Vitreoretinal and Laser Surgery, Pharmacologic Retinal Treatment
Comprehensive retinal diagnostic and treatment solutions to meet your needs
Advanced Diagnostic Equipment
The Retina Group of New York utilizes state-of-the-art diagnostic equipment including OCT (Ocular Coherence Tomography), Fluorescein and ICG Angiography, Automated Visual Field testing, Digital Color Photography, ultrasound, Farnsworth-Monsell and Anomaloscopic Color Vision Testing, Dark Adaptometry, EOG (Electro-oculography), Multifocal (mfERG) and Ganzfeld ERG. We are capable of diagnosing all types of retinal conditions. Dr. Maisel represented the Foundation to Prevent Blindness helping to develop the ANSI standards for the ophthalmic industry for diagnostic testing for visual acuity, tonometers, and intraocular lens implants.
There are many aspects of vision besides visual acuity at both distance and near measured with standardized eye charts.
- Contrast acuity
- Color vision
- Night vision
- Peripheral vision
- Blind spots
Establishing the Ocular Diagnosis or Evaluation the effect of Systemic Diseases on the Eye
The Retina Group of New York has the experience and equipment to diagnose a remarkable number and full host of ocular and systemic diseases from our examinations and testing. Although we only treat retinal conditions, we perform full evaluations on all patients looking for the effect of known conditions and medications on the visual system and occasionally finding undiagnosed problems. The eyes are not just the window to the soul in literature but figuratively. Many diseases can have ocular findings. We can detect early systemic diseases and we frequently are the first to diagnose neurologic, metabolic, hematologic, cancer, cardiac, infectious, inflammatory and autoimmune diseases. Pregnancy can also cause acceleration of diabetic retinopathy. Drugs can have ocular side effects. Myasthenia can cause eyelid drooping or double vision. Identification of an asymptomatic Hollenhorst plaque in a retinal blood vessel or retinal blood vessel inflammation can help prevent a stroke. We have been the first to identify in our patients a wide range of treatable cancers presenting with ocular findings including multiple myeloma, leukemia, lymphoma, and meningioma. Metabolic diseases of which patients have been unaware have included sickle cell disease, diabetes mellitus and thyroid abnormalities. Autoimmune, infectious and inflammatory disorders that can present with eye problems include lupus, Sjogren's syndrome, Lyme disease, syphilis, toxoplasmosis, toxocara canis, parasites, AIDS, cat scratch, Bechet's disease, severe sinus infections and trachoma.
Amsler Grid Testing
The Retina Group of New York recommends that patients monitor their central vision with an Amsler grid and report any abnormalities or changes promptly. Abnormalities such as missing spots, distortion or blotchy vision may indicate one of 50 macular problems.
You can easily test your macular function with this self-administered test.
• Wear your reading glasses and look at the grid at the normal reading distance (approx. 16-18 inches).
• Cover one eye.
• Focus on the black dot in the center of the grid and do not move your eye.
• Check whether all lines of the grid are straight or whether they are distorted, blurred or missing in any areas of the grid.
• Repeat the process with the other eye.
The test should be repeated at regular intervals (daily or at least every week).
Ocular Coherence Tomography (OCT)
The Retina Group of New York utilizes state-of-the-art diagnostic Spectral Domain Heidelberg Ocular Coherence Tomography (OCT) to obtain high resolution images of the retina and underlying layers using low power, safe multicolor laser light through the pupil. High resolution images are obtained in seconds that are helpful in diagnosing and managing many conditions such as diabetic retinopathy, macular degeneration, retinal vein occlusions, cystoid macular edema and central serous retinopathy. All images are displayed on large monitors and explained so that patients can readily see the progress of their treatments. [more...]
Fluorescein angiography is an eye test that uses a teaspoon of a special yellow vegetable dye injected into a vein usually on the arm. The dye quickly reaches the blood vessels in the retina. An imaging system with a low power safe laser illuminates the blood vessels in the retina and choroid. These are the two layers in the back of the eye. [more...]
