Treatments We Offer

At Highland Retina Associates, we focus on preventing, suspending or reversing vision loss caused by conditions affecting the retina. We offer the following latest treatment options to help preserve your precious sight.

In the Office

In the Operating Room


In the Office

Intraocular Injections/Periocular Injections

Intraocular or periocular injections are treatment methods used when a medication is required in a higher dose than is available via eye drops or pills. Before an injection, the patient will be given a medication to numb the eye and minimize any discomfort during the procedure. Additionally, the eye will be carefully cleaned with an iodine solution to reduce the risk of infection. After numbing and cleaning the injection site, a small needle is used to deliver the medication to the eye. Various medications can be injected intraocularly or periocularly, including Avastin, Eylea, and Triamcinolone Acetonide, and Ozurdex.

Intravitreal/periocular corticosteroid injections are often used for the treatment of macular edema and other ocular inflammatory diseases. Corticosteroids, such as Triamcinolone Acetonide and Ozurdex, are naturally-made hormones found within the body. These contain the most potent anti-inflammatory compounds available. It is important to closely monitor the use of corticosteroids because prolonged exposure can cause high intraocular pressure in some people and induce cataract formation.

Intravitreal injections using anti-VEGF drugs are most commonly performed in the treatment of “wet” age-related macular degeneration (AMD), which is characterized by the abnormal growth of blood vessels underneath the retina. If left untreated, “wet” AMD will eventually lead to formation of a macular scar and result in permanent vision loss. Recently, a chemical called vascular endothelial growth factor, or VEGF, was found to be associated with the growth of abnormal blood vessels. This ultimately lead scientists to develop several anti-VEGF drugs aimed at limiting the leakage of fluid and blood from these abnormal blood vessels. Additionally, anti-VEGF therapies have shown to be beneficial in slowing vision loss in patients with other retinal diseases that involve abnormal blood vessel growth or swelling, such as diabetic retinopathy, retinal vein occlusion and macular edema.

There are three primary anti-VEGF drugs that are injected directly into the eye to slow down the growth of the leaking blood vessels: bevacizumab (Avastin), aflibercept (Eylea), and ranibizumab (Lucentis). Avastin, Eylea, and Lucentis have proven very successful in treating patients with AMD and other ocular diseases involving abnormal blood vessel growth; however, these drugs do not cure the diseases. Anti-VEGF drugs are a treatment, not a cure, and most patients require monthly injections. The length of treatment will be decided on after evaluation and discussion with your retina specialist. These monthly injections can last anywhere from four to six months, to indefinitely in some cases. Anti-VEGF injections are administered in an office setting by your retina specialist, and patients are thoroughly numbed prior to the injection. It is important to note that as with any type of medical treatment or surgical procedure, there are potential risks including serious infection (endophthalmitis), clouding of the lens (cataract), retinal detachment (separation of the retinal tissue from the back of the eye), and elevated eye pressure (glaucoma). Please be sure to call your retina specialist immediately if you experience a major decline in vision, loss of vision, or severe pain after the injection. However, it is normal to experience a mild amount of discomfort in the injected eye for up to a week, such as feeling like there is a grain of sand in the eye. Additionally, other common side effects include mild redness of the eye and a red blood spot at the injection site, both of which should subside within a few days. Any mild discomfort can often be resolved with frequent use of artificial tears, Tylenol, and/or the indicated ointment/eye drops prescribed by your retina specialist.


Retinal laser: Laser Photocoagulation and Subthreshold MicroPulse Laser

Laser surgery can be used to treat many different diseases of the retina, and it can be delivered to the retina in a number of different ways depending on the desired treatment. Lasers produce beams of light which are then converted to heat, which can be used to destroy abnormal blood vessels in the eye. Additionally, the heat from the laser can also be used to attach the retina to the back of the eye in the event of a retinal tear or hole.

Subthreshold or sub visible laser photocoagulation allows for tissue-sparing laser treatment without visible retinal scarring. MicroPulse laser divides the laser emission into bursts of short repetitive pulses that last for microseconds, allowing for significant cooling between these ultra-short pulses. The MicroPulse laser contrasts with traditional conventional continuous wave laser, in which the laser energy is delivered in milliseconds. The traditional laser causes thermal reaction and scarring.

