Dr. Paul Guerriero is a Board Certified, Fellowship-trained retina specialist at Spector Eye Care who provides vitreoretinal eye care for patients with varying degrees of retina disorder. Dr. Guerriero and the Spector Eye Care staff utilize advanced diagnostic testing such as Fluorescein Angiography and Ocular Coherence Tomography (OCT) to asses each patient's individual needs. Based on each case, Dr. Guerriero uses medical, laser and surgical treatments for diabetic retinopathy, management of macular degeneration, and other diseases and problems of the retina. Dr. Guerriero has been treating retina conditions for over 20 years, and is an expert at advanced technology therapeutic methods such as Lucentis Injections for macular degeneration and retinal vascular disease, specialized retinal laser treatments, and retinal surgery such as Vitrectomy.
Retinal Disorders & Treatments
The retina is a layer of tissue in the back of your eye that senses light and sends images to your brain. In the center of this nerve tissue is the macula. It provides the sharp, central vision needed for reading, driving and seeing fine detail.
Retinal disorders affect this vital tissue. They can affect your vision, and some can be serious enough to cause blindness. Examples of retinal disorders are:
- Macular degeneration- a disease that destroys your sharp, central vision
- Diabetic Eye Disease (Retinopathy)
- Retinal Tears and Detachment- a medical emergency, when the retina is pulled away from the back of the eye
- Macular pucker - scar tissue on the macula
- Macular hole - a small break in the macula that usually happens to people over 60
- Flashes and Floaters- cobwebs or specks in your field of vision
Macular degeneration or age-related macular degeneration (AMD) is the result of damage to the macula, which is the tissue on the back of the retina that is sensitive to light. With AMD, you lose central vision and cannot see fine details, whether you are looking at something near or far. It is the leading cause of vision loss in people 50 years or older.
Macular degeneration is caused by a number of different factors, including intraocular pressure and bleeding inside the eye. These may be the result of glaucoma, diabetic retinopathy, injury, illness or other similar factors. It is almost always age-related, as tissues become more susceptible to damage over time. You are more likely to develop AMD if you smoke, are over 50 years, have a family history of AMD, have heart disease, have high cholesterol and/or are Caucasian.
Macular Degeneration has no cure, but several types of treatments may be successful in delaying the more severe symptoms. Not all cases of macular degeneration result in total vision loss, however. Some people may only notice a slight blurring of their vision, and more severe symptoms can be delayed with treatment for the duration of their lives. Depending on the type and severity of the disease, treatment may include drug therapy (usually drugs injected directly into the eye), laser surgery or photodynamic surgery.
Diabetic retinopathy occurs when high blood sugar levels cause damage to blood vessels in the retina, causing the blood vessels to swell and leak, or to close, stopping blood from passing through. Sometimes abnormal new blood vessels grow on the retina. All of these changes can cause vision loss.
There are two main stages of diabetic eye disease, or retinopathy. NPDR, or non-proliferative diabetic retinopathy, is the early stage, and many people with diabetes have it. With NPDR, tiny blood vessels leak, making the retina swell. When the macula swells, it is called macular edema, which is the most common cause of blindness in people with diabetes. If the blood vessels in the retina close off (macular ischemia), blood cannot reach the macula. This can cause tiny particles called exudates to form, which can affect vision.
PDR, or proliferative diabetic retinopathy, is the advanced stage, and it happens when the retina starts growing new blood vessels (neovascularization). These new vessels often bleed into the vitreous, causing floaters. If they bleed a lot, they may block all vision. PDR is serious, and can steal both your central and peripheral vision.
Treatment of NPDR and PDR is based on the severity as diagnosed by your ophthalmologist. Medical control of blood sugar and blood pressure can stop vision loss. Sometimes, good sugar control can return some of your vision! If medication is required, you'll be prescribed an anti-VEGF medication, which helps to reduce swelling of the macula, slowing vision loss. This drug is administered by injection. Steroid injections may also be prescribed.
If these treatments do not work, laser surgery might be used to seal off leaking blood vessels and reduce the retinal swelling. Sometimes, more than one treatment is needed, but laser surgery can also prevent blood vessels from growing again. If you have advanced PDR, your ophthalmologist may recommend a vitrectomy, wherein vitreous gel and blood from the leaking vessels are removed. This allows light rays to focus properly on the retina.
Retinal Tears & Detachment
Retinal detachment is a separation of the light-sensitive membrane in the back of the eye (the retina) from its supporting layers. The most common type of retinal detachments are often due to a tear or hole in the retina. Eye fluids may leak through this opening. This causes the retina to separate from the underlying tissues, much like a bubble under wallpaper.
This is most often caused by a condition called posterior vitreous detachment. However, it may also be caused by trauma and severe nearsightedness. Another type of retinal detachment is called tractional detachment. This is seen in people who have uncontrolled diabetes, previous retinal surgery, or have chronic inflammation.
Retinal tears required immediate treatment to prevent retinal detachment and vision loss. Treatment of retinal tears is designed to create a scar, which welds the retina to the back of the eye to prevent further tearing. Tears can be sealed with a laser light or a freezing probe (cryopexy).
Retinal detachment can only be repaired surgically. During surgery, liquid under the retina is removed and the retina reattached to the back wall of the eye. Either cryopexy or the laser is used to produce a scar, so that the scar tissue that forms will reattached the layers of tissue. A silicone band, held in place by nylon sutures, is usually wrapped around the outside of the eye to push the back wall of the eye against the retina to aid healing. Over 90% of retina detachments can be surgically repaired, though some cases may require more than one procedure.
If you are experiencing the symptoms of a retinal tear or detachment, you should obtain a complete eye examination immediately. Please call our Norwalk offices at 203-853-9900 for an appointment.
Flashes & Floaters
At a young age, the vitreous is perfectly transparent. Over time as the eye ages, this vitreous humor can degenerate, losing its form and liquefying. Without the stable vitreous humor, the collagen fibers collapse and bind together to form clumps and knots. It is these fibers that cast shadows on the retina and appear as spots, strings, or cobwebs. While these objects look like they are in front of your eye, they are actually floating inside. What you see are the shadows they cast on the retina, the nerve layer at the back of the eye that senses light and allows you to see.
When the vitreous gel inside your eye rubs or pulls on the retina, you may see what look like flashing lights or lightning streaks. You may have experienced this same sensation if you have ever been hit in the eye and seen “stars.” The flashes of light can appear off and on for several weeks or months. If you notice the sudden appearance of light flashes, you should visit your ophthalmologist immediately because it could mean that the retina has been torn.
Floaters and flashes of light become more common as we grow older. While not all floaters and flashes are serious, you should always have a medical eye examination by an ophthalmologist to make sure there has been no damage to your retina. The appearance of floaters and flashes may be alarming, especially if they develop suddenly. You should see an ophthalmologist right away if you suddenly develop new floaters or flashes, especially if you are over 45 years of age.
Treatment of floaters may include vitreolysis, a non-invasive, pain free laser procedure that can eliminate these disturbances. The procedure uses nanosecond pulses of low-energy laser light to evaporate the collagen and hyaluronin molecules that cause floaters. The end result is that the floater is removed and/or reduced to a size that no longer impedes vision. Depending on the degree of your floaters, multiple sessions may be required.