What Abnormal Results Mean
If blockage or leakage is present, the pictures will map the location of the problem and may identify an opportunity for possible treatment. An abnormal value on a fluorescein angiogram may be due to:
•Blood flow (circulatory) problems, such as blockage of the arteries or veins
•Diabetic or other retinopathy
•High blood pressure
•Inflammation or edema
•Microaneurysms -- enlargement of capillaries in the retina
•Swelling of the optic disc
Indocyanine Green Angiography (ICG)
The Retina Group of New York utilizes state-of-the-art diagnostic laser scanning ophthalmoscopes to image the retina and choroidal circulation. Following an intravenous injection of a fraction of a teaspoon of a green dye in your arm vein, a low power invisible laser is used to scan the retina and capture high resolution digital images of the retina lining the back wall of the eye. As the dye fills the blood vessels of the two circulatory systems of the eye, the images immediately appear showing abnormal blood vessels or patterns characteristic of many ocular conditions such as macular degeneration, central serous retinopathy and macroaneurysms. The low powered infrared laser can often see through cataracts and blood that fluorescein angiography cannot visualize and confirm suspected pathology. All images are displayed on large monitors and explained so that patients can readily see the progress of their treatments.
Digital Color Photography
Color photographs of the eye help us document and follow may retinal problems.
- Diabetic retinopathy
- Macular degeneration
- Branch and central retinal vein occlusions
- Glacoma optic nerve cupping
- Optic atrophy
- Choroidal melanoma
- Macular hole
- Macular pucker
- Retinal Detachment
Ophthalmic ultrasound is helpful in identifying and following certain types of eye conditions. It is commonly used for:
- Retinal detachment
- Retinal evaluation with media opacities such as corneal opacities and cataract
- Vitreous hemorrhage
- Ocular tumors
- Dislocated cataracts and IOLs
- Choroidal detachments
- Foreign bodies
Automated Visual Field testing
We look to see if defects or scotomas appear in the peripheral or central vision and how these change over time. The patterns may indicate macular disease, retinal vascular disease, retinal detachment, glaucoma or neurologic conditions. Patients may have 20/20 acuity but cannot read because of blind spots next to the center of vision. The test just takes approximately 5 minutes and each eye is tested separately to see if a brief visual stimulus is present in the center or peripheral visual field while the patient responds by clicking a button.
Color Vision Testing
The human eye is a remarkable evolutionary achievement and humans are one of the few animals capable of color vison that we can test and quantify with several instruments. Farnsworth-Monsell color test objects are arranged in chromatic order by patients under standardized lighting conditions. Anomaloscopic testing compares the ability to discriminate and match colors and Ishihara color dot testing is well known to all elementary students. While the total inability to perceive colors, or color blindness, is quite rare, about 10% of males have abnormal perception of color usually inherited from their mother. Certain eye conditions and medications can also alter our color perception. Knowing your have a color perception problem may alter your career choice or has been known to influence the style of artists who see less blue as they develop cataracts.
Color vision may be abnormal from birth (congenital) or become abnormal (acquired) due to conditions such as:
- Chronic illnesses : Alzheimer’s disease, diabetes mellitus, glaucoma, leukemia, liver disease, chronic alcoholism, macular degeneration, multiple sclerosis, Parkinson’s disease, sickle cell anemia and retinitis pigmentosa.
- Trauma and accidents or strokes that damage the retina or affect particular areas of the brain or eye.
- Medications such as antibiotics, barbiturates, anti-tuberculosis drugs, high blood pressure medications and several medications to treat nervous disorders.
- Industrial or environmental chemicals such as carbon monoxide, carbon disulphide and some containing lead.
- Age – people over 60 years of age
We are able to see in both bright light and dim light with dark adaptation. We can measure the rate at which the eye adjusts to detect dimming light over 20 minutes. This gives us a normal dark adaptation curve or can identifies hereditary or acquired causes of abnormal night vision or nyctalopia. If you can't see the people around you in the movie theater after 20 minutes you may have a problem.
