Published: 24 August 2024

If you are seeing the 3 F's, you might have a retinal tear or detachment and you should have an eye exam quickly. The 3 F's are: Flashes - flashing lights. Floaters - dozens of dark spots that persist in the center of your vision. Field cut – a curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision. The retina is the nerve tissue that lines the inside back wall of the eye and if there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss. If you have a new onset of any of the three symptoms above, you need to get in for an appointment fairly quickly (very quickly if there are two or more symptoms). If you have just new flashes or new floaters you should be seen in the next few days. If you have both new flashes and new floaters or any field cut, you should be seen in the next 24 hours. When you go to the office for an exam, your eyes will be dilated. A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the outside of the eye to examine the peripheral retina. Some people have a hard time driving after dilation--since the dilating drops may last up to 6 hours, you may want to have someone drive you to and from your appointment. If the exam shows a retina tear, treatment would be a laser procedure to encircle the tear. If a retinal tear is not treated in a timely manner, then it will progress into a retinal detachment. There are four treatment options for retinal detachment: Laser. A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment. Pneumatic retinopexy. This is an office-based procedure that requires injecting a gas bubble inside the eye. The patient then needs to position his or her head for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is then performed around the retinal break. This procedure has about 70% to 80% success rate, but not everyone is a good candidate for a pneumatic retinopexy. Scleral buckle. This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure. Vitrectomy. In this surgery, the gel - the vitreous inside the eye - is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place. The gas bubble will slowly dissipate over several weeks. Sometimes a scleral buckle is combined with a vitrectomy surgery. Prognosis The final vision after retinal detachment repair is usually dependent on whether the center of the retina - called the macula - is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that anyone with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome. Article contributed by Dr. Jane Pan

Published: 17 August 2024

When soft contact lenses first came on the scene, the ocular community went wild. People no longer had to put up with the initial discomfort of hard lenses, and a more frequent replacement schedule surely meant better overall health for the eye, right? In many cases this was so. The first soft lenses were made of a material called HEMA, a plastic-like polymer that made the lenses very soft and comfortable. The downside to this material was that it didn’t allow very much oxygen to the cornea (significantly less than the hard lenses), which bred a different line of health risks to the eye. As contact lens companies tried to deal with these new issues, they started to create frequent-replacement lenses made from SiHy, or silicone hydrogel. The oxygen transmission problem was solved, but an interesting new phenomenon occurred. Because these were supposed to be the “healthiest” lenses ever created, many people started to overwear their lenses, which led to inflamed, red, itchy eyes; corneal ulcers; and hypoxia (lack of oxygen) from sleeping in lenses at night. A new solution was needed. Thus was born the daily disposable contact lens, which is now the go-to lens recommendation of most eye care practitioners. Daily disposables (dailies) are for one-time use, and therefore there is negligible risk of overwearing, lack of oxygen, or any other negative effect that extended wear (2-week or monthly) contacts can potentially have. While up-front costs of dailies are higher than their counterparts, there are significant savings in terms of manufacturer rebates. In addition, buying contact lens solution is no longer necessary! While some patient prescriptions are not available in dailies, the majority are--and these contacts have worked wonders for patients who have failed with other contacts, especially those who have dry eyes. Ask your eye care professional if dailies might be the right fit for you. Article contributed by Dr. Jonathan Gerard