During laser therapy, the patient will remain fully awake but will receive numbing medication to ensure there is no discomfort. Laser surgery is essentially painless; however, some people find the bright lights from the laser to be uncomfortable. After laser surgery patients usually have little to no pain at all. However, if a more extensive laser was used, some discomfort may occur and can be managed with Tylenol, ibuprofen, or another over the counter pain reliever. Additionally, it is normal to have mild blurred vision for several hours after the first laser treatment. Depending on the type of laser surgery, your retina specialist may restrict certain activities for a short period of time following the treatment to avoid any damage to the eye. There are several advantages to laser surgery over conventional surgery. A few advantages include the fact that there is no risk of infection from the laser, it is a very quick surgical procedure (5-15 minutes), the surgery can be performed in an outpatient/office setting, and the patient remains fully awake eliminating any risks associated with anesthesia. Please remember to call immediately if you are experiencing an increased amount of pain or a decrease in vision.


Pneumatic Retinopexy

Pneumatic retinopexy is a treatment method performed for certain types of retinal detachments. Retinal detachment happens when part of the retina detaches from the inner wall of the eye. If not treated in a timely manner, a retinal detachment can lead to permanent vision loss. The pneumatic retinopexy procedure involves injecting an expanding gas bubble into the vitreous cavity. The injected bubble will be positioned so that it will float over the detached area, pushing it against the back of the eye. The doctor will then use a freezing device and/or laser to seal the retina against the wall of the eye. This procedure is most often preformed in an office setting, and the patient is numbed but fully awake throughout. For best results, it is important that the patient maintains the appropriate head position for several days. Additionally, patients with a gas bubble in the eye should avoid traveling in an airplane, any significant changes in altitude, and avoid anesthesia with nitrous oxide (laughing gas) due to the risk of severe pain and vision loss.


Cryotherapy

Cryotherapy involves the application of a very cold probe to the outside of the eye. Like laser surgery, cryotherapy can be used to seal abnormal blood vessels or retinal tears. Cryotherapy is often performed in conjunction with pneumatic retinopexy to seal and repair detached retinas.


In the Operating Room

Vitrectomy Surgery

The vitreous is the clear gel-like substance that fills the inside of the eye. Vitrectomy surgery is a procedure that is used to remove the vitreous gel from the eye. This procedure may be used to treat conditions such as a severe eye injury, diabetic retinopathy, retinal detachments, macular pucker and macular holes.

During a vitrectomy, tiny incisions will be made in the sclera (the white part of the eye). A microscope and microsurgical instruments will be used to remove the vitreous and repair the retina. This procedure may be used in combination with laser treatment to reduce future bleeding or to fix a tear in the retina. Additionally, specialized saline, gas, or silicone oil bubble may be placed in the eye to help hold the retina in place as it re-attaches to the back of the eye. Over time, the gas bubble will disappear and naturally be replaced with normal eye fluid. Silicone oil would need to be removed with another surgery. After the surgery, it is important to remember to keep your head facing downward or in the position designated by your physician for up to several weeks. Maintaining the correct position helps to ensure that the bubble stays in the correct place, and helps prevent other medical issues. It is normal to experience poor vision after the surgery, but vision should improve as the bubble dissolves or is removed later on. Likewise, it is important to note that the outcome of your vision after surgery depends on the degree of damage that the original disease has caused to the retina before the surgery, and how much your body can heal once the normal retinal anatomy is restored. A vitrectomy is usually done in an operating room, and the patient is placed under monitored anesthesia care.


Scleral Buckle

A scleral buckle is a piece of silicone or semi-hard plastic that is placed around the outside of the eye. The scleral buckle is placed securely under the muscles that control the movements deep behind the eyelids. The scleral buckle typically remains permanently in place on the outside of the eye, and it is not readily visible by you or others. Scleral buckles are typically used in the repairing of retinal detachment, either alone or in combination with vitrectomy surgery. This procedure is done in an operating room, and the patient is placed under monitored anesthesia care or general anesthesia. A freezing probe might be used to seal the retinal tears. Sometimes the fluid under the detached retina is drained to allow the retina to settle into its normal position against the wall of the eye.


Highland Retina Associates

  • Highland Retina Associates - 1530 N. 7th St., #502, Terre Haute, IN 47807 Phone: (812) 281-2608