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Clinical Evaluation

A careful and comprehensive retinal exam can be time consuming. Please prepare to be in our office for up to 3 hours on your first visit. This amount of time is necessary in order to perform all of the examinations and diagnostic testing that are needed to diagnose and treat your retinal condition. We ask that you provide our office with a good phone number where you can be reached prior to your appointment so our office can confirm your date and time, but also during the day of your appointment should you need to be reached more urgently.  ​ Upon check in by our front office staff, an experienced ophthalmic technician will speak with you and take your medical and ocular history. Please be prepared to provide the name and contact information (office location, fax number, etc.) of your other providers - such as your primary care physician, referring eye provider (the doctor that sent you to us), endocrinologist, cardiologist, etc. Many retinal conditions are relevant to your overall health and our doctors may need to reach out to your other providers for test results or additional care. After collecting this information, our techs will then test your vision, check our eye pressure, and dilate your pupils. Various diagnostic tests and ocular imaging recommended for your referring condition will be performed by a certified ophthalmic photographer. Once you are dilated and the imaging is complete your physician will speak with you and examine you. Additional diagnostic tests may be recommended to better visualize or diagnose your condition, and a treatment plan will be developed for you that day. If treatment is recommend, most treatments are done in the office that same day. ​ The after-effects of your examination, particularly pupil dilation, may make driving and reading difficult for several hours and cause your eyes to be unusually sensitive to light. Therefore, it is very important that you arrange to be accompanied to and from our office. We also advise you to bring your regular prescription glasses for vision testing, as well as a pair of dark sunglasses to wear after your appointment. ​ The doctors in our practice see sight threatening retinal emergencies. When emergencies are referred to us, our staff makes every effort to work these patients into the schedule. We realize this may inconvenience our regularly scheduled patients, but we also make every effort to see them as expeditiously as possible.  ​ While rare, we ask that all our patients understand and respect our staff, doctors, and most importantly, the individual patient being cared for, should this occur during your scheduled appointment time. We are more than happy to reschedule any patients who may not wish to wait, at their convenience, and we will notify you as soon as we know of any situation which may impact our schedule.  ​ If you have any additional questions feel free to call (860-646-7704), chat, or Send Us A Message.  ​ Insurance coverage information if available in the tab at the top of the page.

Flourescein Angiography (FA)

An FA is a type of dye-based imaging technology that highlights the blood vessels feeding the back of the eye over a continuous span of 5 to 10 minutes and is usually performed the same day as your evaluation. The dye is NOT contrast dye. It is an orange vegetable dye with no cross-reactivity to contrast. The dye is also safe in patients with heart, kidney, or liver disease. If you provider asks for an FA, a specially trained imaging technician will inject 1cc of dye into a superifical vein in your arm or hand. Afterwards, they will take a series of photos as the dye circulates throughout your body. Some patients may feels transiently nauseous or light headed from the dye injection. This usually only lasts a few minutes. The dye may make your skin appears slightly yellow for a few hours and can also turn urine orange for 12-36 hours, as your body clears the substance. None of this is alarming or dangerous. In extremely rare instances, a patient can have an anaphylactic reaction to the dye. Our team is well-suited to provide emergent care, should this occur. An FA is extremely useful for diagnosing cases of poor blood flow, diabetes, wet macular degeneration, ocular melanoma, and retinal vasculitis.

Intravitreal Injections (Eye Injections)

Our doctors will determine whether you may require eye injections to treat your condition. Rest assured, while this may be anxiety provoking for some, our team is excellent at providing you with an efficient and comfortable process. Our doctors perform hundreds of injections every week and our ophthalmic technicians are excellent guides on what to expect in person. The injection process will be explained to you in detail and you will be consented for the procedure, which will include any and all associated risks.  ​ After an eye injection, you will be able to see and go about your day. Most patients have mild blurry vision (remember you will be dilated also!) and some eye irritation. The eye may feel grainy, stingy, or sandy for a couple hours. At most - till the next morning. Some patients may notice a new floater in their vision for 24-48 hours, immediately after treatment, which should also self-resolve. The white part of the eye (called the sclera), may become bright red on occasion after an eye injection. Rarely, the redness can spread and even change color (red --> yellow --> purple). Besides the cosmetic element, this is not dangerous and will take about 1 week to resolve.  ​ We ask our patients to abstain from contact lens use, avoid direct tap water to the eye, hot tubs, saunas, swimming, or other dirty / dusty environments for 24 hours after an eye injection.  If you are have recieved an intravitreal injection and are having pain, reduced vision, or are concerned about what you may be experiencing please call 860 - 646 - 7704.

Laser Surgery

Laser surgery is usually an in-office procedure to treat multiple different conditions, such as retinal tears, retinal holes, and diabetes. Your doctor will speak with you in greater detail depending on the exact treatment required. Most laser treatment takes about 10 minutes and is performed the same day as your evaluation – this is especially true for retinal tears or other time-sensitive conditions – to prevent vision loss. Patients should expect to have 'dark' or 'blurred' vision immediately after the procedure for about 15 minutes. The eye may feel scratchy or irritated throughout the rest of the day. We advise against contact lens use for 24 hours afterwards. Laser surgery in retina is different than LASIK and you can resume your normal activities after leaving our clinic. During the procedure, a topical anesthetic is applied to help dampen any discomfort. Overall, while slightly uncomfortable (like being at the dentist), the procedure itself is generally pain free. In certain situations – like diabetes – multiple separate sessions may be required.

