioned directly above the operated eye. We ask the patient to focus his/her eyes on the light which is on the laser arm. The laser’s operating time is several dozen seconds during which the eye should be kept immobile. The procedure is completely painless.

Both eyes are being operated during one procedure.

AFER THE SURGERY

After half an hour the patient can be discharged. It is recommended for and adult to accompany the patient. For about 3 hours after the procedure the patient may feel burning and tearing in the operated eye, but he or she should not clench eyelids or rub the eye. After three days the patient reports for a check-up examination (included in the price of the procedure).

For 3 weeks after the procedure the patient should avoid smoke (including the cigarette smoke) and dust. The patient is not allowed to wet the eyes during bating or showering at home or swimming at the pool. The patient is not allowed to use the sauna or the solarium. It is recommended not to carry heavy loads (over 15 kg). The patient should avoid heavy sunshine or when that is not possible wear sunglasses with a UVA filter.

THE MOST FREQUENTLY ASKED QUESTIONS

What are the risks of the laser procedure?
The risk of such procedure does not exceed 1%. Most frequent complications are the postoperative infections.

What are the most common side effects of the procedure?
Problems with night vision. Blurred vision of the light points. Weakened contrast view. Hypersensitivity to light. Halos around light sources. The complications occur rarely and most often disappear spontaneously after 6-12 months after the procedure.

Can the vision defect reoccur after the surgery?
In one percent of the patients the vision defect of about 1 diopter reoccurs. Such defect can be corrected after 1 year since the first procedure.

THE PRICE OF THE REFRACTIVE SURGERY

Qualification for surgery – 400 zł

Detail information soon!

To patients suffering from demodex infections (Demodex brevis, Demodex folliculorum), blepharitis, eye-form of rosacea, dry eye syndrome, ophthalmia or other ocular adnexa conditions we recommend a non-standard therapy. If you are interested in this type of treatment visit the Cliradex.pl webpage and see more.