Advanced EyeCare
4030 MacCorkle Avenue
South Charleston, WV 25309
Phone: (304) 766-2220

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Diseases of the Eye

Our top priority is providing you the best eye care. We want to keep your eyes healthy though regular eye health evaluations, communication, and education. This page lists a few of the most common eye diseases.

Blepharitis Inflammation of eyelid margins.

Cataracts Opacity or cloudiness of the crystaline lens that may prevent a clear image from forming on the retina.

Conjunctivitis Inflammation of the conjunctiva (mucous membrane that covers the white of the eye and inner surfaces of eyelids.)

Diabetic Retinopathy Retinal changes accompanying longstanding diabetes.

Dry Eye Syndrome Corneal and conjunctival dryness due to deficient tear production.

Floaters and Flashers Particles that float in vitreous and cast shadows on the retina; seen by patient as spots, cobwebs, etc.

Glaucoma Group of diseases characterized by increased ocular pressure that results in damage to the optic nerve and retinal nerve fibers. Glaucoma is a common cause of preventable vision loss.

Macular Degeneration Retinal degeneration leading to permanent loss of central vision. (Peripheral vision remains intact).

Retinal Detachment Separation of sensory retina from underlying tissue, often requiring immediate surgical repair.


Blepharitis is a common and persistent inflammation of the eyelids.

Symptoms: Irritation, Itching, red eyes, dandruff of eyelids

BlepharitisThis condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes. Blepharitis can begin in early childhood, producing granulated eyelids, and continue throughout life as a chronic condition, or develop later in life.

Bacteria reside on the surface of everyone's skin, but in certain individuals they thrive in the skin at the base of the eyelashes. The resulting irritation, sometimes associated with over activity of the nearby oil glands, causes dandruff-like scales and particles to form along the lashes and eyelid margins.

Sometimes the scaling or bacteria produce only minor irritation and itching, but in some they may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria, which surround them. This can lead to a more serious complication, inflammation of the eye tissues, particularly the cornea (the clear front window of the eye).

It is important that you see your optometrist or ophthalmologist if you demonstrate these symptoms. Treatment may include lid scrubs and an antibiotic ointment.

If lid scrubs and ointment are prescribed, the following is how to use the scrubs and antibiotic ointments:

  • Mix a few drops of Johnson's Baby Shampoo with a small amount of warm water. Gently scrub the eyelashes, right where the lashes grow from the lid, with this mixture using the tip of your finger, Q-tip, or the edge of a wash cloth twice daily or as frequently as instructed. As an alternative to Johnson's Baby Shampoo, a commercially formulated cleaner called OcuSoft Lid Scrubs is also available. It is available without a prescription.
  • Apply a thin coat of the prescribed ointment (generally erythromycin) to the eyelash line, right where the lashes grow from the lid, with the tip of your finger as frequently as instructed.

For additional information:

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What is a cataract?
A cataract is a clouding of the natural lens of the eye, the part of the eye that is responsible for focusing light and producing clear images. The lens works a lot like a camera, focusing light onto the retina. The lens also allows you to see clearly both up close and far away. Although cataracts can result from many different conditions, the most frequent cause is the natural aging process. Cataracts vary from extremely small areas of cloudiness to large opaque areas that cause a noticeable loss of vision. Other causes may include, injury, chronic eye disease, and diabetes. Cataracts can take a few months to several years to develop.

Who gets cataracts?
Cataracts most often develop in people over the age of 55, but they are also found in younger people.

There are three basic types of cataracts: nuclear, cortical, and sub capsular.

A nuclear cataract forms in the outer layers of the lends, which is called the lens cortex, and has cloudy spokes extending from the outer layers of the lens to the center. Many diabetics develop cortical cataracts.

A sub capsular cataract generally begins towards the back of the lens. People with diabetes, high farsightedness, retinitis pigmentosa, or those who are taking high doses of steroids may develop a sub capsular cataract. A common complaint from someone with this type of cataract is poor vision in extremes of light that is, either very bright or very dim light. A sub capsular cataract can also produce great impairment of near vision.

When a cataract forms, light cannot enter the eyes as easily and your vision becomes blurry. The cataract may start out small, and at first have little or no effect on your vision.

The symptoms you may experience, as well as when they occur, are affected by the type of cataract you have.