Common Causes of true Nyctalopia include:
- Retinitis pigmentosa
- Retinal detachment
- Oguchi disease
- Pathological myopia
- Dense Cataracts
- Sorsby's retinal dystrophy
- Vitamin A deficiency
Whole-field scotopic sensitivity (threshold) testing provides clinically beneficial information in a wide variety of ophthalmic conditions. Dark adaptometry is useful in the diagnosis and management of retinal degenerations, senile miosis, high myopia, vitamin A deficiency, and other night blinding conditions. It has also been shown to be useful in the early detection of glaucoma.
Eyes generate electrical signals in response to light and these can be captured using thin hairlike electrodes the way we capture the electrocardiogram or EKG. We utilize different patterns and frequency of flashes or flickers of light of different intensities to separate out isolated areas of the retina such as the central macula, or day time vision, from the cones or the nightime vision generated by the rods. We can look at different layers of the retina altered by conditions, or isolate the response of the optic nerve or the whole eye signals with different tests. Some tests are very precise and the most sentive indicators of early drug toxicity such as Plaquenil and allow us to use these medications safely. Others indicate rare hereditary diseases that can run in families. The tests are often repeated so we can estimate the rate of change or the effect of treatment. These include
The mfERG has been well documented to aid in the diagnosis and monitoring of retinal disorders, hereditary diseases and drug toxicity. Clinical Applications
- Retinotoxic Drug Screening: mfERG is the preferred functional test for plaquenil screening and has been shown to detect toxicity before other methods.
- Age-related Macular Degeneration: Physicians can now visualize functional degradation that has been shown to predict drusen progression.
- Diabetic Retinopathy: Functional delays seen with mfERG testing can precede structural damage, allowing physicians to intervene in patient care before permanent damage occurs
Retinal diseases producing an abnormal EOG will usually have an abnormal ERG too which is the better test for analysis of scotopic and photopic measures. However, a particularly good use for the EOG is in following the affects of high dosage treatment with antimalarials such as chloroquine and plaquenil before the vision is severely affected and the ERG is abnormal. There is considerable variation in the fundus appearance in Best’s disease that has an abnormal EOG.
- Best vitelliform macular dystrophy
- Stargart macular dystrophy
- pattern dystrophies
- membranoproliferative glomeronephritis
- ectodermal dysplasia, ectrodactyly, and macular dystrophy, EEM syndrome
- Retinitis pigmentosa
- Rod-cone dystrophies
- Acquired cone and cone-rod dystrophies
- Oguchi disease
- Fundus Albipunctatus
- gyrate atrophy
- diffuse choroidal atrophy
- diffuse chronic chorioretinal inflammation
- hypertensive retinopathy
- retinal detachment
- silicone oil
- chloroquine and hydroxychloroquine toxicity
- retained intraocular iron foreign bodies (siderosis bulbi)
- progressive high myopia
- choroidal malignant melanoma
What is electroretinography (ERG)?
Electroretinography (ERG) is an eye test measuring the electrical response to light flashes, similar to the way the electrical signals from the heart are recorded with an EKG. It is used to detect abnormal function of the retina, the light-detecting portion of the eye. Specifically, in this test, the light-sensitive cells of the eye, the rods and cones, and their connecting ganglion cells in the retina are examined. An ERG is useful in evaluating both inherited (hereditary) and acquired disorders of the retina. An ERG can also be useful in determining if retinal surgery or other types of ocular surgery such as cataract extraction might be useful. [more...]
Pattern Visual Evoked Potential - PVEP
The VEP can be helpful for evaluating and following many ocular conditions including:
- Optic neuropathy
- Optic neuritis
- Ocular hypertension
- Toxic amblyopia
- Leber hereditary optic neuropathy
- Aluminum neurotoxicity
- Manganese intoxication
- Retrobulbar neuritis
- Ischemic optic neuropathy
- Multiple Sclerois (MS)
- Tumors compressing the optic nerve such as optic nerve gliomas, meningiomas, craniopharyngiomas, giant aneurysms, and pituitary tumors