Contact the Eye Center of Northern Colorado Retina Center: (970) 419.2683 or retina@eyecenternoco.com

• Detached and Torn Retina
• Macular Degeneration
• Diabetic Retinopathy
• Geographic Atrophy
• Testimonials

Detached and Torn Retina

A retinal detachment is a very serious problem that almost always causes blindness if left untreated. A retinal detachment occurs when the retina is pulled away from its normal position. Early symptoms that may indicate the presence of retinal detachment include: flashing lights, new floaters, and/or a gray curtain moving across your field of vision. These symptoms do not always mean a retinal detachment is present; however, you should see your ophthalmologist as soon as possible. Retinal detachment surgery can be performed at our out patient surgery center by our retinal specialist.

Retinal Detachment FAQ



Kent Crews, M.D.
 & Arthur Korotkin, M.D.



Why did I get a retinal detachment?
   

Most retinal detachments occur as a complication of the natural aging process of the eye. The vitreous jelly in the eye undergoes deterioration and liquification over time. It finally pulls off the retina, causing floaters and sometimes flashes of light. For most patients, this is a benign process. In a very small percentage of individuals, the vitreous will pull at and tear the retina. The retinal tear allows fluid to track underneath, and the retina starts to separate from the eye wall. Patients with nearsightedness, family history of retinal detachment, or prior cataract surgery are at greater risk.



Are retinal detachments always a surgical emergency?
  

 Patients with acute changes in vision (less than a couple of weeks) and good central vision may require emergent or urgent surgery. The goal is to reattach the retina before the central vision (macula) is involved. Studies show that patients with chronic symptoms (more than a couple of weeks) or a detachment involving central vision can usually wait a few days for surgery without causing any harm. Detachments affecting central vision are called "macula off". There is excellent research showing that a repair within 7-10 days of central vision loss has just as good a result as emergency surgery. Only about 1 in 4 detachments is considered a surgical emergency.




Will my vision be just as good or better if all goes well with surgery?
   

Unfortunately, the answer to this question is often times "No".  After retinal detachment surgery many patients have some degree of dissatisfaction with their vision. Due to the very serious nature of this disease process, there is usually some permanent damage to either peripheral vision and/or central vision. YOU MUST REMEMBER THAT RETINAL DETACHMENTS ARE BLINDING IF LEFT UNTREATED. Unlike LASIK or cataract surgery, which clear up vision in an otherwise healthy eye, retinal detachment surgery involves helping a critically ill eye that will otherwise be lost. The goal of retinal detachment surgery is not to make you see better, it is to keep you from losing your eye.



Why did I have to see a retinal specialist for this problem?
   

Retinal detachment surgery is a very complex and challenging eye surgery. The retina is more delicate than any other structure in the body. Most procedures take over 2 hours to complete, and sometimes much longer. Retinal surgeons must go through additional years of intense training to learn how to do these procedures. 



Why will I need cataract surgery afterwards?
   

Due to the nature of modern repair techniques, most patients will need cataract surgery in the months following their retinal detachment surgery. This is a result of operating deep inside the eye and also from placing a gas bubble inside the eye to hold the retina in place while it heals. It is generally undesirable to replace the lens during retinal detachment surgery, so it has to be done later on. Cataract surgery is generally a faster and simpler operation, and usually the recovery is quick. Of course, this does not apply to patients who had cataract surgery before developing a retinal detachment.



Why do I have to position my head after surgery?
   

A gas bubble is almost always injected in the eye at the end of surgery. A gas bubble is similar to a beach ball submerged in water - it pushes up against gravity. Retinal surgeons use this technique to position the eye in a desirable location so that the bubble can hold the retina flat in place while it heals. Positioning is extremely important in retinal surgery outcomes and failure of the patient to position may result in failure of the retina to stay reattached.



Why do I have so many post operative appointments?
   

There are many things that can go wrong after uneventful retinal surgery. If problems are detected early, then it is often much easier to intervene and correct the issue. While this is a hassle, it is necessary for optimal outcomes. Please remember that your doctor does not get paid a penny extra for additional visits within three months after your surgery. Extra visits are to assure that your recovery is proceeding well.


What are your outcomes for retina surgery?
   

While every situation is different, Dr. Crews and Dr. Korotkin have very high success rates that are higher than the published national average. They both take great pride in their surgeries and take many careful steps in achieving successful outcomes.



Is my other eye at greater risk of a detachment?
   