Pneumatic Retinopexy

A pneumatic retinopexy is a unique in-office procedure that can be used to treat certain retinal detachments in a minimally invasive manner. Your doctor will determine if you meet the criteria for a successful pneumatic retinopexy as opposed to surgery. All of our offices are capable of offering this procedure and pneumatic retinopexies can be perform immedietly, at the same time as your evaluation - which provides a very timely and efficient treatment for a vision threatening condition. A pneumatic retinopexy involves a local anesthetic to the eye which. Afterwards, your doctor will use cryotherapy (a freezing probe) on the outside of the eye to treat the areas of your retina that caused the retinal detachment ('retinal tears). Afterwards, the physician will inject a small gas bubble into the eye, which will help push the detached retina back into place. The entire procedure takes approximetly 15-20 min in total and you will be able to leave the office right after. The vision may be a little blurry and the eye may be very red and sore for a few days afterwards. You will be asked to position your head for 7 days in a certain way to ensure the gas bubble is pressing up against the correct area. Your doctor will describe this in more detail afterwards. Some doctors will ask you to take eye drops to reduce inflammation after the procedure. Most patients are seen one day after, then one week, then one month. If a pneumatic retinopexy does not work, an operating room procedure is the next step. Getting a pneumatic retinopexy does not preclude you from getting an operating room procedure, should that be needed, and is often the preferred first step due to its minimally invasive nature and good visual outcomes.

Retinal Surgery

Vitreoretinal surgery is often recommended for conditions such as epiretinal membrane, macular hole, vitreous floaters, dislocated lenses after cataract surgery, and more vision threatening conditions like severe diabetes or retinal detachment. Your physician will discuss which kind of surgery may be required for your specific condition and all the details involved during the consent process. Some, but not all of the information below will apply to your specific condition. Some surgeries are performed same day or within 48 hours, depending on the vision threatening nature of the condition. If you think you may have been referred for immediate surgery please do NOT eat or drink anything until your appointment with us is complete. This could delay surgical intervention if it is needed. All surgeries are performed in the ambulatory setting, meaning you come in and go home the same day. You will need someone to both bring you and take you home. If you DO NOT show up with a ride home, the hospital / surgery center will cancel your surgery. Most retina surgery is performed under monitored anesthesia care, which means no general anesthesia. Patients are placed in the a ‘dreamy’ state but are not 100% asleep. You breathe on your own. There is no tube down the throat – which reduces the risk of anesthesia and also significantly shortens recovery time. A local nerve block (like an epidural for the eye) is performed by your doctor to completely numb the eye ball during surgery. In rare situations, we do perform general anesthesia (tube), and this can be discussed with your doctor at your visit. You will have an eye patch over the operated eye for one night. It will be removed at your post operative appointment the next day. You will need eye drops for AFTER the patch is removed by your doctor will be prescribed. We often recommend getting your eye-drops before your post-operative appointment, but you can also pick them up the next day. Your doctor will give you an instruction sheet on the number of eye drops (usually 2-3 different types), their frequency (usually 4x per day), and duration (usually 1-4 weeks). Retina surgery is different than cataract surgery or LASIK surgery. While most of the time it is performed under similar anesthesia – it is often much longer, anywhere from 30min to 2 hours. All retina surgery is performed microscopically through very tiny ‘ports’ called trocars, which go into the white part of the eye (the sclera). Often, these are self-sealing wounds, but you also may require very tiny stitches on the eye which may feel like ‘sand’ or ‘an eyelash’ in your eye for a couple weeks. These dissolve on their own and do not need to be removed. In terms of pain - >99% of patients may be sore after surgery but do not have significant pain requiring more than over the counter Tylenol. On occasion your doctor may prescribe a strong NSAID like Toradol, or a low dose narcotic, but this is exceedingly rare, and at the discretion of your physician. Unlike cataract surgery you are NOT expected to see better immediately after surgery. Depending on the procedure required you may actually see worse than you did beforehand. Your doctor will describe what to expect, but in general, retina surgery requires weeks to months to recover your vision. This can be frustrating, but is a necessary part of the recovery process, in order to give your retina the opportunity to heal. For patients who require a ‘gas bubble’ to be placed in the eye – please note you CANNOT fly or enter high altitudes while the gas bubble exists. The gas can expand at high altitude and can cause a vision threatening increase in your eye pressure. Please let your doctor know if you plan to travel at any point after your surgery date. Most gas bubbles dissolve on their own over 4-10 weeks. For some conditions, you will be asked to ‘position’ yourself in a certain way, anywhere from 3 to 10 days after surgery. This is KEY to a successfully surgical outcome. This can range from strict face down positioning, reading position, laying on your left or right side, etc. The details will be described to you by your doctor after surgery and also written down in your post-surgical instructions. While we can often predict how you may need to position before surgery – this may change depending on what we see during your procedure. We ask our patients to do their best but understand that this is often the hardest part of the recovery process. You can take a break for 10-15 minutes per hour to stretch your neck, eat, go to the bathroom, etc. Please note – this positioning is also required at night and while sleeping. Your doctor will go into detail regarding limitations after surgery. In general, most patients take the first week off. We advise against swimming, hot tubs, saunas, working in or exposure to dirty or dusty environments, or tap water in the eye, during the first several weeks after eye surgery. We also ask patients to limit any excessive or jarring activity such as jumping jacks, running, or lifting weights >15 pounds repeatedly. You can shower after your surgery, but with water hitting the back of the head and using a wet washcloth for the face to avoid shower water getting into your eye. Use of the eyes, such as watching TV, computer work, or reading, will not affect the outcome of the surgery – though you may find that your eyes (even the non-surgical eye!) may feel sore, strained, or dry, after prolonged work. Please let us know if you require any documentation to be excused from certain activities or work during your recovery process.

Patient Registration

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