  • You may notice trouble driving at night due to glare and halos from oncoming headlights
  • Colors appear faded and dull
  • Haze over vision
  • Cloudy vision
  • Normal lighting appearing too bright or too dim

These are a few examples of how your vision could appear if you have a cataract:



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Allergic Conjunctivitis

Allergic ConjunctivitisAllergic Conjunctivitis is an allergic reaction of the eyes. This is an inflammation of the conjunctiva (the membrane covering the white of the eyes and inner lids) due to an allergy. Common allergens are pollen, dust, pet dander, smoke, mold, and air pollution. There are over 22 million people in the United States that suffer from allergy eyes. These allergies may be seasonal, in the spring and fall when pollen counts are at their highest, or may be year round.


  • Itching and watering
  • Redness and burning
  • Scratchy sensation
  • Sensitivity to light
  • Swelling


A person should try to identify the allergy source and avoid exposing themselves to it. There are several antihistamines that can help to control allergy symptoms. There are also several excellent eye drops Dr. St.Jean can prescribe that can help alleviate your symptoms. It is very important for you to see your optometrist or ophthalmologist to determine whether it truly is allergic conjunctivitis and not a more serious problem.

Bacterial Conjunctivitis
Bacterial conjunctivitis is a condition also known as Pink Eye. This is an inflammation of the conjunctiva, which is caused by a bacterial infection. The symptoms tend to be the same as allergic conjunctivitis. One main difference is that pink eye is often characterized by a discharge from the eye. The eyes will frequently be matted shut when first awaking in the morning.

This type of conjunctivitis is highly contagious. You must avoid sharing towels and pillowcases, wash hands often, avoid touching the infected area, and avoid using makeup that may have become contaminated. If you are a contact lens wearer, it is best to dispose of the contaminated contact lens and start with a fresh lens once the infection is gone. In order to clear the infection, you need to see your optometrist or ophthalmologist to be prescribed an antibiotic drop. It is important to use the drop exactly as directed by your doctor in order to fully get rid of the infection.

Viral Conjunctivitis
Viral conjunctivitisViral conjunctivitis is caused by a virus-there is no specific treatment for it, only supportive measures like lubrication. (This is the same as a viral "cold." No antibiotics are needed to "fight" the virus-your body must build up antibodies to the virus on its own to overcome the conjunctivitis.) However, sometimes Dr. St.Jean will prescribe an antibiotic to prevent a bacteria from taking hold in the eye tissues inflamed by the virus. This is called treating to prevent "super infection" of bacteria on top of a viral infection. The symptoms of a viral conjunctivitis tend to be the same as allergic conjunctivitis. This type generally does not present any type of discharge, although it can.

Viral conjunctivitis, like bacterial, is also contagious, therefore you should use the same precautions as mentioned above. It is important to see your optometrist or ophthalmologist in order to get the correct diagnosis and to make sure this is not a more serious problem.

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Diabetic Retinopathy

There are approximately 17 million people in the United States living with diabetes. Diabetes is a disease that prevents your body from making or using insulin to break down sugar in your bloodstream. High blood sugar levels can damage blood vessels in the retina. The damage to retinal vessels is referred to as diabetic retinopathy. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy in their lifetime. There are 2 main types of diabetic retinopathy:

  • Nonproliferative Diabetic Retinopathy (NPDR): this type is commonly known as background retinopathy. This is an early stage of diabetic retinopathy. Tiny blood vessels within the retina leak blood or fluid. The leakage causes the retina to swell or to form deposits (called exudates). If the swelling occurs near the macula, which provides a person with their fine center vision, it can adversely affect the vision and may need to be treated. Treatment of this is with a laser and is called treatment of clinically significant diabetic macular edema. Dr. Williams can evaluate and treat this right in the office-generally on the same day that it is diagnosed. Not all-swelling or macular edema requires treatment-only if it is close enough to the center of vision and a large enough area to be likely to cause visual problems.
  • Proliferative Diabetic Retinopathy (PDR): this type is when abnormal new blood vessels begin to grow on the surface of the retina or optic nerve. Diabetes affects the blood vessels of the eye causing them to decrease the flow of blood to the eye. The retina responds to inadequate blood flow by growing new blood vessels as an attempt to supply more blood to the eye. Unfortunately, the new blood vessels do not supply normal blood flow to the retina. The new blood vessels are abnormal and can break and bleed and thus, if the new blood vessels are present to any significant degree, they must be treated with laser treatment. Proliferative diabetic retinopathy may cause more severe vision loss than nonproliferative retinopathy because it can affect both central and peripheral vision.