The answer is "it depends". If the vitreous has already pulled free in the other eye, your risk of a detachment is quite low. If it has not pulled free, then the risk is substantial. Your other eye will be carefully examined. If there are any weak spots or tears, we will generally recommend preventative laser treatment. This is the case in about 10% of patients.



Are my siblings or children at greater risk of a detachment?
   

Genetics do play a role in retinal detachment. You should educate, but not terrify, your family members about the symptoms of a vitreous and/or retinal detachment. We can provide you with educational brochures for your family if you would like.

    



Macular Degeneration

The macula is a small area in the retina at the back of the eye that allows you to see fine details clearly and perform activities such as reading and driving. Macular degeneration is the deterioration or breakdown of the macula. It reduces vision in the central part of the retina, however, does not affect the eye's side or peripheral vision. Patients with wet macular degeneration often require consultation with a retina specialist. There are new treatments including Avastin & Lucentis which have revolutionized care.

MACULAR DEGENERATION: FREQUENTLY ASKED QUESTIONS

Kent Crews M.D.
 & Arthur Korotkin M.D.



1) What is the macula?
   

Your eye is designed similarly to a photo camera. The back of the eye is lined by the retina, which is analogous to the "film" in a camera. The center of the retina is called the macula, which is responsible for your central vision. Central vision is important in reading, driving, recognizing faces and most other essential visual functions.



2) What is Age-Related Macular Degeneration?
   

Age-Related Macular Degeneration (also known as AMD or ARMD) is a process of degradation and damage that occurs in the macula. It is linked with age as well as genetic and environmental factors. For instance people of Northern European ancestry and smokers are more likely to have worse AMD. It is one of the most common causes of vision loss in people over the age of 60.



3) What are the types of AMD?
   

There are generally two types of AMD: dry and wet (also known as non-exudative and exudative). The dry type, which accounts for about 90% of all AMD, may or may not affect your vision. When it does affect your vision, the worsening of vision is generally slower and milder. There is a sub-type of dry AMD called Geographic Atrophy, which may result in gradual but severe loss of central vision.
    The wet type of AMD, which accounts for about 10% of all AMD, tends to be more rapidly progressive with a more severe loss of central vision.



4) Does AMD only affect one eye?
   

AMD tends to affect both eyes, but may not affect them equally in terms of vision loss.



5) Can I have more than one type of AMD?
   

Yes. Generally, wet AMD begins as dry and later becomes wet. If you have dry AMD in both eyes, you may develop wet AMD in one or both eyes. Once one eye develops wet AMD the risk of the other eye developing wet AMD is about 10-15% per year.



6) Are there treatments available for dry AMD?
   

Yes. While dry AMD tends to cause a relatively lesser degree of visual impairment in most people there is currently only one treatment proven to decrease risk of vision loss. For people with high risk dry AMD, such as intermediate AMD in both eyes or advanced AMD in one eye, taking AREDS vitamins may help reduce the risk of vision loss by about 20-25% in dry AMD. (Please see separate AREDS information page for more information.) There are a number of other treatments under investigation but it will be some time until any are commercially available, if they are found to be effective.
The following *high-dose supplements are recommended:

Vitamin C 500 mg  Vitamin E 400 IU  Beta Carotene 15 mg 

Zinc (zinc oxide) 80 mg   Copper (cupric oxide) 2 mg

*available in many over the counter multivitamin formulations


7) I have dry AMD what is the plan for treatment?
   

The best available evidence currently recommends that if you smoke you should quit. If you are not a smoker, you should take AREDS supplement daily to reduce your risk of vision loss. Your retina should also be examined periodically to catch appearance of new wet AMD, which can then be treated. You should be aware of symptoms of wet AMD.



7b) Why can't smokers take AREDS supplement?
   

AREDS supplement contains several ingredients, one of which is high-dose vitamin A in the form of beta carotene. There are other large studies that demonstrated a significantly increased risk of lung cancer in smokers who use high-dose vitamin A in the form of beta carotene. Thus, most doctors do not recommend use of AREDS supplement in smokers.



7c) Do smokers have any treatment options for dry AMD?
    

The AREDS supplement contains Zinc and Copper. They have been studied as part of the original AREDS study and found to be beneficial in helping reduce risk of vision loss. While the full AREDS formula is more beneficial, taking just Zinc and Copper supplements may be of benefit. (Please see AREDS information sheet for details.)



