GLAUCOMA –ELEVATED INTRAOCULAR PRESSURE
GENERAL OPHTHALMOLOGICAL QUESTIONS
LASER VISION CORRECTION
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I often have small dots and flies, //the spider web that moves as I move the eye in the field of vision. Is this dangerous? They terribly bother me, can this be treated or operated?
The spots and spider web or flies are the most common symptoms of vitreous degeneration. Vitreous is a gel-like matter that fills the eye apple. With time it loses its fluidity, i.e. simply said, it shrinks and its irregularities are seen in the form of flies, dots, etc. This is a natural degenerative process, which mostly occurs with elderly persons, but with the young people too with shortsightedness it occurs much earlier. It does not require any treatment but just the usual monitoring of the patient. In some cases, if the patients are particularly bothered with it, an in-depth operation of vitreous removal may be done, the so-called vitrectomy. It is noteworthy that even though this is a normal process in the eye, these patients should be monitored because it is possible that during collecting and removal of the vitreous gel/humor from the eye bottom a rupture is created on the eye bottom, and there is a danger of ablation of retina, which is an emergency situation and requires an operation. Besides the usual flies or spider web in front of the eyes, the symptoms indicating this, include a sudden increase in their number, flashes during the eyes closed or at dusk or a cover that covers the field of vision. In such cases an ophthalmologist should be immediately contacted – if there is a rupture, he will treat it with laser on an outpatient basis, that is to say, in the worst case of retina ablation, plan an urgent surgical procedure.
I am 65 years old and have noticed the worsening of vision and waving of the lines before one eye when I do the crosswords or watch the TV. What is this about?
Waving of the lines represents the disease of macula, the yellow spot which is the center of the vision in eye bottom. There are too forms of macular degeneration, dry and wet. The dry form advances more slowly, but can be slowed down by taking vitamin complexes to prevent it from passing to the wet form. The wet degeneration may be treated with the injections of Avastin or Lucentis, the so-called VEGF therapy that decreases the permeability of sick blood vessels and prevents accumulation of the fluid in macula.
I have been diagnosed diabetes since 5 years ago. In the last examination it was determined that I had initial changes and bleeding in the eye bottom veins. What is the cost and what does the complete examination for a person with diabetes include?
Besides the standard check of visual acuity and measuring the intraocular pressure, with every person with diabetes we dilate the pupils for a detailed examination of eye bottom (300kn). If indications exist, we do the ultrasound examination of the eye and OCT for the evaluation of microstructure in the back of the eye, which is additionally charged (100, i.e. 500kn). Sometimes it is necessary to do the fluorescein angiography (FAG), an examination by which, by way of contrast, we can see the place where the small veins leak (600kn). Further therapy is done depending on the test results and in consultation with the doctor.
I have been treated for diabetes and have been on insulin for 10 years. I have done laser two times on both eyes, despite that my vision is still deteriorating. Has the laser damaged the eye?
Diabetes is a chronic and progressive disease that damages the blood vessels/veins. With regularly applied laser photocoagulation the places through which the fluid and the blood leak are sealed and further deterioration of the disease is prevented. However, the laser therapy cannot heal the underlying disease. If not regulated well, diabetes continues damaging the eyes despite the laser treatment.
I have been diagnosed with wet macular degeneration. I was proposed the treatment with medicaments Avastin and Lucentis. What is their cost and what is the difference between these medicines?
Avastin and Lucentis are the medications that are applied in treatment of the wet form of macular degeneration. They belong to the group of antibody anti VEGF (vascular endothelial growth factor) and decrease the permeability and the growth of new blood vessels. Avastin was originally developed for treatment of metastatic colorectal cancer, but in the ophthalmology is in the so-called off label use throughout the world. Its cost is 1500 kn. Lucentis was developed for the eye application only, and is a smaller molecule in composition compared to Avastin; its cost is 8400kn. So far no difference has been established in their effect, and the studies that compare both medicines are currently underway. It is important to know that the patient who wishes to do so, may at any time pass from one medicament to another during the treatment.
I was diagnoses with the thrombosis of eye veins a month ago. My vision is very weak. Is there a medicine for that?
Depending on the extent to which thrombosis is present, the symptoms and the recovery vary. During the eye vein thrombosis, most frequently the accumulation of the liquid and swelling (edema) of the macula, i.e. yellow spot occur. The standard therapy of this disease today is anti VEGF therapy with Avastin, an injection that is applied every 6 weeks in the eye. The earlier the therapy starts, the bigger are the chances for recovery. Something new both in the world and the Svjetlost Clinic is a new injection of depot preparation Ozurdex, a slow-release corticosteroid which has the action for as long as 6 months.
I am 33 years old and I have noticed a dark spot that is stationary before the eye in the centre of the field of vision with curvature of the lines.
Given the age it is probably the central serous retinopathy (CSR). It most commonly occurs with young men. The cause is not known, but, among the other, it is associated with the stress too. The therapy is supplemented with dorzolamide (Diamox) pills and diklofenak drops (Naclof), as the most common, but also with modifications. The disease usually passes by itself in a month without leaving any consequences on vision. However, in some cases, a chronic character of the disease is also possible, so then a more invasive therapy is applied (laser, Avastin) because in such cases the disease may leave more permanent vision damage.
I am 60 years old, I have had a cataract surgery, however, the vision on the left eye is still as weak as before the operation. I was diagnosed with cellophane maculopathy, and was advised to undergo vitrectomy. What is this about and will my vision be improved?
This is also one of the diseases of the macula, whereby the membrane is thin and with its appearance reminds of cellophane (hence the name), it is pulled over the macula, stretches the tissue and thus the vision deteriorates. The only possible treatment is vitrectomy whereby the back of the eye is accessed through the small holes on the sclerotic coat of the eye and the membrane is peeled from the macular surface with microsurgical instruments. Restoration of the visual acuity depends on the length of the disease, the shorter it is, the bigger are the chances for full restoration of visual acuity.
What is the difference between gas, oil and air which are placed as a tamponade after vitrectomy?
Air is usually applied in non-complicated operations such as removal of the blood from the eye with non-complicated diabetes patients, it usually lasts for a week or two, and then leaves the eye. Flying on a plane is not recommendable during the two weeks. Gas is applied with diabetes patients, non-complicated ablations, surface macula diseases such as, for example, macula rupture etc. It stays in the eye for a month. It is important to note that after such tamponades the patient cannot see as long as gas or air is in the eye. He/she should not fly on the airplane for a month. The silicon oil is applied when strong tamponade is necessary, usually with severe ablations and diabetes patients. The advantage is that the patient is able to see immediately, and the disadvantage that the oil has to be removed in the second procedure. Also, of all the mentioned tamponades, oil has the biggest number of factors for development of the cataract, so sometimes the cataract surgery is recommended along with vitrectomy in the same procedure. Other complications, such as the elevation of the intraocular pressure, are also possible.
I have been diagnosed with retinitis pigmentosa. My vision is very weak, but I am still able to walk on my own. I have read about a bionic eye, could I be a candidate too?
We currently do not implant the bionic eye at Svjetlost Clinic and it is in the experimental program. However, we are in touch with the institutions abroad and we inform our patients about all the news. You are not a candidate for the time being. The patients for bionic eye should be completely blind with their optical nerve preserved. Bionic eye has so far given modest results such as differentiating light, darkness and shapes of objects.
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