What are the visual symptoms of diabetes?Diabetic Retinopathy
Diabetes can cause many different changes in vision, such as:

  • Changes in nearsightedness and farsightedness
  • Fluctuating or blurring of vision
  • Occasional double vision
  • Loss of visual field
  • Flashes and floaters


Visual loss can be caused in the following ways:

  • Vitreous hemorrhage: the new blood vessels may bleed into the vitreous (the clear, jelly-like substances that fills the eye). If the hemorrhage is small, you may only see a few floaters. If the hemorrhage is large, it may block out large portions of your vision. Usually the hemorrhage will clear on its own, although it could take days, months, or longer to clear. If the hemorrhage does not clear, then a surgical procedure, called a vitrectomy, might be recommended.
  • Traction retinal detachment: when proliferative diabetic retinopathy is present, scar tissue associated with new blood vessels can pull the retina from its normal position. More severe vision loss can occur if the macula or large areas of the retina are detached.
  • Neovascular glaucoma: occasionally, new, abnormal blood vessels will start to grow on the iris (the colored part of the eye). This blocks the normal flow of fluid out of the eye. Pressure in the eye then builds up, resulting in neovascular glaucoma. This is a severe eye disease that damages the optic nerve.


How is diabetic retinopathy treated?
The best treatment is to prevent the development of diabetic retinopathy. It is important to control your blood sugar to lower your risk. If you do develop diabetic retinopathy, it can be treated in the following ways:

  • Laser surgery: laser treatment is often recommended for PDR, macular edema, and neovascular glaucoma. The main goal of treatment is to prevent further loss of vision. Multiple laser treatments are sometimes necessary. Laser treatment does not cure diabetic retinopathy and does not always prevent further loss of vision.
  • Vitrectomy: a vitrectomy may be recommended if you have advanced PDR. This is a surgical procedure performed in the operating room. The vitreous is removed and replaced with a clear solution. This often prevents further bleeding.


When should I schedule an exam?
If you have diabetes, it is recommended that you have a yearly eye health examination. If diabetic retinopathy is found, it may be necessary to be seen more frequently. Pregnant women with diabetes should have an examination in their first trimester. Diabetic retinopathy can progress quickly during pregnancy.

It is important to remember that if you need to be examined for glasses, your blood sugar should not be fluctuating. When your blood sugar is not stable, your vision will fluctuate also.

It is important to control your diabetes as much as possible to minimize your risk of developing diabetic retinopathy. Early detection of diabetic retinopathy is crucial. Remember that the best treatment is to prevent complications as much as possible by controlling your blood sugar.

For more information, visit the American Diabetes Association

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Dry Eye Syndrome

Dry Eye SyndromeWhat is dry eye?
Dry eye syndrome is corneal and conjuntival dryness due to deficient tear production. The tears your eyes normally produce are necessary for overall eye health and clear vision. Dry eye syndrome occurs when your eye do not produce enough tears. There are two methods that produce tears. One method produces tears at a slow, steady rate and is responsible for normal eye lubrication. The other method produces large amounts of tears as a response to eye irritation..

What causes dry eye syndrome?
Dry eyes can result from the normal aging process, exposure to environmental conditions, less frequent blinking, or from medications such as antihistamines, oral contraceptives, or antidepressants. Although dry eyes can occur in both men and women, it is more common in women, especially after menopause.

What are the symptoms of dry eyes?
The most common symptoms are stinging, itchy, scratchy and uncomfortable eyes. Sometimes it feels as if something is in your eye. When your eyes are dry the irritation to that will sometimes temporarily produce more tears as a natural reflex to comfort the eye. This will result in excessive watering - even though the eyes are really dry on a baseline level. In fact, dry eyes are the most common reason seen for excess watering.