7d) What about lutein, zeaxanthein, and fish oil?
   

Lutein and zeaxanthein were not studied in the original AREDS trial and are thus not currently included in the recommended vitamin formulation for dry AMD. However, there is some evidence, albeit not proven in large well-conducted studies, that lutein, zeaxanthein, and possibly fish oil may play a role in reducing your risk of progression. We currently recommend taking those supplements in addition to the AREDS formula.



8) What are the symptoms of wet AMD?
   

New distortion of straight lines on an Amsler grid or elsewhere, blurry vision, or decline in vision. If you experience any of those you should call your eye doctor.



9) Are there treatments available for wet AMD?
   

Yes. One of the most exciting advances in eye care in recent years has been the advent of a new class of medications able to treat wet AMD. Prior to these medications wet AMD meant eventual loss of central vision and the treatments were geared towards slowing vision loss, not improvement or stabilization of vision. The new medications called anti-VEGF medications help stabilize vision in vast majority of people with wet AMD and improve vision in a smaller proportion of patients.



10) What makes wet AMD wet? Why is it called that?
   

Wet AMD gets it's name from growth of new abnormal blood vessels under the macula. These blood vessels cause problems because they leak fluid and bleed, causing damage to the macula and decreasing vision.



11) What is the course of wet AMD if no treatment is given?
   

The natural history of wet AMD (course if no treatment is given) is severe loss of central vision over a period of several months to couple of years. This is due to continued leakage and bleeding of abnormal blood vessels under the macula. After a period of time scar tissue forms around these vessels. When scar tissue forms current treatments will not be effective.



12) What should I do if I have one or more close family members who have macular degeneration?
   

If you have one or more close blood relatives with AMD (mother, father, brother, sister, etc) you are more likely to develop macular degeneration. A regular eye exam that includes detailed examination of the retina with your pupils dilated is recommended to detect any possible early disease. You are unlikely to develop significant AMD prior to age 50 or 60.



13) I have a friend who is experiencing a loss of vision, is it macular degeneration?
  

While macular degeneration is a relatively common condition, there are many other conditions that can cause a decline in vision. Most of these conditions, such as cataract, are treatable. The only way to diagnose a condition is by having an eye exam with your eye doctor.

Diabetic Retinopathy

The retina is the nerve layer at the back of the eye that senses light and sends images to the brain. If you have diabetes mellitus, your body does not use and store sugar properly. High blood-sugar levels can damage blood vessels in the retina. Through a dilated examination, your ophthalmologist can diagnose any diabetic retinopathy and determine if further testing or treatment is needed. Maintaining normal blood sugar levels is key to preventing further damage to your retina. More complex cases may require a consultation with Dr. Kent Crews, our board certified, fellowship trained retina specialist.

Geographic Atrophy
: Frequently Asked Questions



Kent Crews, M.D. & Arthur Korotkin, M.D.



1) What is Geographic Atrophy?


Geographic atrophy is the most severe form of dry macular degeneration (AMD). It affects approximately 10% of patients with dry AMD. Basically, the supporting cell layers under the macula die off. The visual cells in the retina cannot survive without this support, so they start to die off slowly as well.



2) What are the risk factors for Geographic Atrophy?


This condition is more frequent as people reach the late 70s. By the mid-80s, it is quite common. A prior history of smoking and high blood pressure may contribute to this process.



3) How severe is the vision loss? 


Advanced geographic atrophy can lead to severe loss of central vision. A patient's ability to read, drive, and watch TV can be lost. Moderate geographic atrophy can lead to “dead spots” in vision, but this is usually not bothersome if the center of the macula is not involved. Most patients start off with small patches of geographic atrophy. These slowly expand until they join, and then the macula is destroyed. 



4) Is there any treatment? 


Unfortunately, there is no medical treatment to halt or slow this process. We think eye vitamins, lutein, zeaxanthin, sunglasses, not smoking, and good blood pressure may help.



5) Do Avastin or Lucentis help patients with geographic atrophy?


Again, there is no medical treatment for this disease. Some patients have wet macular degeneration as well, and this part of the disease may be treatable with injections.



6)  Will I go completely blind from geographic atrophy?
   

The answer to this is a definite "NO". Geographic atrophy affects the central vision only. The peripheral vision is preserved, allowing a patient to see well enough to take care of themselves.

Testimonials

Peter J. Standard, MD
Urologist , Fort Collins, CO