What is the treatment for dry eyes?Dry Eye Syndrome
The most frequent treatment for dry eyes is the use of artificial tears. Artificial tears, such as Refresh Tears, can be purchased without a prescription. For more severe dry eyes, ointments can be used. This is best when used at bedtime because it tends to blur vision. Tears drain away from the surface of the eye and drain into little openings in the upper and lower lids nasally (the puncti) and then drain into your throat. One treatment option for significant dryness is the placement of a small plug (punctum plug)in one or both of the puncti in each eye. These plugs are considered "permanent", although they can come out on their own and need to be replaced or can be removed if they do not solve the irritation or in some way bother the patient. Another treatment option is to physically close off the puncti with what is called cautery. This is generally considered a truly permanent procedure, although rarely a puncum closed with cautery may reopen. Another treatment option is to use a prescription drop, which was approved in the summer of 2003. This is called Restasis and currently reserved for more severe cases of dry eyes, but may be used more widely in the future as more experience is gained with its usage.

It is helpful to prevent dry eyes by using a humidifer during the winter months when the heat is on. A person with dry eye syndrome should avoid anything that may cause dryness, such as an overly warm room, hair dryers or wind. Some people feel that smoking is also very bothersome when you have dry eyes.

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Floaters and Flashes

Floaters and Flashers

What are floaters?
Floaters appear as small black or transparent spots, lines, threads or "cobwebs" in your vision. As your eyes move, the floaters usually move too. Floaters are most noticeable when looking at something light colored (for example, a white wall, the sky, etc.).

What causes floaters?
The inner part of your eye is filled with a clear, jelly-like fluid called the vitreous. As you age, fibers in the vitreous tend to pull loose from the retina. When the fibers pull loose from the retina, they cast a shadow, which is what is perceived as a floater. Flashes of light can sometimes accompany these floaters.

What are flashers?
Flashes are sensations of light, when no light is really there. They may appear as many tiny bright lights or like flashes of lightning. They may be more noticeable with eye movement or in a dark room.

What causes flashes?
Flashes may occur when the vitreous jelly pulls on the retina. They may only last for a second or two. These flashes may appear off and on for several weeks or months. As you grow older, it is more common to experience flashes. If you notice the sudden appearance of flashes of light, you should visit your eye doctor immediately to make sure the retina hasn't been torn.

Are floaters and flashers serious?
Many people experience floaters. Floaters that you have had for years and have not changed, are usually not serious. It is usually the sudden onset of new floaters that may be serious and the onset of flashes of light with these floaters can also be serious. If you notice a shower of floaters, a sudden decrease in vision, or a curtain that is obstructing your vision you must call your eye doctor immediately.

Important - anyone with flashes or the sudden onset of new floaters should be examined promptly by their eye doctor. These can be symptoms of a more serious problem like a retinal detachment.

What is the treatment for flashes and floaters?
It is important that you have a dilated exam by your eye doctor at the onset of any flashes or floaters. Once determined that there is no serious problem, like a retinal detachment, there is no treatment needed. Your floaters and flashes will likely go away on their own within a few days, weeks, or months. Sometimes it may take longer for them to go away.

If your eye doctor finds a retinal detachment, surgery would be indicated to repair that.

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Glaucoma is one of the leading causes of blindness in the United States, affecting millions of Americans. The loss of sight from glaucoma is usually preventable if you seek treatment early enough.

What is glaucoma?Glaucoma
Glaucoma is a disease generally, but not always, characterized by increased intraocular pressure that results in damage to the optic nerve (carries the images we see to the brain) and the retinal nerve fibers. The higher the pressure in your eye, the greater the chance of damage to the optic nerve. When nerve fibers are damaged, blind spots in your vision start to develop. These blind spots are sometimes not noticed until much damage has already been done to the optic nerve. If the entire nerve is destroyed, blindness results.

Early detection and treatment by Dr. St. Jean are the keys to preventing optic nerve damage and blindness from glaucoma.

What causes glaucoma?
Your eye is filled with a clear liquid, called the aqueous humor. This liquid circulates through the eye. A small amount of liquid is constantly being produced, while an equal amount of fluid is flowing out of the eye through a part of the eye called the drainage angle. (The aqueous humor is not part of your tears.)

If the drainage angle does not drain enough fluid or gets blocked off, the fluid has nowhere to drain and the pressure within the eye may increase. Drainage may decrease due to injury, infection, disease, but most frequently decrease simply due to advance in age. The increase of pressure can cause damage to the optic nerve.

Regular eye health examinations are the best way to detect glaucoma. During your examination, Dr. St.Jean will measure your intraocular pressure in each eye, inspect the drainage angles of your eyes, evaluate any optic nerve damage, and test the visual fields of each eye. All of these tests may be repeated over time to evaluate any changes to the optic nerve and to determine if the damage is increasing over time.

What are the different types of glaucoma?

  • Chronic open-angle glaucoma: This is the most common type of glaucoma. Over 90% of adults with glaucoma have this form. As a person gets older, the drainage angle of the eye can become less efficient and the pressure within the eye can gradually increase. Usually vision damage is very gradual and painless and it is not noticed until the optic nerve has had severe damage.
  • Angle-closure glaucoma: This form of glaucoma results when the drainage angle become completely blocked off because of increased intraocular pressure. When the pressure builds up suddenly, it is called acute angle-closure glaucoma.


What are the symptoms of open-angle glaucoma?

  • tunnel vision
  • visual field gradually decreases
  • can case blindness if left untreated


What are the symptoms of angle-closure glaucoma?

  • blurred vision
  • severe eye pain
  • headache
  • rainbow haloes around lights
  • nausea and vomiting


If you have any of these symptoms, call our office immediately. Angle-closure glaucoma needs to be treated immediately to prevent blindness.

Who is at risk for glaucoma?
High pressure alone does not necessarily mean that you have glaucoma. Dr. St. Jean gathers a lot of different information from your examination to determine your risk for developing it.

  • age
  • African ancestry
  • family history of glaucoma
  • past injuries to the eyes


How is glaucoma treated?
The best treatment for glaucoma is prevention. It is very important to have regular eye health examinations to detect the disease early.

Glaucoma is usually controlled will with eye drops. These drops are designed to lower the intraocular pressure in the eye. In order for these medications to work properly, it is important to use them continuously and exactly as prescribed by your doctor.

Laser Surgery
In open-angle glaucoma, the drainage angle is treated. The laser is used to modify the drain to help control eye pressure. This type of laser treatment is referred to as trabeculoplasty.

In angle-closure glaucoma, the laser actually creates a hole in the iris in order to improve the flow of aqueous fluid to the drainage angle. This type of laser treatment is referred to as iridotomy.

Treatment of glaucoma requires teamwork between the doctor and you, the patient. If you are prescribed eye drops to control your pressure, you must make sure that you take your drops as instructed. Never stop taking your medication. Frequent eye health examinations are critical to monitor your eyes and vision for any changes.

3D-Eye Glaucoma Presentation

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Macular Degeneration

Macular degeneration is the leading cause of blindness for people age 55 and older. There are an estimated 10 million Americans living with this incurable eye disease.

What is macular degeneration?
Macular degeneration is caused by the deterioration of the central portion of the retina, the macula. This area is the area of the eye that records the images that we see and sends them from the optic nerve to the brain. The macula is responsible for central vision and controls our ability to see fine detail, recognize faces, and our ability to drive a car.

What causes macular degeneration?
There are two types of macular degeneration:

  • Dry Macular Degeneration: The "dry" type of macular degeneration leads to thinning and pigment clump formation of the macula. Dray macular degeneration is much more common than we macular degeneration. It tends to progress more slowly that "wet" type. The amount of central vision that is lost is related to how severely the macula is affected. Interestingly, one cannot always judge how much vision is affected by the apparent amount of dry macular changes, although generally, the more changes that are seen the more the vision will be affected. Vision loss tends to be gradual with dry macular degeneration, where as, it is generally abrupt with wet macular degeneration. There is currently no treatment for dry macular degeneration.
  • Wet Macular Degeneration: With "wet" macular degeneration, abnormal blood vessels grow under the retina and macula. These new blood vessels may then bleed and leak fluid, causing the macual to sell and lift. When this happens central vision becomes distorted. Vision loss may be quite rapid and severe.


What are the signs and symptoms of macular degeneration?

  • a gradual loss of the ability to see objects clearly
  • objects appear to be distorted in shape and straight lines appear wavy or crooked
  • a loss of clear vision
  • a dark area appearing in the center of vision


Macular Degeneration
Example of what vision could look like with Macular Degeneration, versus an example of normal vision

There is a simple test called Amsler Grid Test that you can monitor your vision by checking at home. This tool is important for indication macular degeneration. It is recommended that the test be done at least twice a week.

How to take the Amsler Grid Screening

  1. Place the test on a wall or back of a door using tape. The grid should be at eye level in a well-lit area.
  2. Stand 18-20 inches away and look at the dot in the center of the grid. If you wear glasses for reading, wear them while taking this test.
  3. While continuing to look at the dot, cover your left eye with your hand and look at the dot in the center with your right eye.
  4. Did the dot or squares around the dot change or disappear?
  5. Did you see any distortion or blurring in the grid lines?
  6. Repeat the test as above, cover the right eye?


If you answered yes to the questions in step 4 or 5 or notice any other change in your vision, please call our office immediately to set up an appointment. This screening is part of total eye health maintenance, but does not replace a thorough eye examination.

Macular Degeneration

How is macular degeneration treated?
Currently there is no treatment for "dry" macular degeneration. If you develop "wet" macular degeneration, it is important that it is discovered early. Immediate laser treatment is necessary in attempt to save your vision. This laser treatment works by sealing off leaking blood vessels. However, it does not guarantee that your vision will be saved. In April 2000, the FDA approved a new treatment called Photodynamic Laser Therapy (PDT), which used a light-activated drug called Visudyne. PDT is not appropriate for all types of "wet" macular degeneration. If this type of treatment is indicated, Dr. St. Jean will refer you to a retinal specialist for further evaluation and to see if you qualify for PDT.

There is no treatment for Dry Macular Degeneration, although certain vitamin and mineral supplements have been shown to slow its progression.

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Retinal Detachment

Retinal Detachment

What is Retinal Tear?
Retinal tears occur when there is traction on the retina from the vitreous gel inside the eye.

As people age, the vitreous gradually becomes thinner and can separate from the retina. This is known as a posterior vitreous detachment (PVD). PVDs are almost always harmless and cause floaters, but in some cases, this can lead to a retinal tear. Retinal tears frequently lead to retinal detachments.

What is a Retinal Detachment?
A retinal detachment occurs when the retina's sensory and pigment layers separate.

A retinal detachment is an ocular emergency because of the devastating effects it can have on your vision

What are the three main types of Retinal Detachments?
The most common type of retinal detachment is when there is a break in the sensory layer of the retinal causing it to separate and allowing fluid to seep under it, causing the layers of the retina to separate.

Who is at higher risk for this type of detachment?

  • People who are highly nearsighted
  • People who have recently undergone eye surgery
  • People who have experienced an injury to the eye


The second type of retinal detachment is when the vitreous or scar tissue creates traction on the retina which pulls the retina loose.

Who is at higher risk for this type of detachment?

  • People with diabetes


The third type of retinal detachment is when fluid collects underneath the layers of the retina, which causes the retina to separate from the back of the eye.

Who is at higher risk for this type of detachment?

  • This usually occurs with the occurrence of another eye disease that causes swelling or bleeding


What are the signs and symptoms of a Retinal Detachment?

  • Flashes of light
  • "Wavy" vision
  • A veil or curtain obstructing vision
  • Shower of floaters
  • Sudden decrease in vision
  • Shadow in your peripheral vision


It is very critical that if you have any of the above symptoms to call your eye doctor immediately. Time is very crucial.

How are Retinal Detachments detected?
When a retinal detachment is suspected, your eye doctor will thoroughly examine your retina. One of the main concerns is whether the macula (which is the center of the retina that is responsible for central vision) is attached. This is very important whether or not the macula is attached. This will determine what type of corrective surgery the patient must have. This will also determine how the patient's vision may be after surgery. If the retinal detachment involves the macula, your vision may be severely affected.

What is the treatment for Retinal Detachments?
There are a few different ways to treat a retinal detachment. The type of treatment depends on the type of detachment, location, and severity.

  1. Laser surgery
  2. Pneumatic Retinopexy (Gas Bubble)
  3. Scleral Buckle


What can I do?
Early detection is the key to successfully treat retinal detachments and retinal tears. You should be aware of how your vision normally is in each eye, especially if you are in a high-risk group as discussed above. Try to monitor your vision a few times a week by covering one eye and then the other.

Report any changes in your vision immediately to your eye doctor.

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